WK10AssgnLondon-simpsont copy

Report generated on 5/7/2023, 9:22:36 PM America/Denver Performance Overview for Tonya London-Simpson on case Andrew Chen The following table summarizes your performance on each section of the case, whether you completed that section or not. Time spent: 13hr 43min 16sec Status: Submitted Case Section Status Your Score Time spent Performance Details Total Score 45% History Done 65% 2hr 36min 20sec 75 questions asked, 13 correct, 7 missed relative to the case's list Physical exams Done 81% 54min 18sec 19 exams performed, 10 correct, 1 partially correct, 2 missed relative to the case's list Key findings organization Done 3min 59sec 7 findings listed; 3 listed by the case Problem statement Done 17min 34sec 122 words long; the case's was 51 words Differentials Done 100% 24min 8sec 3 items in the DDx, 3 correct, 0 missed relative to the case's list Differentials ranking Done 100% (lead/alt score) 33% (must not miss score) 27sec Tests Done 100% 2min 48sec 1 test ordered, 1 correct, 0 missed relative to the case's list Diagnosis Done 100% 8sec Management plan Done 5hr 13min 48sec 1236 words long; the case's was 592 words Exercises Done 40% (of scored items only) 29min 40sec 2 of 5 correct (of scored items only) Attempt: 2744864

Report generated on 5/7/2023, 9:22:36 PM America/Denver History Notecard by Tonya London-Simpson on case Andrew Chen Use this worksheet to organize your thoughts before developing a differential diagnosis list. 1. Indicate key symptoms ( Sx ) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning. 2. Characterize the attributes of each symptom using "OLDCARTS" . Capture the details in the appropriate column and row. 3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. HPI Sx = right ankle pain Sx = Sx = Sx = Sx = Sx = Onset after fall Location right ankle Duration after fall Characteristics throbbing, stabbing Aggravating walking, moving ankle Relieving IBU, ace wrap, elevate, ice Timing / Treatments after fall Severity 10/10 Attempt: 2744864

Management Plan by Tonya London-Simpson on case Andrew Chen Primary Diagnosis with ICD Code and Rationale: Salter-Harris Type 2 Fracture - right ankle, S89.321A + ankle X-ray M25.771 The patient is a 14-year-old male who presents with his father with complaints of pain, swelling on his right ankle, and an inability to bear weight on his right foot. He was playing in a basketball game when he went for a layup, stepped back on another player's foot, and fell. His fall created a domino effect, resulting in other players falling on his right foot. He went home, iced, and elevated his ankle. However, when he took a shower, he removed the ACE wrap and forgot to put it back on. He has 10/10 pain when moving and now when resting. He took Ibuprofen last night and this morning for pain relief. Guidelines: According to Stead et al. (2022), only children can present with physeal fractures due to the lack of growth plate fusion. According to the American Academy of Pediatrics, ankle fractures are children's third most common physeal fractures (Moseley et al., 2022). The Salter-Harris classification system is an essential guideline for classifying and understanding these types of fractures. A Salter-Harris fracture can occur in any pediatric bone with a growth plate (Corsino et al., 2021). There are five types of Salter-Harris fractures, with type 1 having the least significant on bone growth and type V having the highest. Type II fractures that do not involve epiphysis breakage account for 40 % of distal tibia fractures (Margalit et al., 2020). According to Tarantino (2021), type II fractures occur most often in males and are most likely to cause bone deformity or growth arrest. Margalit et al. (2020) state distal physis contributes 50 % towards the growth of the tibia, and injuries result in premature physeal closure (PPC) and angular deformity. Symptoms include bone deformity, limited range of motion, inability to bear weight on the affected limb, pain, and swelling around the end of the affected bone (Tarantino, 2021). Differential diagnosis Sprain of the right ankle, S93.401A Melanson & Shuman (2021), ankle sprains are the most commonly seen sprains in primary care, sport medicines practices, and emergency rooms. The ankle is "sprained" when rolled or twisted unusually and is common in children, especially those that play sports (Melanson & Shuman, 2021). Ligaments that help stabilize the joints stretches, or tears occur with swelling, tenderness, bruising, pain, and stiffness, all sprain symptoms. This is a probable diagnosis but was ruled out by the right ankle x-ray. Contusion of the right ankle, S90.01XA A contusion results from a blunt force that ruptures capillaries under the skin while leaving the skin intact (Simon et al., 2021). A contusion is also called a bruise. The most common symptoms are bruising, pain, and swelling at the injury site. The bruising usually starts as red/purple and changes colors as it heals. According to Simon et al. (2021), causes of a contusion include unusually landing on the ankle, twisting the ankle awkwardly, and crushing or compressing the tissue in the ankle. For this patient, the inability to bear weight with the pain rule of this diagnosis. Medications including OTC Minocycline 100 mg po QD for acne Benzoyl Peroxide Face Wash 5% topically QD Salicylic Acid topically QD Excused absence for the day Physical activity restrictions include gym class for 4-6 weeks Ibuprofen 200 mg - Take 2 tabs po PRN Q6-8 hours, pain and swelling

Immobilization with short leg splint until seen be ortho RICE - rest, ice (for 10 minutes, 2 -3 times a day), compression (ACE wrap), and elevate above the heart when resting Education Educate Andrew and his father about ankle fractures and possible treatments. He will need to be informed he will need to be in a cast or splint for 4-6 weeks, so he will not play in the finals. Educate them that rest and immobilization will be necessary. Educate on complications of cast or splint, including compartment syndrome, and to go to the emergency room if this occurs. He should be taught to evaluate swelling and keep the cast clean and dry. He should be taught to monitor numbness and tingling, worsening pain, and the feeling of muscle bulging— non-weight bearing until follow-up with orthopedics. Crutches are to be used and teach him to use the axilla to bear weight. Please let me know about pain management and follow-up if Ibuprofen does not control pain. Additional test CPT code 73600 - X-ray right ankle 2 views None needed at this time Referrals Orthopedic surgeon for further evaluation of the fracture Follow-up Orthopedic surgeon for evaluation of the fracture The father signed a medical release to send right ankle x-ray films to an orthopedic surgeon. He will need to follow up with the clinic for the 15-year well-child visit and as needed. Problem Statement Andrew Chen is a 14-year-old male who presents with his father complaining of pain and swelling in his right ankle. While playing basketball, he went for a layup, stepped on another player's feet, and fell. His fall created a domino effect, and multiple players fell on his right foot. He cannot bear weight on the right foot due to pain. The physical exam was significant for tenderness over the right medial malleolus and moderate tenderness at the distal tibia/fibula junction. Dorsalis pedis pulses are symmetrical bilaterally. There is decreased active and passive range of motion to the right ankle. Social Determinants of Health No concern for financial strain, food insecurity, housing instability, or financial stress is voiced or observed. Psychologically, Andrew is at risk due to his wanting a college scholarship, and he can no longer play in the finals that had college scouts in attendance. Andrew also seems to be an active male. With the fracture, he is no longer able to as functional. With his age, he also identifies more with his friends, and having to rest will take him away from the team. A support system that includes his peers will help to prevent depression. Health promotion Follow the RICE protocol, eat a well-balanced diet with no supplements, stay hydrated, educate about concussion reporting and being forthcoming with any injury, discuss substance abuse and usage, including the legality, discuss seatbelt usage and enforce its importance, educate about sexually transmitted infections, discuss psychological stability and coping resources for instability, discuss social media overuse and the probability of it leading to anxiety. Discuss having accommodations while using crutches, including help carrying books and having extra time to get from class to class. Risk factors: ankle injury - left, falls, skin irritation, bruising, soreness,

Electronic Health Record by Tonya London-Simpson on case Andrew Chen History of Present Illness Category Data entered by Tonya London-Simpson Reason for Encounter fall with right ankle pain and swelling History of present illness A 14-year-old male presents after a fall yesterday during a basketball game. He stated that he was going for a layup when he fell. He hit his right elbow and shoulder when another student fell on his right ankle, followed by another with a pileup on his right foot. He complains of 10/10 pain, swelling, difficulty walking, and moving his leg. Risk Factors: age, gender, team sports, peer pressure, Family history: maternal great-grandmother - bone cancer Past Medical History Category Data entered by Tonya London-Simpson Past Medical History cystic acne Hospitalizations / Surgeries full term C-section, routine nursery care, formula fed, no circumcision, no hospitalization or surgeries Medications Category Data entered by Tonya London-Simpson Medications minocycline 100 mg po QD for acne, Benzoyl peroxide face wash 5% QD, Salicylic acid topically QD, Ibuprofen 200 mg po PRN Q 6-8 hour, pain and swelling Allergies Category Data entered by Tonya London-Simpson Allergies no known allergies Preventive Health Category Data entered by Tonya London-Simpson Preventive health immunization up to date

Family History Category Data entered by Tonya London-Simpson Family History Mom - none, Dad - none, sister - none, brother - none, maternal grandmother - cataracts, maternal grandfather - MI @ 70-year-old, paternal grandmother- depression, paternal grandfather - none, maternal great grandmother - bone cancer, maternal great grandfather - colon cancer, paternal great grandparents - unknown Social History Category Data entered by Tonya London-Simpson Social History Lives at home with parents, 2 siblings, attends school, plays basketball, has a dog Review of Systems Category Data entered by Tonya London-Simpson General Alert and oriented Integumentary / Breast no rash, positive for swelling right ankle HEENT / Neck No runny nose, sore throat, cough, or congestion, no nuchal rigidity, no ear drainage Cardiovascular No shortness of breath, no palpitations, no chest pain, no fainting spells Respiratory No shortness of breath, no wheezing, no cough, no sputum production Gastrointestinal no diarrhea, vomiting, constipation, no abdominal tenderness or distention, no bloody stools Genitourinary no dysuria, no frequency, no urgency, no urethral discharge, no genital rashes Musculoskeletal pain and swelling right ankle, difficulty walking and moving ankle, Allergic / Immunologic no allergies noted, immunization up to date Endocrine no heat or cold tolerance, Hematologic / Lymphatic no bleeding, bruising at right ankle Neurologic No headaches, no dizziness Psychiatric no anxiety or depression noted