Thinking it through Case Study #1: Part One



As a good provider, you are consistently keeping an open mind when treating patients. Doing this allows you to not become so fixated on a diagnosis

that you miss or discount important clues. A good provider will consider multiple pathologies that could be related to the signs and symptoms the

patient presents with. Along with obtaining a good history you will also perform a physical assessment to rule out possible pathologies or to find

signs and symptoms that confirm a pathological pathway.

This assignment will be in two parts that will simulate the thought processes you will make as a provider. The first part will give you enough

information to start the thought processes to consider certain pathologies that can be associated with initial symptoms. The second part will give you

the information needed to rule out or confirm different pathologies.

Think this through. More ideas are definitely better than fewer ideas.


You are dispatched to an Abdominal Pain Patient.

You respond to a residence at 1.30 a.m. after finally getting back to sleep from a busy shift. Upon entering the residence, you find a 71-year-old man

lying on the couch in obvious distress. He notices you enter the room and watches as you walk to him, but continues to clutch his stomach. He states,

“My stomach hurts really bad”, and indicates that the pain is in his upper epigastric area. He states his pain is at a level 8/10 and that his pain

started yesterday after he ate a large fatty lunch. He reports that he has had episodes like this twice before, but the pain was resolved by over the

counter antacids. However, the pain with this episode has not resolved with multiple doses of over the counter antacid. Furthermore, any positional

changes do not produce any changes in his discomfort and pain.

His medical history includes Multiple myeloma, Hypertension, and dyslipidemia. One year ago, he underwent an allogenic bone marrow transplant for

multiple myeloma. He states that the transplant was successful and that he is closely monitored by his Hematologist/ Oncologist. Currently his

medications include: Cyclosporine, Prednisone, and Lisinopril.


~What are some of the symptoms or parts of the history that you as a care giver would be concerned about and why?

~What pathologies could be causing the symptoms above and what additional findings would you look for to confirm or rule out those findings?