Neck pain can be acute or chronic and can significantly disrupt activities of daily living (ADL). This chapter presents a patient-based case scenario of a 42-year-old construction worker who presents to an urgent care clinic complaining of acute neck pain for 3 days, finally diagnosed as cervical strain. The advanced practice provider performs the history and physical examination on the patient and finds pertinent positives and negatives. All findings reviewed with the patient. Discussed conservative treatment to include mild muscle relaxant, use of over-the-counter analgesics for pain control, application of heat/cold for 20 minutes several times a day, and possible referral to physical therapy for exercises and rehabilitation. The chapter provides tables outlining the common diagnosis with cardinal signs and symptoms as well as diagnostic testing for the reader’s review. Clinical diagnostic reasoning for the final diagnosis is outlined.

This chapter presents a patient-based case scenario of a 38-year-old Caucasian female who presents to the acute care office with complaints of rectal pain (proctalgia), finally diagnosed as perianal abscess. It briefly describes introduction to complaint and history of complaint. The chapter also discusses physical examination, case study, differential diagnosis, diagnostic examination and clinical decision making about rectal pain. The pain is constant and throbbing occurring around the rectum. An erythematous mass is present in the perianal area. White blood cell (WBC) count on the complete blood count (CBC) is slightly elevated; however, the patient is afebrile. The absence of bleeding ruled out an anal fissure, cancer, or hemorrhoids. The patient is to return for a follow-up appointment in 1 week at which time the results from the wound culture will be reviewed and antibiotics adjusted if necessary.

This chapter presents a patient-based case scenario of a 24-year-old female who complained of painful intercourse. She states she has been experiencing painful intercourse for the past 6 months. Results of pelvic examination (PE) and diagnostic study on a 24-year-old female reveal the diagnosis of insufficient lubrication of vagina because of inadequate arousal before sexual intercourse. Evidence to support this is based on complaints of painful intercourse with dryness, friction, burning, tearing, and irritation. The physical examination reveals abrasions, bruises, and a tear. Diagnostic tests included urine pregnancy test, Pap smear, and pelvic ultrasound and pelvic x-ray. The patient wanted to discuss actions to take when her spouse drinks and forces intercourse. The patient stated that the spouse can become abusive if sexual intercourse is denied. Recommended talking with social services to discuss a personal safety plan and to return to the clinic if the symptoms do not subside.

This chapter presents a patient-based case scenario of a 60-year-old male who presents with complaints of intermittent rectal bleeding over the past 2 weeks, finally diagnosed as diverticulitis with internal hemorrhoids. It is interspersed with case describing an initial chief complaint, history, and physical examination. After physical assessment and detailed history of onset, the patient had blood work (complete metabolic panel [CMP], complete blood count [CBC]), which revealed a hemoglobin of 10.5 ml and elevated white blood cells (WBCs) at 14.5 ml. A digital rectal exam was performed, which indicated internal hemorrhoids. The chapter provides tables outlining the common diagnosis with cardinal signs and symptoms as well as diagnostic testing for the reader’s review. Clinical diagnostic reasoning for the final diagnosis is outlined. The approach is to give pertinent information as well as demonstrate the process of clinical reasoning.

This chapter provides a standard method of formulating a differential diagnosis that the advanced practice provider (APP) can use throughout clinical practice for memory loss. It presents a patient-based case scenario of a 70-year-old African American female who presents to the acute care clinic with complaints of "memory loss", finally diagnosed as cerebral infarction. The chapter helps the reader to learn the process of formulating a differential diagnosis using the skills of gathering appropriate data from the history, physical examination, and relevant diagnostic testing. It is interspersed with case describing an initial chief complaint, history, and physical examination. It then provides tables outlining the common diagnosis with cardinal signs and symptoms as well as diagnostic testing. Clinical diagnostic reasoning for the final diagnosis is outlined. The approach is to give pertinent information as well as demonstrate the process of clinical reasoning.

Establishing differential diagnoses for client complaints is a critical step in the delivery of optimum health care. This chapter presents a patient-based case scenario of a 35-year-old male who presents with a complaint of spells of palpitations, finally diagnosed as pheochromocytoma. An abdominal/pelvic CT was performed and a small mass was noted on the left adrenal gland. MRI was also performed, which confirmed adrenal mass. The patient was referred to a renal specialist to discuss further treatment including medication and surgery. Additional follow-up will be through the renal clinic. The chapter is interspersed with cases describing an initial chief complaint, history, and physical examination. Tables outlining the common diagnosis with cardinal signs and symptoms as well as diagnostic testing are provided for the reader’s review. Clinical diagnostic reasoning for the final diagnosis is outlined. The approach is to give pertinent information as well as demonstrate the process of clinical reasoning.

A panic episode is characterized by a sudden onset of an intense fear when there is no real danger or apparent cause. This fear triggers severe physical symptoms and cause a great deal of "fright" for the person having the episode. Panic episodes often manifest in the late teens or early adulthood, and are experienced by females more than males. This chapter presents a patient-based case scenario of a 20-year-old female who reports to the clinic seeking assistance for her recent onset of panic episodes triggered by emotional trauma. The advanced practice provider (APP) performs the assessment and physical examination on the patient and finds the following data: recent history of the end of an abusive relationship, no abnormal physical exam findings. The APP educates the patient on the use of Emotional Freedom Technique (EFT) at the first sign of increasing anxiety or onset of panic sensations.

This chapter presents a patient-based case scenario of a 16-year-old Caucasian female with multiple mouth lesions. According to the patient, she had been experiencing these painful mouth lesions over the past several weeks with increasing severity. The chapter describes an initial chief complaint, history, and physical examination. It provides tables outlining the common diagnosis with cardinal signs and symptoms as well as diagnostic testing for the reader’s review. Clinical diagnostic reasoning for the final diagnosis, aphthous ulcer (canker sores) is outlined. The approach is to give pertinent information as well as demonstrate the process of clinical reasoning. Patient provided with a prescription for Aphthasol and instructed on its use. Encouraged to avoid spicy foods and those hot in temperature. Reviewed the use of over-the-counter analgesics for systemic pain control and as an antipyretic. Discussed the importance of routine dental examinations.

Establishing differential diagnoses for client complaints is a critical step in the delivery of optimum health care. Night sweats are a symptom that can be observed in a variety of health imbalances. This chapter presents a patient-based case scenario of a 51-year-old female who reports to the clinic with a history of sudden onset of hot flushes and night sweats. The advanced practice provider (APP) performs the assessment and physical examination on the patient and finds the following data: history of vasomotor symptoms consistent with perimenopausal/menopausal hormonal changes and no abnormal physical exam findings. A normal complete blood count (CBC) rules out an infection and lymphoma. No change in medications rules out a medication-induced cause. A normal neurologic examination rules out a neurologic cause for the symptoms. The APP discusses hormone replacement therapy options with the patient. Suggested following up with OB/GYN provider.

Painful urination, or "dysuria", is generally more common in women than in men, with a reported prevalence of up to 25" of women in the United States. This chapter presents a patient-based case scenario of a 45-year-old female who reports to the clinic with a complaint of pain with urination, onset earlier this morning, finally diagnosed as acute cystitis. The advanced practice provider (APP) performs the assessment and physical examination on the patient and finds the following data: history of dysuria onset acutely this morning; urine dip reveals 2+ leukocytes and positive nitrates. The presence of urine leukocytes confirmed a lower urinary tract infection. Appropriate antibiotic therapy is prescribed by the APP along with recommendations for the patient to take a daily dose of a high-quality probiotic product for the entire duration of antibiotic therapy and the two weeks following completion.