Discussion Part One (graded)

Setting: Small town family practice clinic

Part 1: You've been busy this morning-it seems like everyone in town has got some kind of upper respiratory illness. You pull the chart for your next patient; the chief complaint is a mole. You review the chart. You have not met this patient. Jimmy M. is 58-years-old and has not been to the office in over 5 years. Last time he was here was for a physical, which was normal.

When you enter the room, you see a man sitting in the chair. He has light red hair, turning gray at temples and green eyes. His skin color is deeply tanned on his face and arms. You introduce yourself after entering the room. You ask Jimmy what brings him in to see you today. Jimmy states, "The only reason I'm here is because my wife told me I have to come and have you check a mole on my back. She is always pestering me to have someone look at these moles. I have had moles and freckles all my life. I can't see my back but she says the one on my back looks different than the others and is growing. She looked it up on the Internet and says it could be cancer. She is always finding strange diseases on the Internet. She made me come, so here I am."

PMHx: Reports general health as great, "I never get sick."

Childhood/previous illnesses: chicken pox

Chronic illnesses: None

Surgeries: None

Hospitalizations: None

Immunizations: Does not receive the flu shot, last Tdap 2000.

Allergies: sulfa drugs: hives

Blood transfusions: None

Drinks one to two beers most nights of the week. Smokes one and a half ppd, smoking since age 12. Denies illicit drugs

Sleeps 6 hours per night. States wife says he snores loudly.

Current medications: None

Social Hx: married for 25 years, works as a roofer, does not exercise.

Family Hx: Parents are alive, both parents have high blood pressure, mother has diabetes. Siblings x 2 with hypertension. Two children ages 24 and 22 in good health.

Discussion Questions Part One:

• What further questions do you have for Jimmy at this visit?
• What is your differential diagnosis list for this visit thus far with rationale?
• Based on your differential diagnoses list, identify what body systems you'd examine along with pertinent positive/negatives in each system and any diagnostic tests you would like to perform?

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