Mrs. Susan Derrick is a 77-year-old female who comes to the office with complaints of increasing symptoms of lethargy; fever, night sweats, a 15 lb. weight loss over 6 months; bleeding gums when she brushes her teeth; purplish patches in the skin; and shortness of breath. She also reports a feeling of deep pain in her bones and joints, worse than her usual arthritis pain. She notes that her employment history includes working at a dry-cleaning shop for 15 years, with an exposure to dry cleaning chemicals (benzenes are known to be a possible cause of leukemias). She currently lives with her son and daughter-in-law and their teenage son in a single family home. She has Medicare, a Medicare supplement plan and has a modest social security payment each month. She is financially comfortable living with her family. Generally she has been in good health, only treated for hypertension, occasional gastric reflux and osteoarthritis – worse in left hip.HPI: As stated in case above.
· Omeperzol 20mg po daily
· HCTZ 25mg po daily
· Acetaminophen 325mg 2 po every 6 hours PRN hip pain
PE: Enlarged lymph nodes and swelling or discomfort in the abdomen.
You diagnose this patient with acute lymphoblastic leukemia (ALL).
ANSWER THE FOLLOWING QUESTIONS:
1. What additional history about her past work environment would you explore?
2. What additional objective data will you be assessing for?
3. What tests will you order? Describe at least four lab tests.
4. What are the differential diagnoses that you are considering? Describe two.
5. List at least two diagnostic tests you will order to confirm the diagnosis of ALL.
6. Will you be looking for a consultation? Please explain.
7. As the primary care provider for this patient with ALL:
· Describe the education and follow-up you will provide to this patient during and after treatment by the hematologist-oncologist.
· Describe at least three (3) roles as the PCP for the ongoing care of the ALL patient.