Megan Johnson, age 16, is accompanied at the clinic by her mother who is concerned about her daughters increasing fatigue and new onset of her “heart racing.” Megan admits that she has been tired more often and has started having some heart

Megan Johnson, age 16, is accompanied at the clinic by her mother who is concerned about her daughters increasing fatigue and new onset of her “heart racing.” Megan admits that she has been tired more often and has started having some heart palpitations. She says the palpitations occur daily, are intermittent, and make her feel more fatigued. She often will take naps related to this. Her appetite has decreased, and Megan admits she is a finicky eater. Her diet is poor and consists more of “junk” foods, and few meats and vegetables. She also drinks numerous energy drinks related to the fatigue, which seems to exacerbate the palpitations.

Her family history is negative for neurologic, psychiatric, and autoimmune diseases, as far as she knows. Megan is on no medications, although her mother has tried to get her to take a multi-vitamin daily, but she has not been consistent. She is active in school and participates in several extracurricular activities (cheerleading, pep squad, and debate club). She denies smoking, drinking alcohol or use of illicit drugs. Her menstrual cycle started at age 12, and she states her periods are very heavy, often lasting 7 days with the first 4-5 being the heaviest.

Patient: Megan Johnson (DOB April 9th)

Physical exam:

Vital signs: T- 98.4, HR 96, RR 20, BP 94/68, SPO2 96% on RA

Height/weight 5’ 8” and 123 lbs.

General AAOx3; appropriately dressed, well groomed, appropriate affect

Head/neck Normocephalic; oropharynx and conjunctivae are pale; neck supple

                                 with full ROM, no lymphadenopathy, no thyromegaly

Lungs CTA in all fields

Heart RRR without murmur, gallop, or ectopy. No lifts heaves or thrills

                                 noted. Carotid unremarkable for bruits.

Abdomen Soft, flat, non-tender, no organomegaly, bowel sounds audible in all

                                 quadrants.

Extremities No clubbing, cyanosis, or edema

Skin Pale, no rash or lesions

Neurologic exam:

CN I-XII WNL, Negative Babinski

Diagnostics:

CBC

Range

WBC

7.6

3.4 – 13.5

RBC

3.36

3.54 – 5.8

Hemoglobin

9.1

11.6 – 15.0

Hematocrit

29%

35 – 44%

MCV

74

70-85

MCH

21

23-31

MCHC

25

32-36

RDW

15.6

12.3 – 15.4

Platelets

167

150 – 385

Neutrophils

5850

1700-7500

Lymphs

4,061

1250-7000

Monocytes

32

28-825

Eos

48

40-390 Basos

9

7-140 Serum iron 28 mcg/dL Range 60 to 170 mcg/dL

TIBC 400 mcg/dL Range 240 mcg/dL to 450 mcg/dL

Serum ferritin 10.5 mcg/L Range 11 to 307 mcg/L

What is your prescription for Megan? Be sure you include the follow-up management in the patient education section, and the diagnosis, including ICD10 code, in your rationale. Hint: This diagnosis should be very specific.

Please be sure that you review the guidelines before submitting.