Pain PR is a 35-year-old female who presents with a sudden onset of intermittent mid-epigastric pain that started 4 weeks ago. Pain is 6/10 on the pain scale and described as burning that worsens a

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 Patient With Sudden Onset of Intermittent Mid-Epigastric Pain

PR is a 35-year-old female who presents with a sudden onset of intermittent mid-epigastric pain that started 4 weeks ago. Pain is 6/10 on the pain scale and described as burning that worsens after she eats Mexican food and when she is lying down. She has never experienced this before. PR reports that she has been taking over the counter (OTC) antacids that seemed to help at first, but now they provide no relief. She reports associated regurgitation and feeling of fullness all the time and this morning she had a sore throat. 

Past Medical History 

• Anaphylactic reaction to penicillin Medications 

• OTC antacids 

Family History 

• Noncontributory 

Social History 

• Occupation: Elementary school teacher (10 years) 

• Nonsmoker 

• Denies illicit drug use 

• Consumes wine two to three times per month •

 Regular exercise 

Physical Examination 

• Weight: 145 lbs.; blood pressure: 128/72; pulse: 80; respiration rate: 18; temperature: 98.7 °F 

• General: Calm, cooperative, in no apparent distress 

• Eyes: Pupils equal, round, reactive to light 

• Ears: Tympanic membranes clear 

• Nares: Without nasal septal deviation; pharyngeal mucosa pink and moist 

• Throat: Oropharynx without edema, erythema, tonsillar enlargement, lesions 

• Abdomen: Nondistended, soft, round, nontender; normoactive bowel sounds in all quadrants 

Discussion Questions 

1. What are the top three differential diagnoses for PR? 

2. What diagnostic tests, if any, are required for PR? 

3. What pharmacological, nonpharmacological, and/or nutraceutical therapies should be prescribed for PR?

 4. The results from PR’s H. pylori test returned positive. What treatment should be added to her plan of care?