Case 1 Case 2 Case 3 Chief Complaint(CC) “I am here today due to frequent and watery bowel movements” “I have pain in my belly” “neck swelling” History of Present Illness (HPI) A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hours A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex A 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restriction PMH No contributory Patient denies Patient denies PSH Appendectomy at the age of 14 Surgical removal of benign left breast nodule 2 years ago Drug Hx No meds Birth control No medication at the time Allergies Penicillin NKA NKA Subjective Fever and chills, Lost appetite Flatulence No mucus or blood on stools Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination Mild difficult to shallow, Neck feels tight, Pt states she feels Palpitations Objective Data PE B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10 B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6 General well-developed female in no acute distress, appears slightly fatigued acute distress and severe pain 42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress. HEENT Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous. Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip. Bulging eyes Neck Supple Diffuse enlargement of the thyroid gland Lungs CTA AP&L CTA AP&L CTA AP&L Card S1S2 without rub or gallop S1S2 without rub or gallop S1S2 without rub, Tachycardia Abd positive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness. • INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round • AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable • PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area benign, normoactive bowel sounds x 4 GU Non contributory • EXTERNAL: mature hair distribution; no external lesions on labia• INTROITUS: slight green-gray discharge, no lesions• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)• UTERUS: ante-flexed, normal size, shape, and position• ADNEXA: bilateral tenderness with fullness; both ovaries without masses• RECTAL: deferred• VAGINAL DISCHARGE: green in color Non contributory Ext no cyanosis, clubbing or edema no cyanosis, clubbing or edema no cyanosis, clubbing or edema Integument good skin turgor noted, moist mucous membranes intact without lesions masses or rashes Thin skin, Increase moisture Neuro No obvious deformities, CN grossly intact II-XII No obvious deficits and CN grossly intact II-XII No obvious deficits and CN grossly intact II-XII What other subjective data would you obtain? What other objective findings would you look for? What diagnostic exams do you want to order? Name 3 differential diagnoses based on this patient presenting symptoms? Give rationales for your each differential diagnosis.

A new client of yours, Jacob Maxwell, wants to open a small diner selling calamari, oysters, fried shrimp, catfish sandwiches, salads, French fries, and sodas. He is planning to open the diner on the March 1, 2019. You, as an independent consultant, have been hired to develop a cash pro forma budget for his business venture (note: this is a spreadsheet that helps forecast income and expenses over a period of time). It can be used to plan for and manage the business if done correctly.