Case Examples

Case # 1: Jenny Jenny is a 45-year old woman who has visited the ER multiple times in the last month c/o of chest pain. She was given a temporary Rx of Ativan and referred back to primary care. Although cardiac tests were negative, Jenny continued to believe she was having a heart attack. She indicated the Ativan helped her “a little,” but she had become reluctant to be alone for fear she would be without assistance in the event of a heart attack. What might be Jenny’s diagnosis? What treatment represents her best chance for a long-term positive outcome?

Case # 2: Bill Bill is a 23 year-old man who has cancelled his appointment for a flu shot 5 times. You’ve been alerted to this pattern by the scheduler who mentioned Bill sounded anxious over the phone. During the call, Bill revealed he “doesn’t like shots” and feels faint just thinking about it. He downplayed the problem and suggested the shot is not that important, indicating, “I never get the flu anyway.” What might be Bill’s diagnosis? Are there any potential medical concerns other than the need for a flu shot?

Case #3: Antoine Antoine is a 14 y.o. boy who presents with a two month history of abdominal pain and headaches. He was seen a month ago and given omeprazole without relief. He has used Tylenol for his headaches but finds the greatest relief by lying in his bed. He has significant fatigue and bites his mother’s head off every time she suggests he get up and do something productive.   Is this a typical adolescent? If not, what further information would you want? What treatments would you consider ?