True or False: Malnutrition is faulty nutrition due to inade…

Questions

True оr Fаlse: Mаlnutritiоn is fаulty nutritiоn due to inadequate or unbalanced intake of nutrients or their impaired assimilation or utilization.

Mаtch up the cоrrect fооds with their nutrient function

Intrо аnd Chief Cоmplаint (PLO 2) Pаtient Infо and Chief Complaint: Patient name: Barney Jackson Patient age: 65 years old Patient self-reported gender: Male Chief complaint: “Possible left foot infection” Care setting: Internal medicine office, scheduled appointment Section Task 1: (A.) List ten (10) differential diagnoses for this patient scenario, based solely on the information provided above. [PLO 2] (B.) For each diagnosis, list two (2) symptoms, risk factors, or historical findings that would help you differentiate that specific diagnosis from the others. Each symptom, risk factor, or historical finding may only be used once in total when answering this question.

Pаtient Histоry: HPI: This is а 65-yeаr-оld male patient whо presents with a complaint of a “possible left foot infection”. Pt reports this started about 3 months ago. The affected area is located and isolated to the top of the left second toe and has gotten bigger since it started. Pt reports he sought care at an urgent care where they prescribed him an antibiotic a month ago and this got “a little bit better, but not much”. He was instructed to follow up with his primary care provider, prompting his visit today. Unfortunately, since that visit, the pt reports his symptoms have worsened and never fully went away. Pt states that the area is painful, achy, and has started to turn dark and red in places. He describes the pain as “achy” and “burning”, rating it 5/10 currently. The pain never seems to fully go away and is worse with walking or prolonged standing. He notes the pain is somewhat better elevation of the foot. Elevation seems to help improve the pain. The pain radiates up and down the leg at times. Pt does not recall any specific preceding trauma or cold exposure prior to the onset of this. He reports he thinks he has an infection because there appears to be a wound on the foot that has been present since his symptoms started, 3 months ago. This has been consistently present, only slightly improved after taking antibiotics. As for associated symptoms, the pt also reports intermittent pains in both legs at times, particularly after doing a lot of walking but admits to doing less walking lately because of this. The pains run up and down the lower legs below the knee without other radiation. Additionally, he states that the left leg sometimes feels cool to the touch compared to the right leg. With that, he notes tingling at times in the left leg. No complete loss of sensation reported. No other wounds or skin problems of the legs reported elsewhere. Pt admits to slow healing of scratches on his legs in the past, but nothing like this. Pt denies recent fall/injury or known preceding trauma. Medications: Lisinopril/HCTZ 20/25mg PO daily Carvedilol CR 20 mg PO daily Atorvastatin 40mg, one tablet taken PO at bedtime Tamsulosin 0.4mg, one tablet taken PO daily Daily multivitamin (generic, OTC) – one tablet taken PO daily at breakfast Tylenol 650mg PO 1-2 times daily on occasion for B/L leg pain Allergies: Morphine (causes itching) Past Medical History: Chronic conditions: Primary Hypertension (diagnosed 25 years ago) Hyperlipidemia (diagnosed 20 years ago) BPH (diagnosed 10 years ago) Surgeries: Right Achilles tendon rupture s/p repair 2014 Left radius fracture s/p repair ORIF 2019 Health Maintenance/Immunizations: Up-to-date on most recommended, age-appropriate vaccines including COVID, influenza, Tdap. He has not had a shingles or a pneumonia vaccine. Pt last colonoscopy was 15 years ago at age 50 (no concerning findings reported). Family History: Father: Deceased, age 61 due to heart attack. PMHx included HTN and COPD (he was reported to be a smoker) Mother: Alive, age 75, PMHx includes HTN, high cholesterol Siblings (2): Brother – age 52, alive, PMHx includes: heart attack and high cholesterol Sister – deceased at age 56 due to heart attack Children (3) are all reported to be alive and well. Ages 25 (F), 23 (F), and 20 (M) Social History: Tobacco/Vape: Pt reports 1 PPD use of cigarettes for the last 30 years) Alcohol: Pt reports having an occasional beer 2-3 times per week. Illicit drugs: Pt denies illicit or prescription drug use/abuse currently or recently. Pt admits to prior marijuana use in his 20’s, but none since. Marital/Sexual: Divorced once at age 23, then has been re-married for the last 28 years with three children. Living situation: Lives in a home with his wife in El Centro Job: Recently retired Executive Accounts Manager for the City of San Diego (he worked at this job for 35 years) Hobbies: Spending time with his family, fishing, and growing vegetables in his garden to share with family and friends. Diet: No specific diet followed, normal American diet. Pt states he enjoys eating BBQ at cookouts with his friends Religion: Catholic Sleep: Averages 6-7 hours of sleep per night ROS: General: No more fatigue than usual, but less active than usual due to leg pains No recent weight changes (up or down) No fever/chills or appetite changes Skin: See HPI. +Pt has left foot second toe wound with reported overlying skin changes and discoloration (reported as “dark and red in certain place”). The area is not reported to be hot to the touch. No diaphoresis, jaundice. Head, Eyes, Ears, Nose, Throat (HEENT): No vision changes, no redness, no itching, no tearing, no discharge No ear pain, tinnitus, hearing changes No nasal congestion, sinus pain/pressure No gum bleeding No facial swelling, jaw pain, sore throat, or difficulty swallowing No neck pain, or LAD Respiratory: No SOB, DOE, PND or orthopnea No cough or recent URI symptoms No pain with breathing No hemoptysis Cardiovascular: No chest pain, palpitations No generalized LE edema No syncope or light-headedness Gastrointestinal: No abd pain, distension, or n/v No diarrhea/constipation, no blood in stool or melena Genitourinary: No changes in, or difficulty with, urinating. No polyuria, no nocturia, no hematuria, no flank pain Musculoskeletal: +See HPI. +Left foot pain, particularly at the 2nd toe. The pain waxes and wanes depending on activity. L 2nd toe wound reported. +B/L distal leg pain at times, waxes and wanes. No new weakness or joint pain Neurological: See HPI. +Paresthesias to L foot at times. No numbness, focal weakness. No HA, dizziness, vertigo, or tremor. No confusion Psychiatric: No unusual changes in mood, racing thoughts, grandiose ideas, or paranoia No insomnia or recent lack of sleep No suicidal ideations, auditory or visual hallucinations Endocrine: No heat or cold intolerance, no polyuria or polydipsia Hematologic/Lymphatic: No easy bruising or bleeding, no epistaxis