Relying solely on the classic features of a disease may be misleading. That's because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient's symptoms and signs — is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.This case portrays a poor patient outcome after a misdiagnosis.Case scenarioA previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.On physical examination the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.Written Assignment:Developing a list of possible conditions that might produce a patient's symptoms and signs is an important part of clinical reasoning.As an NP in primary care what would you have done differently?Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?If a serious diagnosis comes to mind based on a patient's symptoms:Ask yourself; Have you considered the likelihood of it and whether it needs to be ruled out by testing or referral?Because many serious disorders are challenging to diagnose, have you considered ruling out the worst case scenario?Ask yourself: Do you have sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?What other diagnosis could it be? How might the treatment to date have altered the patient outcome?What other diagnostic and laboratory or imaging was needed in order to make a complete differential list? What support tools would you consider using in helping to create a differential diagnosis list?Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?

Scenario: A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 7.2 mg/dl.Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following: Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms. Explain how the highlighted processes interact to affect the patient. Explain any racial/ethnic variables that may impact physiological functioning.Written Expression and Formatting - Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.Written Expression and Formatting - English Writing Standards: Correct grammar, mechanics, and proper punctuationWritten Expression and Formatting - The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.__________________________________________________________________________________________________ Topic: The effectiveness of face mask in reducing the spread of coronavirus. Create a PPT professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated.

Provide an analysis of the short story "The Story of X" by Lois Gould. This is not a summary; make sure that you offer an interpretation of the short story and that you “read between the lines" in order to address each aspect of analysis: Audience Purpose Content Mood  Style Structure