Case Scenario for Acute Bronchitis

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Case Scenario: Carl Fowler, a 46-year-old man, presents to a health clinic for a check-up. He was last seen in the clinic three years prior when he had acute bronchitis. A year ago, he was told that his blood pressure was "a little high" when he donated blood. His past medical history consists of a fractured clavicle sustained when he was playing a pickup game of football at age 24. The fracture healed without complications. He had an inguinal hernia repaired at age 30. He has had no serious illnesses and has no known chronic diseases. He has no known allergies and does not take any medication on a regular basis. Prior to seeing the nurse practitioner, he fills out a history form which elicits a family history and review of systems. His father died of a heart attack at age 72. His mother is alive and well at age 76. He has a 44-year-old sister who recently had a hysterectomy and has been treated several times in the past for depression. He has a 22-year-old son and an 18-year-old daughter who are in good health. A paternal uncle has hypertension and a maternal uncle has prostate cancer. There is no known family history of diabetes mellitus. On review of systems, he has occasional headaches, experiences shortness of breath when he walks up stairs, and gets up once a night to urinate. Questions: 1. What should the major objectives of this health maintenance visit be? Health maintenance guidelines, according to the National Institute of Health for ages 40-64 for men include: wellness check for blood pressure, weight and height for BMI, and potential health risks. Screening tests should include Hepatitis C, Diabetes, and risk for TB and HIV screening. An A1C, Hepatitis panel, and a TB skin test can be performed. Gestational diabetes, family history of diabetes, and an elevated BMI are all risk factors for DM. Habits should be discussed, such as

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