Patient With Sudden Onset of Intermittent Mid-Epigastric PainPR 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 naphylactic reaction to penicillin Medications TC antacids
Family History oncontributory
Social History ccupation: Elementary school teacher (10 years) onsmoker enies illicit drug use onsumes wine two to three times per month egular exercise
Physical Examination eight: 145 lbs.; blood pressure: 128/72; pulse: 80; respiration rate: 18; temperature: 98.7   eneral: Calm, cooperative, in no apparent distress yes: Pupils equal, round, reactive to light ars: Tympanic membranes clear ares: Without nasal septal deviation; pharyngeal mucosa pink and moist hroat: Oropharynx without edema, erythema, tonsillar enlargement, lesions bdomen: 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 PRàH. pylori test returned positive. What treatment should be added to her plan of care?