Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
SUBJECTIVE
Peter is a 16‐year‐old male who presents to your pediatric primary care office with complaints of right knee pain and swelling for 1 week. He can bear weight on his leg with only mild dis-comfort. He lives in New York City, but reports that he spent the summer working as a camp counselor in Madison, Connecticut. He resides at the camp while working there and spends his days hiking and doing outdoor activities. He has also participated in summer soccer clinics but does not recall a specific injury, and has attributed his occasional muscle aches to his activity levels. Peter denies any current rashes, but does state that he had a lot of bug bites and poison ivy exposure during his time working as a camp counselor and has generally ignored the symp-toms. He describes a few weeks of feeling more tired with intermittent headaches, but believes it’s due to spending time in the sun and working with kids. He isn’t sure whether he has had a fever. He also denies any pain or swelling in other joints. He did not go see the nurse on‐site at the summer camp. He reports he is sleeping through the night and his appetite has been good with no recent weight loss.
Past medical history: Patient is a healthy 16‐year‐old male with no significant past medical history.
Family history: Maternal and paternal family history is unremarkable. Patient has 1 sibling, a sister, who is well. A maternal grandmother has rheumatoid arthritis, lupus, and hypertension.
Social history: Peter lives at home with his parents and younger sister. He has a pet dog that sleeps in his room. He is attending high school and in the 11th grade and is also an avid soccer player.
Medications: Daily multivitamin.
Allergies: Amoxicillin (hives, at age 2)
OBJECTIVE
Vital signs: Weight: 140 lbs; height: 68 inches; BMI: 21.3; temperature: 100.4°F; HR: 76; RR: 16;
B/P: 108/72.
General: Alert, tired appearing but in no acute distress.
HEENT: Head is normocephalic and atraumatic. Scleras are clear. PERRLA bilaterally. Normal fundi exam bilaterally. Otoscopic exam reveals normal tympanic membranes with visible land-marks and appropriate light reflex. Nares are patent. Oropharynx is normal without erythema or exudate. Tongue is midline.
Skin: No rashes noted on exam. Skin is warm and dry.
Neck: No lymphadenopathy present. Full range of motion with no reported pain.
Respiratory: Lungs clear to auscultation bilaterally. No wheezes, rales, or rhonchi present.
Cardiovascular: Regular rate and rhythm. S1S2 normal. Pulses 2+ throughout.
Gastrointestinal: Abdomen soft, nontender, nondistended, with no masses or hepatosplenomeg-aly palpated. Bowel sounds normoactive in all 4 quadrants.
Neurological: Alert and oriented. Grossly normal. Sensation intact to lower extremities. Patellar and Achilles deep tendon reflexes 2+ bilaterally.
Musculoskeletal: Assessments of the joints, with a particular focus on those of his right lower extremity (hip and ankle) are normal with the exception of the right knee. Left lower extremity exam is normal, and there is obvious asymmetry between the two knees. To right lower extremity: minimal tenderness to the knee joint upon palpation. The knee feels warm to touch. Non‐pitting edema is present. Further exam displays a positive “bulge” sign, evidence of fluid collection in the joint, as well as a negative McMurray test and negative anterior drawer sign test/Lachman test. The patella tracks normally. Range of motion of the right knee is limited due to swelling, with full extension but flexion limited to only 90°. No hypermobility is noted. Full strength (5/5) is noted to right lower extremity, and Peter’s gait is normal with no limp at time of exam.
CRITICAL THINKING
Which diagnostic tests should be ordered in this case and why?
___Complete blood count (CBC)
___Comprehensive metabolic panel (CMP)
___Erythrocyte sedimentation rate (ESR)
___C‐reactive protein (CRP)___Rheumatoid factor
___Anti‐nuclear antibody (ANA)___Lactic acid dehydrogenase (LDH)
___Enzyme‐linked immunosorbent assay with reflex Western blot (ELISA)
___X‐ray___Magnetic resonance imaging (MRI)
___Synovial fluid (cell counts, Gram stain, culture and sensitivity, PCR)
What is the most likely differential diagnosis and why?
___Infectious cause (septic arthritis, osteomyelitis, Lyme arthritis)
___Autoimmune diseases (juvenile idiopathic arthritis, systemic lupus erythematous)
___Trauma/Injury
___Malignancy (tumor secondary to osteosarcoma, lymphoma, neuroblastoma)
What is the plan of treatment?
What are the plans for referral and follow‐up care?
What health education should be provided to this patient?
What demographic characteristics might affect this case?
Are there any standardized guidelines that should be used to treat this case? If so, what are they?
Is there any other information that would be helpful in determining a diagnosis?
If this patient were 6 years old, would it change how he would be tested and treated?
At what point would inpatient treatment be more appropriate than outpatient for this patient?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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