A theory of local politics that asserts that a constellation…
Questions
A theоry оf lоcаl politics thаt аsserts that a constellation of interests in finance, real estate, banking, development, and media promoting development are the dominant actors in local politics is:
Pаtient Histоry: HPI: Ursulа Vаnderlun is a 69-year-оld female patient whо presents with the complaint of “coughing for 4 weeks”. She notes this all began after she was exposed to one of her grandchildren who had an upper respiratory infection. That occurred about one month ago. Within a week, she reports that she developed a cough, which has not resolved since. The cough has recently worsened over the last 2-3 days. The cough is reported to be productive of green sputum with occasional flecks of bright red blood. Over the past 2-3 days she feels that she has had a fever, which she finally measured last night to be 101.8°F. She admits to chills. She reports mild chest discomfort diffusely when coughing but denies chest pain. She admits to feeling short of breath when climbing more than a few stairs and feels more fatigued than usual. The patient denies previous respiratory problems such as chronic cough, sputum production, or shortness of breath. She denies a history of recent travel or other sick contacts. Medications: HCTZ 25mg, one tablet taken PO daily Lisinopril 10mg, one tablet taken PO daily Metformin 500mg, one tablet taken PO twice daily Glipizide XL 2.5mg, one tablet taken 30 mins prior to first meal Tylenol 500mg (OTC), taken as 1-2 tablets q8 hrs PRN fever (last dose last night, >12 hours ago) Allergies: Ciprofloxacin (anaphylaxis suspected, by patient report of throat swelling, rash, and itching) Past Medical History: Chronic conditions: Diabetes Mellitus Type 2 (diagnosed 10 years ago) Primary Hypertension (diagnosed 15 years ago) Surgeries: Total hysterectomy due to uterine fibroids (8 years ago) R shoulder rotator cuff repair (5 years ago) Distal large intestine polypectomy with negative biopsy results (3 years ago) Immunizations: Up-to-date on recommended, age-appropriate vaccines including COVID, influenza, Tdap, and shingles. OB-GYN Hx: G2P2 – No hx of STI/STD. Last mammogram completed was 8 years ago. Pt reports she is post-menopausal s/p total hysterectomy 8 years ago due to uterine fibroids. No hx of abnormal paps. No oral or other hormone replacement therapy. Family History: Father: alive, 89 years old. Known hx of hypertension, diabetes Mother: alive, 88 years old. Known hx of obesity, breast cancer s/p surgical resection and chemotherapy, also has a hx of hypothyroidism Sister 1: alive, age 65, no reported medical problems Sister 2: deceased, age 54, death related to drug (opiate) overdose Children: two, both alive and well Child 1 (male): Age 41, healthy, with two children of his own Child 2 (female): Age 39, healthy, with two children of her own Social History: Tobacco/Vape: Denies Alcohol: One glass of red wine on Friday nights each week. Illicit drugs: Denies drug use Marital/Sexual: Pt is married, only sexually active with her husband of 30 years. Living situation: Lives with her husband in their long-term home in Ocean Beach Job: Retired city council member and administrator Hobbies: Gardening, painting, visiting her local parks and museums. Diet: Vegetarian Religion: Presbyterian Sleep: Averages 6 hours of sleep per night ROS: Constitutional: See HPI. Additionally, positive for chills. Denies night sweats, weight loss, or weight gain recently. Skin: Denies hair loss, nail pitting, rashes, lesions, or skin discoloration. HEENT: Positive for sore throat after coughing. Denies rhinitis, congestion, ear pain or discharge, eye pain or change in vision, headache. Denies hearing loss, tinnitus, or nasal discharge. No lymph node or gland swelling reported. CV: See HPI. No palpitations, no unilateral leg swelling, or edema of lower legs. No syncope or presyncope reported. Pulmonary: See HPI. No orthopnea noted. GI: Denies constipation, diarrhea, abdominal pain or distention, heartburn. No blood in stool reported. GU: Denies dysuria, urinary frequency, urgency, or hematuria. Denies urinary incontinence. No unusual vaginal bleeding or discharge. MSK: Denies trauma, joint swelling or joint pain, arthralgias or myalgias. Neuro: Denies dizziness or lightheadedness, dysarthria, slurred speech, or weakness. Denies seizures, tremors, or confusion. No other weakness observed. Psych: Denies depression, mania, suicidal ideation, homicidal ideation or hallucinations. Endocrine: Denies heat or cold intolerance, polyuria, polydipsia, or polyphagia. Heme/Lymph: Denies easy bruising or bleeding. The EKG below was obtained at patient’s arrival today: (Note: This EKG is unchanged from the patient’s most recent prior EKG last year and is a standard 10-second recorded EKG strip) Section Task 2: (A.) Given the provided patient history, narrow your differential diagnosis list to your top three (3) most likely diagnoses. [PLO 2] (B.) For each of your top three diagnoses listed, please provide two (2) physical exam findings that would help you increase or decrease your suspicion for that diagnosis. Findings can be either positive or negative, but any specific finding can only be used once. [PLO 2] Please use the format below when providing your answer: Dx 1: PE finding 1 PE finding 2 Dx 2: PE finding 1 PE finding 2 Dx 3: PE finding 1 PE finding 2 (C.) (Q2.) Please provide an interpretation for the provided EKG shown above. You must include the following information in your interpretation: [PLO 3] -Rate (an estimate is acceptable) -Rhythm -Overall interpretation of the EKG (i.e., What are your findings and, if applicable, describe if this EKG is consistent with a specific condition or diagnosis?)