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Reаd the fоllоwing cаse scenаriо, as documented in a "SO"AP format. Then follow the directions. Patient Information Name: Emily LawsonAge: 34 yearsSex: Female Race: WhiteOccupation: Elementary school teacherMarital Status: MarriedInsurance: Blue Cross Blue Shield of TN Chief Complaint (CC) "I've had migraines for years, but lately they're happening more often." History of Present Illness (HPI) Emily Lawson is a 34-year-old female who presents to establish care for worsening headaches. She reports a history of migraine headaches beginning in college, but states that over the past four months the headaches have become more frequent. Previously, she experienced one migraine every two to three months; however, she now experiences approximately two to three headaches per month. She describes the headaches as a throbbing pain that typically begins behind her left eye and spreads to the left side of her head. The pain is usually rated as 8/10 and lasts approximately 12–24 hours if untreated. She reports associated nausea, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). She prefers to lie in a dark, quiet room until the headache resolves. She denies experiencing an aura before the headaches. Emily reports that the headaches often occur around the time of her menstrual cycle and seem to be triggered by increased stress at work, inadequate sleep, and occasionally skipping meals. She has been taking over-the-counter ibuprofen with some relief but feels that it is becoming less effective. She estimates taking ibuprofen approximately 4–5 days per week over the past two months because of frequent headaches. She denies fever, chills, recent head trauma, neck stiffness, seizures, weakness, numbness, tingling, difficulty speaking, vision loss, loss of consciousness, gait instability, or recent illness. Emily states she is becoming increasingly concerned because her mother died from a brain tumor several years ago. "I know I've always had migraines, but now I'm worried something more serious could be causing these headaches." Past Medical History Migraine headaches Seasonal allergic rhinitis Gynecologic History LMP: 10 days ago Menstrual cycles occur every 28–30 days, lasting 4–5 days with moderate flow. Reports that headaches frequently occur 1–2 days before the onset of menses or during the first day of her menstrual period. Gravida 2, Para 2. Husband has had a vasectomy (or, alternatively, uses oral contraceptives if you want to discuss estrogen-containing contraception and migraine in a future course). Denies current pregnancy. Past Surgical History Cesarean section ×2 Medications Ibuprofen 400 mg as needed for headaches (reports using 4–5 days/week) Cetirizine 10 mg daily during allergy season Daily multivitamin Allergies No known drug allergies (NKDA) Family History Mother: Deceased at age 58 from glioblastoma Father: Hypertension and hyperlipidemia Sister: Migraine headaches Maternal grandmother: Type 2 diabetes mellitus Social History Emily is married and lives with her husband and two young children. She works full-time as an elementary school teacher and describes her job as rewarding but increasingly stressful. She denies tobacco or illicit drug use. She drinks one to two glasses of wine on weekends and consumes approximately three cups of coffee daily. She exercises by walking several days each week but reports decreased physical activity because of her headaches. She sleeps approximately five to six hours per night and frequently wakes feeling unrefreshed. Review of Systems General Reports fatigue. Denies fever, chills, or unexplained weight loss. HEENT Reports recurrent unilateral headaches, photophobia, phonophobia, and nausea during headaches. Denies vision loss, diplopia, hearing loss, tinnitus, nasal congestion, sore throat, or dysphagia. Cardiovascular Denies chest pain, palpitations, syncope, or edema. Respiratory Denies cough, dyspnea, or wheezing. Gastrointestinal Reports nausea associated with headaches. Denies vomiting, abdominal pain, diarrhea, or constipation. Neurological Reports recurrent headaches. Denies dizziness, seizures, weakness, numbness, paresthesias, tremors, speech changes, balance problems, or loss of consciousness. Musculoskeletal Reports occasional neck and shoulder tightness after prolonged computer work. Denies joint pain, muscle weakness, or recent injury. Psychiatric Emily reports increased stress related to work and family responsibilities but denies persistent sadness, hopelessness, excessive anxiety, panic attacks, or suicidal ideation. A PHQ-9 was administered during today's visit with the following responses: Question Score Little interest or pleasure in doing things 0 Feeling down, depressed, or hopeless 1 Trouble falling asleep, staying asleep, or sleeping too much 2 Feeling tired or having little energy 1 Poor appetite or overeating 0 Feeling bad about yourself 0 Trouble concentrating 1 Moving or speaking slowly or being fidgety/restless 0 Thoughts of being better off dead or self-harm 0 Total PHQ-9 Score: 5 (Mild depressive symptoms) Emily states that her sleep difficulties and fatigue are primarily related to stress and frequent headaches. Vital Signs BP: 118/76 mmHg HR: 74 bpm RR: 16 breaths/min Temperature: 98.4°F (36.9°C) SpO₂: 99% on room air Height: 5'6" (168 cm) Weight: 156 lb (70.8 kg) BMI: 25.2 kg/m² Pain (during visit): 3/10 Physical Examination General Alert, pleasant female in no acute distress. Appears stated age. Maintains appropriate eye contact and answers questions appropriately. Mental Status Alert and oriented to person, place, time, and situation. Speech is clear and fluent. Mood is mildly anxious when discussing her headaches. Affect is appropriate. Thought processes are logical and goal-directed. Memory, attention, concentration, judgment, and insight are intact. HEENT Head normocephalic and atraumatic. Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Fundoscopic examination reveals sharp optic disc margins without papilledema. Visual fields intact by confrontation. Cardiovascular Regular rate and rhythm, S1 and S2 present, no murmurs, rubs, or gallops. No carotid bruits auscultated bilaterally. Peripheral pulses 2+ and symmetric. No lower extremity edema. Neurological Cranial nerves II–XII intact. Motor strength 5/5 throughout. Muscle tone normal. Sensation intact to light touch. Deep tendon reflexes 2+ and symmetric. Negative pronator drift. Finger-to-nose and heel-to-shin testing intact. Rapid alternating movements normal. Negative Romberg. Normal gait, including tandem walking. No focal neurological deficits. Musculoskeletal Full active range of motion of the cervical spine and all extremities. Mild tenderness over the bilateral upper trapezius and cervical paraspinal muscles. No spinal tenderness or joint swelling. Strength 5/5 throughout. --------------------------------------------------- Written Response Question Based on Emily Lawson’s history, PHQ-9 screening results, and physical examination findings, identify the diagnostic studies and/or laboratory tests that are appropriate to further evaluate her condition. In your response: Identify the diagnostic studies and/or laboratory tests that are indicated based on Emily’s clinical presentation. Explain the purpose of each diagnostic study or laboratory test. Describe how the results would help confirm or rule out your differential diagnoses, evaluate for potential secondary headache etiologies and neurological “red flags,” and support your clinical reasoning and diagnostic decision-making. If diagnostic testing is not indicated at this time, explain your rationale using the patient’s history and physical examination findings. Respond in 2–3 well-developed paragraphs using evidence-based clinical reasoning and appropriate medical terminology. Provide in-text citations to support your rationale when appropriate (e.g., Goolsby & Grubbs, 2023, p. 83). Course textbook(s), course lecture notes, and course content are the only resources permitted for this assignment. A reference page is not required. Your response should demonstrate advanced clinical reasoning based on the patient’s neurological, mental health, and musculoskeletal assessment findings, including interpretation of the PHQ-9 screening results, headache characteristics and associated symptoms, neurological examination findings, and identification of any findings that may suggest secondary headache disorders. Please see the attached rubric.