Need Response for the below case study discussion

APA format 3 correspondent references and argument needs to be akin to what is posted as tally to the living-souls distinction   Patient Initials: RF               Age: 15                       Gender: M SUBJECTIVE DATA: Chief Annoyance (CC): A sad trouble in twain flexures delay interrupted clicking in one or twain flexures and the affection of the patella epidemic. History of Confer-upon Illness (HPI): RF is a 15-year-old manly who reports sad trouble in twain flexures. Casually one or twain flexures click, and the resigned describes a epidemic affection subordinate the patella. He states that the trouble has been on and off for the definite foul-mouthed months and initially merely confer-upon behind serious zeal but has gotten worse past starting trace this summer and seems to be confer-upon balance repeatedly than anteriorly. The resigned states that the clicking comes and goes and isn’t constantly confer-upon in twain flexures at the corresponding spell. The epidemic affection subordinate the patella is balance pronounced past he afloat doing the hanker skip in trace. The resigned states that he is telling to endure gravity as the trouble is a sad ache. Icing his flexures behind sports and induction ibuprofen acceleration to bring the trouble and protuberance but twain befall balance ordinaryly now making it arduous to join-in in sports. The resigned feels that he may be balancedoing it delay all of the sports he join-ins in and is worried encircling not substance telling to play soccer if it continues to get worse. The resigned scolds the trouble 7/10 behind serious zeal. Medications: Ibuprofen 200 mg vocal tab, two tabs complete 6 hours as needed for trouble.  Allergies: No disclosed garbage, influence, or environsupernatural allergies. Past Medical Truth (PMH): None Past Surgical Truth (PSH): None  Sexual/Reproductive History: Resigned is not sexually locomotive at this spell. Personal/Social History: Resigned denies smoking, alcohol use, and illicit garbage use. The resigned is very locomotive delay sports careclose soccer, basketball, baseball, and trace. He states that he tries to eat courteous proudestly owing of sports but doesn’t constantly frame the best choices for snacks. He tries to elude soda most of the spell and reports drinking a lot of soak. Immunization History: Immunizations are up to age. Gets influenza vaccine every-year. Significant Family History: Paternal grandfather has hypertension, and father has borderline hypertension. Maternal grandfather has mark II diabetes. Lifestyle: RF is a freshman in proud develop who lives delay twain of his parents and older sister. RF plays soccer, basketball, baseball and join-ins in trace for proud develop. RF too plays club soccer careclose and traveling most of the year. RF is a cheerful ward, robust, and enjoys substance locomotive. He too join-ins in refuse sports and skis during refuse rupture.  RF works part-spell as a arbitrator during the summers due to his commitment to develop and sports. Review of Systems: General: No fresh gravity frame or waste of sagacity. Resigned denies ruby, passion, or chills. HEENT: No headaches or dizziness. No changes in anticipation. He does not rub glasses, and his definite eye exam was orderly subordinate a year ago. Denies eye drainage, trouble, or wrap anticipation. No changes in hearing. Has had no fresh ear epidemic, tinnitus or absolved in the ears. Denies sinus epidemic, glomeration, and epistaxis. He reports his view of slight is scatiness. Definite dental exam was foul-mouthed months ago for ordinary cleaning. Denies bleeding gums or a toothache. Denies dysphagia or throat trouble. Neck: No truth of trauma, denies fresh damnification or trouble. He denies neck inelegance. Breasts: Denies any confront changes. Denies truth precipitatees. Denies truth of magnitudees or trouble. Respiratory: Denies a cough, hemoptysis, and sputum springation. Resigned denies any deficiency of life delay trusting or delay labor. Resigned reports no trouble delay intuition or dolefulness. Cardiovascular/Peripheral Vascular: No truth of rumbling or chest palpitations. No edema or claudication. Denies chest trouble. No truth of arrhythmias.   Gastrointestinal: Denies abomination or vomiting. Resigned reports no abdominal trouble, diarrhea, or constipation. Definite bowel progress was this dawning. Denies rectal trouble or bleeding. Denies changes in bowel behavior. Denies truth of dyspepsia. Genitourinary: Denies changes in urinary archetype. No dissoluteness, no truth of STDs or HPV, the resigned is heterosexual and not sexually locomotive. Denies hematuria. Denies pressure, quantity, and dysuria. Musculoskeletal: No shyness in file of excitement for all limbs though resigned reports arduousy tender flexures behind unreasonable purify from sports.  No truth of trauma or fractures. Resigned reports sad trouble in twain flexures. The resigned states interrupted protuberance in flexure articulations behind participating in sports. Resigned reports clicking in one flexure and casually twain. The resigned states that the trouble is worse behind participating in the hanker skip or bestow hanker distances. Resigned denies truth or closeness of misalignment of either flexure. Psychiatric: Denies suicidal or homicidal truth. No supernatural sanity truth. Denies care and dejection. Neurological: No dizziness. No problems delay coordination. Denies falls or seizures. Denies callousness or tingling. Denies changes in reminiscence or thinking archetypes. Skin: No truth of bark cancer. Denies any new precipitatees or sores. Resigned reports manifold blisters from sports which are treated delay Neosporin, band-aids, and NewSkin relative. Denies eczema and psoriasis. Denies craving or protuberance.   Hematologic: No bleeding disorders or truth of lineage transfusion. Denies unreasonable bruising. Endocrine: Resigned reports no endocrine symptoms. Denies polyuria, polydipsia. Resigned denies no pharisaism to warmth or composed. Allergic/Immunologic: Denies environmental, influence, or garbage allergies. No disclosed immune deficiencies. OBJECTIVE DATA:  Physical Exam: Vital signs: B/P 118/74; P 65 and ordinary; T 98.6; RR 16; O2 100% on locality air; Wt: 125 lbs.; Ht: 5’7”; BMI 19.1 General: RF is a courteous-developed, courteous-nourished Caucasian teenage manly who appears to be in no mitigated afflict.    HEENT: Head: Skull is normocephalic, atraumatic. No magnitudees or lesions. Eyes: PERRLA, +straightforward and consensual student tally. EOM scatiness, 20/20 anticipation bilaterally delayout punishment. Fundoscopic exam normal, vessels scatiness, the optic disc delay absolved margins. Ears: Bilateral superficial ears no lesions, magnitudees, drainage or benefit. Tympanic membranes scatiness, pearly gray, no bulging, no erythema, and landmarks appreciated bilaterally. Hearing scatiness bilaterally. Nose: No nasal ostentatious, no execute, no hinderance, septum not deviated. Turbinates pink and juicy. No polyps or lesions bilaterally. Nares obvious delay no edema or erythema. Throat: Oropharynx absolved and mucosa juicy. No erythema or exudate. Uvula midline, palate rises symmetrically. Mouth: No lesions, no thrush. Juicy mucous membranes. Healthy dentition confer-upon. Tongue midline. Neck: Supple, non-tender. Liberal file of excitement. Trachea midline. No magnitudees. Thyroid and lymph nodes not evident. Chest/Lungs: Thorax non-tender delay symmetric dilution. Respiration ordinary and unlabored, delayout a cough. Tactile fremitus correspondent bilaterally and main in loftier lung fields.  Breath sounds absolved delay unsupposable sounds. All lung fields delay acoustic shock tenors.    Heart: Ordinary scold and rhythm; regular S1, S2; no rumblings, rubs, or gallops. Apical pulse not clear. Apical pulse was barely evident. JVP appears to be approximately close than 6 cm delay HOB proud-minded to 45 degrees. No carotid bruits or JVD appreciated. Peripheral Vascular: Pulses 2+ bilateral pedal and 2+ radial bilaterally. No pedal edema. Popliteal pulses 2+ bilaterally. Abdomen: Abdomen entire, pressible, and non-tender delayout precipitate, palptelling magnitude or organomegaly. Locomotive bowel sounds. Tympany balance most quadrants delay areas of sadness distinguished upon shock. No abdominal bruits. Genital/Rectal: Adequate tenor, no magnitudees distinguished, infinite genitalia scatiness. Musculoskeletal: Regular resigned and locomotive ROM in loftier and subordinate extremities. No focal articulation inflammation or abnormalities appreciated in loftier extremities. + benefit to palpation at the subordinate pole of the patella bilaterally. + Q prepossession main than 10 degrees bilaterally. Clicking confer-upon delay progress in direct flexure. Regular alignment of the flexures bilaterally. All loftier and subordinate termination articulations delayout effusions or erythema. Spine delayout benefit and file of excitement is liberal. Main benefit was distinguished in flexures bilaterally when strong, and quadriceps are relaxed. Regular muscle force confer-upon counter opposition. Neurological: CN ll-Xll grossly scatiness. Awake, lively, and oriented to peculiar, situate and spell. The resigned can progress all limbs on direct and gratuitously. Skin: Warm, juicy, and scatiness. Bark is haggard. + edema direct flexure. No peripheral cyanosis. No clubbing. No precipitatees or bruises confer-upon. ASSESSMENT: Lab Tests and Results: CBC- Normal Erythrocyte sedimentation scold (ESR) - Normal Diagnostic ordeal: Passive production-flexion sign- explicit- which is benefit on palpation of the tendon at the subordinate pole of the patella. McMurray ordeal- Privative for locking during articulation progress. X-ray- privative MRI- Showed proud distinguished tension delayin the proximal later convenient appearance of the tendon at its spring. Differential Diagnosis: Patellar tendinitis: This is the most mitigated distinction based on the resigneds HPI, ROS, substantial rate, and symptom studies. The resigned’s proudest annoyance was a sad trouble in the flexures delay interrupted clicking in one or twain flexures. The resigned is robust and join-ins in manifold sports that unintermittently put a purify on his flexures. The quadriceps prepossession was main than ten which suggests patellar tendinitis. The resigned plays sports that include a lot of bestow and skiping which adds purify to the flexure articulations. The resigned was too explicit for benefit on palpation at the subordinate pole of the patella bilaterally. Lastly, the MRI was explicit for proud distinguished tension delayin the proximal later convenient appearance of the tendon where it springates from. Oscheerful Schlatter's disorder: A practicable distinction as it is a despicable problem which typically befalls during spells of rapid development usually in fit, locomotive boys. Oscheerful Schlatter’s disorder is associated delay trouble orderly underneath the flexurecap in one or twain flexures, repeatedly worse behind sports in-particular proud contact activities using the quadriceps muscles. However, limping is repeatedly a confer-upon, and the resigned spoiled limping in the ROS. Trouble is main delay stair climbing and flexureling, and the resigned did not advance to either. Flexion and production accomplish acception trouble in the tibial tubercle which was not confer-upon upon substantial exam of the resigned. Chondromalacia patellae: This is a practicable distinction due to the closeness of flexure trouble upon palpitation and acceptiond trouble delay zeal. However, chondromalacia patellae are balance despicable in females or living-souls delay a truth of flexure trauma. The resigned is manly and spoiled trauma to either flexure. The resigned spoiled a truth of misalignment which is too akin to chondromalacia patellae. An x-ray of the flexure would demonstration irregularities of the patellofemvocal articulation. Medial meniscus shatter: This distinction is a possibility owing it can befall behind a wresting damnification and the resigned join-ins in sports such as soccer, basketball, and skiing that complicate wresting progresss. Clicking may be confer-upon delay a medial meniscus shatter which the resigned reputed and was too appreciated upon substantial rate in the direct flexure. McMurray ordeal was privative for locking during articulation progress. The resigned spoiled arduousy delay gravity endureing. Juvenile rheumatoid arthritis (JRA): Practicable due to flexure articulation soreness and inelegance, nevertheless, twain typically ameliorate delay zeal. Articulation protuberance may too confer-upon delay JRA and was reputed by the resigned in his ROS. The resigned spoiled gravity waste and ruby which are despicable symptoms. The resigned too spoiled misinterpretation trouble. A CBC would demonstration anemia, leukocytosis, and thrombocytosis. The ESR would be proud-minded. References  Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's conduct to substantial establishment (8th ed.). St. Louis, MO: Elsevier Mosby. Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced sanity rate and clinical distinction in earliest care (5th ed.). St. Louis, MO: Elsevier Mosby. Huether, S. E., & McCance, K. L. (2017). Disorder of the articulations. In alterations of musculoskeletal part (6th ed., pp. 991-1038). Rath, E., Schwarzkopf, R., & Richmond, J. (2010). Clinical signs and narrowless interdependence of patellar tendinitis. Indian Journal of Orthopaedics, 44(4), 435-437 3p. doi:10.4103/0019- 5413.6931