Solved by a verified expert:please assist with questions:The patient is Elizabeth, age 16, with a chief complaint of a left ankle injury. Elizabeth is an Irish dancer and has been seen in the past for other injuries. At the last visit 8 months ago, Elizabeth had a groin pull and was sent to physical therapy (PT) for evaluation and treatment. The PT notes state Elizabeth has lax ligaments and responded well to PT. She was released to return to dance without restrictions 3 weeks ago.HPI: Elizabeth presents with her mother. You note Elizabeth is on the exam table with her legs resting on the table. Her left ankle is wrapped in an ace bandage. A pair of crutches is resting against the wall. You introduce yourself as the student NP and tell the patient and her mother you are starting the exam, but your preceptor will be in as well to examine and evaluate her. Elizabeth states that during dance class last night she “landed on the side of my ankle and I heard a pop. The dancers across the room heard the pop too.” Elizabeth was unable to bear weight and had to be carried to the car. Last night Mom iced the ankle and came here first thing in the morning.When Elizabeth tries to bear weight, her left ankle gives away, and she is unable to walk unassisted. Mom did not want to go to the ER last night. She asks if she did the right thing by waiting until the morning to get Elizabeth evaluated.PMHx: Reports general health as good. No serious health issues. She had previous ankle and groin injuries related to dance.Childhood/previous illnesses: chicken poxChronic illnesses: NoneSurgeries: appendectomy 2 years agoHospitalizations: noneImmunizations: Does not receive the flu shot. Other childhood vaccinations are up to date, mother has declined the HPV series.Allergies: NoneETOH, tobacco, illicit drugs: deniesSleeps 8 hours nightlyCurrent medications: daily multivitaminSocial Hx: High school student in 10th grade gets good grades. She has been an Irish dance for 8 years and has dance class twice a week.Family Hx: Parents are alive and well. Mother in good health and father has a history of thyroid storm 3 years ago. Brother age 12 in good health. Maternal and paternal grandparents are alive, paternal grandmother recently diagnosed with breast cancer, and paternal grandfather in assisted living due to dementia.Discussion Questions Part One:What further questions do you have for Elizabeth at this visit?What is your differential diagnosis list for this visit thus far with rationale?Based on your differential diagnosis list, identify what body systems you’d examine along with pertinent positive/negatives in each system and any diagnostic tests you would like to perform?Did her mom do the right thing by waiting until this morning or should she have taken her to ED last night?Elizabeth is a teenager, is it a HIPAA violation to share healthcare information with her parents if she is not present?
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