Answer the questions that APPLIES

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Answer the questions that APPLIES...ONLY FOR A DIETITIAN ON THIS CASE STUFY DOWN BELOW: 1. What are the primary and secondary diagnoses for this case? Explain at a pathophysiological level in relation to the symptoms. 2. How did the team arrive at the diagnosis? 3. What are other factors in the case presented for consideration? 4. What other considerations may exist that contribute to the diagnosis - investigative reasoning? 5. Outline the appropriate steps for treatment management and expected outcomes. 6. What presenting factors may inhibit positive outcomes? 7. What would your communication style/approach be with this patient? 8. Describe the contributions of an interprofessional team and how each profession impacts the patient's diagnosis, treatment, and outcome. CHIEF COMPLAINT "Low platelets." HISTORY OF PRESENT ILLNESS A new patient, age 42, is referred by his health insurance helpline to establish care and to discuss "Tow platelets" noted on a recent life insurance blood test. He has been without a PCP since college and has no prior labs for comparison. He feels completely well, stating he rarely gets sick, using the local urgent care center rarely for colds and minor injuries. He denies any unusual bleeding, bruis-ing, or skin changes. There is no known personal or family history of blood or liver disorders. REVIEW OF SYSTEMs The patient's ROS is negative for fever, chills, weight loss, or fatigue. He has no nasal congestion, earache, or sore throat. He reports no vision changes, tearing, or redness/yellowing of the eyes; no cough, SOB, or wheezing; no chest pain, palpitations, or edema; no abdominal pain, nausea, vom-iting, reflux, melena, change in bowel movements, or rectal bleeding: no rashes, jaundice, pruritus, or skin lesions; no bruising, epistaxis, or swollen lymph nodes; no headache, dizziness, weakness, or paresthesia; no insomnia, depression, or anxiety. RELEVANT HISTORY The patient underwent an appendectomy as a child but has no other hospitalizations or medical diagnoses. He denies taking any prescription or OTC medications, herbs, vitamins, or other sup-plements. He had all childhood vaccines and receives annual flu shots from an urgent care clinic. His family history is significant for diabetes (mother and brother). The patient is married and has two young children. He is the director of sales for a local winery, working 50 hours per week; and has worked there for 17 years. He drinks 3 to 4 glasses of wine daily, which he describes as a "neces-sary part of my job." He has never had any work, home, or legal problems related to alcohol, and he denies binges, cravings, or withdrawal symptoms. He has never used tobacco or recreational drugs. He eats out 4 days per week: steak, potatoes, pasta, bread; his wife cooks his favorite foods at home, including carne asada with tortillas, rice, and beans. His exercise is limited to taking his kids to a park once a week. ALLErgIEs None. MEDIcATIons None. ÉxAmINatIOn Aale T 36.9°C (98.4°F), P 82, R 16, BP 138/84. SpO, 97%, HIT 175.26 cm (69 in), WT 1089 kg (240 Ibs), BMI 35. General: Well-developed, over-nourished Latins, A8Ox3, all vital signs stable. In no scute distress Prychlatrie Pleasant affect, euthymie mood, fluent speech, good insight. amally iders nastrand nairsear chest but no saunaice, asles, or varcosties noted No alone, Eyes: PERRLA, conjunctivae clear, no scleral icterus. ENT/Mouth: No oropharyngeal lesions. Neck: Supple with no lymphadenopathy or thyromegaly. Chest: No gynecomastia or axillary lymphadenopathy noted Heart: RRR with no murmurs, gallops, or rubs. Carotid and radial pulses are 2+ bilaterally. Lungs: Lungs clear to auscultation with no adventitious sounds noted. Abiomen: Protuberant with central adiposity and well-healed surgical scar at R10; no capit medusae, bulging flanks, or fluid wave present. Normal active bowel sounds noted in all quadrant with so Bruits of friction rubs. Normal areas of tympany and dullness to percussion noted. sot non-tender: no masses or hernia appreciated. Hepatomegaly with liver span percussing to 20 cm a the mid-clavicular line; palpated liver edge is firm but smooth and non-tender. Spleen tip is pale. ble but non-tender. Musculoskeletal: No muscle atrophy; trace pitting edema of bilateral pretibial areas; no presacral edema, clubbing, or cyanosis. Neurologic: Normal gait; no tremors or asterixis present; no focal deficits noted. Diagnostic Tests: Labs brought in by patient dated 1 month prior to visit: WBC = 8.9 × 10¾L Hgb = 15.0 g/dL Hct = 44.1% MCV = 99 fL (H) Platelets = 112 × 10/uL (L) Peripheral smear = Platelet numbers low; no clumping or giant forms; mormal lymphocyte morphology BUN = 16 mg/dL Creatinine = 1.00 mg/dL Sodium = 136 mmol/L Chloride = 102 mmol/L Potassium = 4.8 mmol/L Calcium = 9.9 mg/dL Glucose = 100 mg/dL (H) Albumin = 3.6 g/dL (L) Protein = 6.2 g/dL ALT = 28 IU/L • AST = 40 IU/L ALP = 141 IU/L • Tbili = 1.2 mg/dL • Dbili = 0.8 mg/dL (H) • HbAIC = 6.0 (H) • HCVAb = negative • HBsAb = positive HBcAb = neg • HBsAg = neg • HIV Ab = neg Total cholesterol = 212 mg/dL (H) HDL = 39 mg/dL. (L) • LDL = 142 mg/dL (H) Trigs = 386 mg/AL (H)