Diagnoses Diagnosis

A 60-year-old woman presents with fatigue, anorexia, weight loss, and a low-grade fever with duration of approximately 3 weeks. Her spouse is with her, and they are concerned about the symptoms she is experiencing. In addition, the woman reports that she has pain in her hands and stiffness that is worse in the morning. In her health history, the patient notes that her mother and sister both have rheumatoid arthritis (RA).

The practitioner performs a puysical exam on the patient and finds that she has symmetrical swelling and tenderness of the metacarpophalangeal and proximal interphalangeal joints of both hands. She also has decreased range of motion and crepitus of the wrists and elbows. The patient’s skin is pale and dry, and she has mild splenomegaly. The practitioner orders further laboratory tests to confirm the diagnosis of RA and to assess the severity and activity of the disease. These tests include anti-cyclic citrullinated peptide (anti-CCP) antibodies, C-reactive protein (CRP), complete blood count (CBC), serum albumin, serum creatinine, liver function tests, and urinalysis. The results show that the patient has high levels of anti-CCP antibodies and CRP. The CBC reveals mild anemia and leukocytosis, which are common in RA. The serum albumin is low. The serum creatinine is normal. The liver function tests are normal.

The urinalysis is normal.
Case Questions
1. Create a Problem list for this patient. What is the priority diagnosis?
2. Based on the information provided, what are the key features that support your diagnosis?
3. What are the possible differential diagnoses diagnosis list and rationales for excluding or including the diagnosis for the patient’s condition based on her history and physical examination findings?
4. What additional laboratory tests or diagnostic procedures would you consider ordering for this patient?
5. What treatment would you prescribe for this patient? Be detailed in your plan for this patient and include traditional and complimentary options for this patient. Write out any prescriptions exactly as you would write them on a prescription pad or call in the prescription to a pharmacy. If you have additional orders write those out as well.
6. Provide your recommendations for follow-up.
7. What educational topics would you provide for this patient?
8. Describe your plan for monitoring the patient’s lab or diagnostic procedures ordered.

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