August 2016 Critical Care Case of the Month

Jillian L. Deangelis, APRN, CNP

Theodore Loftsgard APRN, ACNP

Department of Anesthesiology

Mayo Clinic Minnesota

Rochester, MN USA

Critical Care Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours 

Lead Author(s): Jillian L. Deangelis, MS, APRN, CNP.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

History of Present Illness

The patient is a previously healthy, albeit anxious, 15-year-old girl seen by her primary care physician. She has had several months of general malaise and ongoing fatigue and an increased frequency in night terrors over the past few weeks. Her family attributes this to stress of school and her new job. She was noted to have lost 3 kg in the previous nine weeks.

PMH, SH, and FH

Her PMH was unremarkable. She is a student and denies smoking, drinking or drug abuse. Her family history is noncontributory.

Physical Examination

• Vital signs: BP 100/60 mm Hg, P 90 beats/min and regular,  R 16 breaths/min, T 100.8 ºF, BMI 15.  
• Diffuse, non-tender lymphadenopathy through the submandibular and upper anterior cervical chains.
• Lungs: clear
• Heart: regular rhythm without murmur.
• Abdomen: slightly rounded and firm.

Which of the following are diagnostic considerations at this time? (Click on the correct answer to proceed to the second of seven panels)

1. Anorexia nervosa
2. Lymphoma
3. Mononucleosis
4. Teenage adjustment disorder
5. All of the above

Cite as: Deangelis JL, Loftsgard T. August 2016 critical care case of the month. Southwest J Pulm Crit Care. 2016;13(2):46-53. doi: http://dx.doi.org/10.13175/swjpcc056-16 PDF