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.
Allergies: NKDA
Medications:
• 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:
- What additional history about her past work environment would you explore?
- What additional objective data will you be assessing for?
- What tests will you order? Describe at least four lab tests.
- What are the differential diagnoses that you are considering? Describe two.
- List at least two diagnostic tests you will order to confirm the diagnosis of ALL.
- Will you be looking for a consultation? Please explain.
- 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.
