Directions:
Click here to open your browser's e-mail system. This is where you
will record your answers to questions plus any comments you want to
pass along to your instructor. After entering your answers, you can
check your response by clicking "Faculty Comments". In the
subject line of the e-mail form, enter your name and the name of the
case being submitted, i.e., Case #3." When you finish your session
with Family Medicine On-line, click the Send button in the e-mail
window to forward your answers to your instructor. If you end your
session before completing the case, click the Send button to submit
your answers, and then exit your browser.
To complete the case during another session, go to the first page of the case and click the link above and then advance to the page where you left off. When finished with this session, click the Send button in the e-mail window. All materials copyrighted 2003 by Penn State University.
 |
This case scenario assumes you are in a multi-specialty group practice. Your
office staff includes a nurse and a laboratory/radiology technician. Your
office group has a diagnostic x-ray machines and laboratory equipment to
perform the tests listed. One of your patients, Mrs. Jones, called requesting you to see her 70 y.o. mother, Mrs. Martin, who is visiting from Florida. Her mother is complaining of left knee pain after falling at her home. Before we see this patient, let's review some important information
regarding falls in the elderly. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
Now lets see Mrs. Martin, your patient's 70-y.o. mother. You
were given the history that she was walking on kitchen tile floor and fell. There were no
symptoms of dizziness or palpitation prior to her fall. There was no loss of
consciousness. She complained of left knee pain after the fall. Her grandchildren recently
came into the kitchen after having a snowball fight outside. The slippers she borrowed
from her daughter had no tread. She had not had an eye exam for two years and noted her
vision is not as good as before. Allergy: Penicillin Medication: Theophylline, Lasix dosages unknown. Social history: No history of alcohol, tobacco, or drug use, married 40 years widowed 10 years. Lives in Florida currently vacationing for winter holidays with daughter age 45, her husband and 2 grandchildren ages 10 and 8. Patient's other daughter, age 39 lives in California. Patient had planned on staying with daughter for two weeks, patient arrived 2 days prior.
|
|
|
|
 |
HEENT: Alert, oriented in NAD, normocephalic,
atraumatic, pupils equal, reactive to light, extraocular motion intact. It is noted to be
bilateral cataracts in both eyes on fundoscopic examination. It is difficult to assess
patient's fundi secondary to cataracts. No gross hemorrhages or exudates are appreciated.
Canals are clear. TMs intact. There is no battle's sign, hemotypanium, or raccoon's eyes.
There are no oral lesions. Moist oral mucosa. Neck is supple, non-tender, no JVD. Trachea
midline. No masses noted and no adenopathy. Chest is generally clear to auscultation. A
few scattered rhonchi noted. No wheezes or rales. Good air exchange. Cardiac regular rate
and rhythm, though noted to be somewhat tachycardiac. Soft 1-2/6 systolic ejection murmur
heard at left sternal border. No rubs, S-3 or S-4 appreciated. Abdomen: Bowel sounds are present; soft non-tender, no masses, no CVA tenderness, no hepatosplenomegaly appreciated. Extremities are without cyanosis, clubbing or edema. Palpable dorsalus pedus pulse present bilaterally. Full range of motion right hip, ankle and foot. Palpable effusion right knee. Patient unable to move right knee due to pain. Moderate ecchymosis to right lateral aspect of knee 3x5 cm. GU/Rectal: Normal female external genitalia. No lesions noted. Normal rectal tone. No masses. Guaiac brown. Heme-negative stool. Neuro: Patient is awake and alert, 5/5 arm strength. Click on the diagnostic test name to order the examination.
|
|
|
|