Sharif Cherryover 6 years ago

ase: palpitations A 35-year-old woman presents to your office complaining of palpitations for the past few weeks. She paid little attention to her symptoms because she had been under job-related stress and she thought these symptoms would disappear. Instead, her occasional skipped beats increased in frequency to twice a day, lasting up to 2 minutes. Her father, who suffered from heart disease, urged her to see a doctor. There had been no chest pain, shortness of breath, or dizziness. She consumes about two cups of coffee a day. She recently tried some diet pills to lose weight but stopped this medicine when her symptoms became more fre- quent. On examination, she is of average build. Her blood pressure is 130/85 mm Hg, her heart rate is 92 bpm, and her temperature is 98.6°F (37°C). Head, ears, eyes, nose, and throat (HEENT) examination is normal. No conjunctival pallor noted. Neck examination is supple. No jugular venous distension. Thyroid gland is normal size without nodules and is nontender. There are no associated thyroid bruits. Lung exami nation is normal. Cardiac examination reveals regular rate and rhythm with normal S1 and S2. No midsystolic click is heard. Abdominal and extremity examinations are normal. Neurologic examination reveals no resting tremor. Reflexes are normal. Guide Questions: 1. What is your initial impression? 2. What are your differential diagnosis? 3. What are your pertinent negatives and pertinent positive that would rule in or rule out a differential diagnosis? 4. What are the ancillary studies you would request and why?