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Sophie, an 82-year-old from assisted living, is brought in to see you

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Sophie, an 82-year-old from assisted living, is brought in to see you. She has deteriorated in the last 3 days and has become mildly confused, making mealtimes difficult, as the patient has begun refusing food. Sophie has a low-grade temperature. Her caregiver has noted that she frequently grabs at her abdomen and groans as if in pain, and there may have been blood in her last void, an hour ago. There is no one to confirm when the patient's last BM was. Sophie has been a fairly healthy lady. Her PMH is significant for lumbar disc disease, and PSH is positive for a cholecystectomy. Upon physical examination, you find that she has left, lower quadrant abdominal pain with palpation that appears to radiate to her left flank. By the time you assessed for CVA tenderness, Sophie was groaning with any attempted physical examination, even straight leg raises. Identify five other questions you would ask her caregiver, providing rationale. She's 82, so these need to make sense based on the presenting information. (15 points: 3 points each) • You conduct a physical examination. Describe 2 body systems (vital signs don't count) that you would include in your assessment. Be specific when describing your exam and provide your rationale (10 points). • Identify three differential diagnoses. Provide your rationale (6 points) and determine what you think is the most probable diagnosis, providing a brief description of the pathophysiology (4 points). (10 points total). Think outside the box. Don't let them all be related to the same body system. Identify 1 diagnostic test you would order, providing your rationale (5 points). Do not use any laboratory studies. Identify 1 pharmacologic treatment, including dose/duration, based on your most probable diagnosis and provide your rationale. (5 points). YOU MUST USE A NATIONALLY RECOGNIZED TREATMENT GUIDELINE. DO NOT use the PDR, or Epocrates. These are not treatment guidelines, but medication references. This is based on outpatient treatment, not inpatient care, so do not recommend IV medications.