Case 1: A 40-year-old housewife complains of progressive weight gain of 20 pounds over the last year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance. She claims her menses have been irregular in the last year.

She has an 18-year-old daughter and has been trying to have another child with her new partner but has been unsuccessful. 

Case 2: A 48-year-old woman presents with severe right shoulder and neck pain that has been present for the past three months. She denies any injury or known precipitating event. The pain seems to be worse with shoulder and neck motion, and most of the pain is in the lateral arm and neck area. The arm pain seems to stop at the middle of the arm, and the patient denies numbness or tingling in the hands. She is difficult to examine because of the pain, although she seems to have full passive and active motion of the shoulder and neck.

Case 3: A 43-year-old man, a known case of diabetes mellitus and hypertension (both well controlled), with no history suggestive of high-risk sexual behavior, presented with a painless swelling over the left side of the neck since 30 days which was insidious in onset and gradually progressive; fever since 15 days which was of sudden onset, intermittent, relieved with medications and was associated with generalized body ache; diarrhea since 3 days which was sudden in onset, foul smelling, watery, non-bloody, 7–8 episodes per day. He has lost 4 kg of weight in 15 days.

He was a vegetarian, did not keep cats as pets and was not known to be having an immunocompromised state. On clinical examination, only the lymph nodes in the posterior triangle of the left side of the neck were palpable. These were non-tender and were not matted. 

For the case you have chosen, post to the discussion:

• Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
• In SOAP format, list: 
  • Pertinent positive findings that validate your main diagnosis
  • Pertinent negative findings that make you think of other differential diagnoses
  • Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.
• Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
• Initial post must have a minimum of 300 words, excluding references.