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Clinical Competency Chart # 546-1-57

Clinical Competency Chart # 546-1-57. Tyler Aholt Team 3 . Patient History . Middle aged female GERD Hepatitis B [12 years ago] Current tobacco use Blockages in Right Coronary Artery; stents placed in 2006, 2008 Occasional heart palpitations; angina COPD with asthma

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Clinical Competency Chart # 546-1-57

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  1. Clinical Competency Chart # 546-1-57 Tyler Aholt Team 3

  2. Patient History • Middle aged female • GERD • Hepatitis B [12 years ago] • Current tobacco use • Blockages in Right Coronary Artery; stents placed in 2006, 2008 • Occasional heart palpitations; angina • COPD with asthma • Hypothyroidism diagnosed in 2005

  3. Medications • Advair • Aspirin • Fluticasone • Metoprolol • Naproxen • Pantoprazole • Reglan • Spiriva • Ventolin

  4. Lesion • Patient presents with widespread diffuse area of white plaques with ill-defined borders on the hard palate and the dorsum of the tongue. The lesion seems to extend onto the soft palate leading towards the pharyngeal space. These lesions can be wiped off.

  5. Patient Dialogue • Have you had these lesions before? [Yes] • Are you diabetic? [No]; HIV+? [No] • How long have you had these lesions? Did the lesions first appear on the palate or on the tongue first? [I don’t know] • How often do you use your inhaler? [Advair, Ventolin, Spiriva all 2 puffs/day; Ventolin]

  6. Differential Diagnosis • Aspirin Burn • Chemical burn [due to asthma inhaler] • Acute Candidiasis • Geographic Tongue

  7. Provisional Diagnosis • Acute Candidiasis • Patient is using Advair which causes the patient to be candidiasis prone • Lesions can be wiped off • Treatment – Topical and systemic antifungals [antimycotics] • Nystatin Mouthwash • Ketoconazole Tablets • Fluconazole Tablets

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