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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the clinical presentation of influenza.

  • Discuss influenza-related complications.

  • Develop a patient-specific treatment plan for influenza.

  • Identify appropriate target populations for vaccination against influenza.

  • Compare and contrast available options for preventing influenza.

  • Discuss strategies to control influenza outbreaks.

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PATIENT PRESENTATION

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Chief Complaint

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“I feel like a truck ran over me. Every muscle and bone hurts, and I am burning up.”

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HPI

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Vladimir Kharitonov is a 67-year-old Russian man who presents in mid-December to an urgent care clinic with complaints of 1-day history of fever, up to 39°C (102.2°F), muscle and bone aches, feeling tired, and headache. He has not had anything to eat in the past 12 hours due to loss of appetite and has not taken his glyburide this morning. He has been in his usual state of health previously and reports that some of his coworkers have been sick with the “flu.” He decided to come to the clinic in hopes that an antibiotic can allow him to recover sooner since his son is getting married next weekend. He missed his regular physical appointment 1 month ago because he was “too busy.”

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PMH

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  • Type 2 DM for 14 years

  • Hyperlipidemia

  • HTN

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FH

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Father and sister with type 2 DM

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SH

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Lives at home with his wife; works full time; quit smoking 10 years ago, but smokes occasionally when really stressed or in a social setting; drinks alcohol in a social setting—mostly vodka

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Meds

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  • Aspirin 81 mg PO daily

  • Hydrochlorothiazide 25 mg PO daily

  • Glyburide 5 mg PO every morning

  • Metformin 1 g PO twice daily

  • Lantus 35 units SC at bedtime

  • Lipitor 10 mg PO daily

  • Centrum Silver one tablet PO daily

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All

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NKDA

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ROS

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Complains of severe fatigue, body aches, alternating between being too cold and sweating, sore throat, nonproductive cough, and a headache. He denies nasal congestion, nausea, vomiting, or diarrhea.

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Physical Examination

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Gen
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WDWN overweight man in NAD

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VS
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BP 150/90 (patient reports similar readings at home), P 95, RR 18, T 38.5°C; Wt 95.5 kg, Ht 5′10″

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Skin
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Warm and moist secondary to diaphoresis, no lesions

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HEENT
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PERRLA; EOMI; TMs intact; wears dentures; mild pharyngeal erythema with no exudates

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Neck/Lymph Nodes
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Neck is supple and without adenopathy; no JVD

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Lungs/Thorax
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CTA; no crackles or wheezing

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