Table of Contents

Camilla Franklin iHuman Case Study

Camilla Franklin is a 48-year-old female presenting with persistent fatigue and irritability that has been significantly impacting her quality of life for the past 2 months. In this comprehensive guide, we’ll walk you through how to approach her case, from initial history-taking through physical examination to the final diagnosis of perimenopause with associated sleep disturbance and mood changes. You’ll learn the key clinical reasoning steps, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this complex endocrine and psychological case simulation.

Camilla Franklin iHuman Case Overview (Doorway Information)

Patient Overview: Camilla Franklin is a 48-year-old Caucasian female presenting with a chief complaint of “persistent fatigue and irritability” that has been progressively worsening over the past 2 months. She describes experiencing overwhelming tiredness that interferes with her daily activities, accompanied by increased irritability, mood swings, and difficulty sleeping. The patient reports feeling “not like herself” and is concerned about these changes affecting her work performance and relationships.

Key Background Information:

Age/Gender: 48-year-old female
Chief Complaint: Persistent fatigue and irritability
Duration: 8 weeks of symptoms
Associated Symptoms: Sleep disturbances, mood swings, difficulty concentrating
Significant History: Regular menstrual cycles until recently, no significant medical history
Current Medications: None
Occupation: Office manager with high-stress responsibilities
Lifestyle: Previously active, but recent decrease in energy levels

The patient appears tired but alert and oriented, with normal vital signs. Her presentation suggests hormonal changes consistent with perimenopause, making this an excellent case for learning systematic endocrine and psychiatric assessment skills.

Camilla Franklin (48 y/o female) – Fatigue and Irritability Assessment

CC: Persistent fatigue and irritability
MSAP: 8-week history of progressive fatigue, irritability with sleep disturbances, mood changes, and difficulty concentrating
Associated symptoms: Hot flashes, irregular menstrual periods, weight gain
History: Previously healthy, no significant medical history, family history of thyroid disease
High-stress occupation – Office manager

History Questions:

How can I help you today?
When did you first notice feeling more tired than usual?
Can you describe your irritability? What triggers it?
Have you experienced any changes in your sleep patterns?
Tell me about your menstrual cycle – any changes recently?
Have you noticed any hot flashes or night sweats?
Any changes in your weight or appetite?
Do you have difficulty concentrating at work or home?
Have you experienced mood swings or feelings of sadness?
Any family history of thyroid problems or depression?
Are you taking any medications, including over-the-counter supplements?
How would you rate your stress levels at work and home?
Have you noticed any changes in your energy levels throughout the day?
Any hair loss, dry skin, or feeling cold more often?
Do you experience palpitations or racing heart?
Any headaches or muscle aches?
Have you had any recent major life stressors or changes?
Do you drink alcohol or use caffeine? How much daily?
Tell me about your exercise routine and any recent changes
Any changes in your libido or sexual function?

Physical Exam:

Vitals: pulse, BP, respirations, temperature
General appearance: overall energy level, affect
Skin: examine for dryness, texture changes
Neck: palpate thyroid gland
Cardiovascular: heart rate, rhythm, murmurs
Neurological: deep tendon reflexes, mental status
Reproductive: discuss menstrual history, pelvic exam if indicated

Assessment note:

C.F. is a 48 y/o Caucasian female presenting with 8-week h/o progressive fatigue, irritability, and sleep disturbances. She reports mood swings, difficulty concentrating, and recent irregular menstrual periods with occasional hot flashes. Physical exam reveals slightly elevated blood pressure, normal thyroid on palpation, and mildly depressed affect. PMH is unremarkable. Family history significant for maternal thyroid disease.

Laboratory Results: TSH: 3.2 mIU/L (normal), Free T4: 1.1 ng/dL (normal), FSH: 45 IU/L (elevated), Estradiol: 25 pg/mL (low)

Diagnosis: Perimenopause with associated mood and sleep disturbances

Plan:

Hormone level confirmation with repeat FSH and estradiol
Consider low-dose hormone replacement therapy or alternative treatments
Sleep hygiene counseling and possible sleep study referral
Stress management techniques and counseling referral
Lifestyle modifications including regular exercise and nutrition counseling
Follow-up in 4-6 weeks to assess symptom improvement

Camilla Franklin SOAP Note

Patient: Camilla Franklin Subjective Data

CC: 48-year-old female presents with “persistent fatigue and irritability”

HPI: 48-year-old female presents today with complaints of overwhelming fatigue and increased irritability that has been progressively worsening over the past 8 weeks. The patient describes feeling exhausted even after a full night’s sleep and reports difficulty maintaining her usual energy levels throughout the day. She states that her irritability has increased significantly, causing tension in her relationships both at work and home. The patient reports irregular menstrual periods over the past 3 months, with some cycles being heavier and others lighter than usual. She experiences occasional hot flashes, particularly at night, which disrub her sleep. The patient denies chest pain, palpitations, shortness of breath, or significant weight changes.

Medications: None currently

Allergies: (medication, environmental, food) The patient denies any known medication, environmental, or food allergies

PMH: No significant past medical history. Reports regular gynecological exams with last Pap smear 8 months ago (normal).

LNMP/OB History: LMP was 6 weeks ago. Previous cycles were regular every 28 days until 3 months ago. G2P2 – two healthy pregnancies and deliveries in her 20s.

PSH: Denies any surgical procedures.

Sexual History: Sexually active with husband of 20 years. Reports decreased libido over past few months.

Hospitalizations: None.

Health Maintenance: Reports annual physical exams. Last mammogram 1 year ago (normal).

Immunizations: Up to date with all adult immunizations including annual flu vaccine.

Family History: Maternal history of hypothyroidism diagnosed in her 50s. Paternal history of hypertension and diabetes. No family history of depression or psychiatric disorders.

Substances: (Tobacco, alcohol, illicit drugs, caffeine) The patient denies tobacco use and illicit drug use. Reports social alcohol consumption (2-3 glasses of wine per week). Moderate caffeine intake – 2 cups of coffee daily.

Home environment: Lives with husband in suburban home. Reports supportive family environment.

Employment type: Office manager for large medical practice. Reports high-stress work environment with recent increased responsibilities.

Diet: Reports eating regular meals but notes decreased appetite recently. Tends to skip breakfast due to morning fatigue.

Sleep: Reports difficulty falling asleep and frequent awakening during the night, especially due to hot flashes. Feels unrefreshed upon waking.

Exercise: Previously exercised regularly (walking 3x/week), but has decreased activity due to fatigue.

Safety: Reports feeling safe at home and work. Denies history of abuse.

Objective Data

ROS: (Perform an appropriate ROS based on the C/C and HPI; documented in i-Human assignment)

General: Reports overall good health aside from current symptoms. Denies fever, chills, or unintentional weight changes. Eye contact appropriate but appears tired. Speech clear and coherent.

Skin, Hair and Nails: Reports some increased dryness of skin recently. Denies hair loss or changes in nail texture.

HEENT: Denies headaches, vision changes, or hearing problems. No sinus congestion or throat pain.

NECK: Denies neck pain, stiffness, or swollen glands.

Thorax and Lungs: Denies shortness of breath, cough, or chest pain. No history of lung disease.

Cardiovascular: Denies chest pain, palpitations, or syncope. Reports occasional awareness of heartbeat during hot flashes.

Peripheral Vascular: Denies extremity swelling, coldness, or leg cramps.

Abdomen: Denies nausea, vomiting, constipation, or abdominal pain. Reports normal bowel movements.

Genitourinary: Reports irregular menstrual periods as noted in HPI. Denies urinary frequency, urgency, or dysuria.

Metabolic/Hematologic: Reports feeling cold more easily recently. Denies excessive thirst or hunger.

Psychiatric: Reports increased irritability and mood swings. Denies suicidal ideation but notes feeling “overwhelmed” at times.

Musculoskeletal: Reports general muscle fatigue. Denies joint pain or stiffness.

Neurologic: Reports difficulty concentrating and some forgetfulness. Denies headaches, dizziness, or neurological symptoms.

Vital Signs: Temperature: 98.2°F, Pulse: 78, BP: 138/85, Respirations: 16, SpO2: 98%

Assessment

General: Middle-aged female appearing stated age, alert and oriented x 4. Appears tired but not in acute distress. Affect somewhat flat.

Skin, Hair and Nails: Skin appears slightly dry but no lesions noted. Hair normal thickness and distribution. Nails normal.

HEENT: Head normocephalic and atraumatic. PERRLA. No lymphadenopathy noted.

NECK: Thyroid gland normal size and consistency on palpation. No nodules or tenderness detected.

Thorax and Lungs: Chest expansion symmetrical. Lungs clear to auscultation bilaterally.

Cardiovascular: Regular rate and rhythm. Normal S1 and S2 without murmur, rub, or gallop.

Peripheral Vascular: Peripheral pulses 2+ bilaterally. No edema noted.

Abdomen: Soft, non-tender, non-distended. Normal bowel sounds in all quadrants.

Genitourinary: External genitalia normal on inspection (if pelvic exam performed).

Psychiatric: Cooperative with interview. Mood somewhat depressed. Thought process logical and goal-directed.

Musculoskeletal: Normal gait and posture. No obvious muscle weakness.

Neurologic: Alert and oriented. Normal deep tendon reflexes. No focal neurological deficits.

Differential Diagnoses

Perimenopause: The patient’s age (48), irregular menstrual periods, hot flashes, mood changes, and sleep disturbances are classic presentations of perimenopause. The elevated FSH and decreased estradiol levels support this diagnosis.

Hypothyroidism: Fatigue, mood changes, difficulty concentrating, and family history of thyroid disease make this a consideration. However, normal TSH and Free T4 levels make this less likely.

Major Depressive Disorder: Persistent fatigue, irritability, sleep disturbances, and difficulty concentrating could indicate depression. However, the hormonal changes and timing suggest perimenopause as the primary cause with secondary mood symptoms.

Sleep Disorder: The patient’s sleep disturbances could be contributing to her fatigue and mood changes. However, this appears to be secondary to hormonal changes rather than a primary sleep disorder.

Chronic Fatigue Syndrome: While the patient has persistent fatigue, the presence of other perimenopausal symptoms and normal physical exam findings make this less likely.

Most Likely Diagnosis: Perimenopause with associated mood and sleep disturbances, evidenced by age-appropriate onset, irregular menstrual periods, vasomotor symptoms (hot flashes), mood changes, and confirmatory laboratory findings showing elevated FSH and decreased estradiol levels.

Plan

Health Promotion:

✓ Menopause Education – Provide comprehensive education about perimenopause and expected changes ✓ Lifestyle Modifications – Discuss diet, exercise, and stress management techniques

✓ Bone Health – Recommend calcium and vitamin D supplementation, discuss bone density screening

Screening:

✓ Cardiovascular Risk Assessment – Monitor blood pressure, lipid profile given estrogen decline

✓ Cancer Screening – Ensure up-to-date mammography and cervical cancer screening

✓ Bone Density – Consider DEXA scan baseline given hormonal changes

Treatment Options:

✓ Hormone Replacement Therapy – Discuss benefits and risks of HRT for symptom management

✓ Non-hormonal Alternatives – Consider SSRIs for mood symptoms, gabapentin for hot flashes

✓ Sleep Hygiene – Counseling on sleep hygiene practices and bedroom environment modifications

Complete Step-by-Step Guide to Writing the Camilla Franklin iHuman Case Study

Completing the Camilla Franklin iHuman case requires a systematic approach that recognizes the complex interplay between hormonal changes, psychological symptoms, and lifestyle factors in middle-aged women. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, review the doorway information and formulate your initial clinical approach.

Key Information to Note:

48-year-old female with “persistent fatigue and irritability”
8-week duration of symptoms
Consider hormonal changes typical for this age group

Initial Clinical Mindset: Approach this case with perimenopausal transition as your primary consideration. The age, symptom pattern, and duration suggest hormonal changes affecting multiple body systems.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for distinguishing between hormonal, psychiatric, and medical causes of fatigue and irritability.

Onset: When symptoms began and progression pattern

Key points to elicit: Gradual onset over 8 weeks, progressively worsening

Location: Systemic symptoms affecting energy and mood

Target response: Generalized fatigue, mood changes affecting daily function

Duration: How long symptoms persist and daily patterns

Important detail: Fatigue present throughout day, worse mornings

Character: Detailed description of fatigue and irritability

Critical descriptors: “Overwhelming tiredness,” “easily frustrated”

Aggravating factors: What makes symptoms worse

Essential findings: Stress, poor sleep, hot flashes

Relieving factors: What provides some relief

Key response: Rest helps somewhat, but doesn’t restore normal energy

Associated Symptoms:

Ask specifically about: menstrual changes, hot flashes, sleep disturbances, mood swings, concentration difficulties

Step 3: Review of Systems (ROS)

Conduct a thorough ROS focusing on endocrine and psychiatric systems:

Endocrine:

Menstrual history and recent changes
Vasomotor symptoms (hot flashes, night sweats)
Weight changes, temperature intolerance
Energy level fluctuations

Psychiatric:

Mood changes, irritability patterns
Sleep quality and disturbances
Concentration and memory issues
Interest in activities, relationships

General:

Overall energy patterns
Appetite changes
Weight fluctuations

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

Previous pregnancies and gynecological history
Any prior hormonal treatments
Mental health history

Family History:

Critical finding: Family history of thyroid disease
Menopause patterns in female relatives
Mental health history in family

Social History:

Occupation: High-stress office management role
Relationship status: Married, stable relationship
Exercise habits: Previously active, now decreased
Substance use: Minimal alcohol, moderate caffeine

Step 5: Physical Examination Strategy

Perform a comprehensive examination with focus on endocrine and psychiatric assessment:

Vital Signs:

Expected findings: Possible mild hypertension, normal other vitals
Note: Patient should appear tired but stable

Endocrine Examination:

Thyroid palpation for size, nodules, tenderness
Assess for signs of hypo/hyperthyroidism
General appearance for hormonal changes

Psychiatric Assessment:

Mental status examination
Mood and affect evaluation
Cognitive assessment (concentration, memory)

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Perimenopause

Supporting evidence: Age, irregular menses, vasomotor symptoms, mood changes

Secondary Considerations:

Hypothyroidism
- Rationale to consider: Fatigue, mood changes, family history
- Rationale to exclude: Normal TSH and Free T4 levels
Major Depressive Disorder
- Rationale to consider: Mood symptoms, sleep disturbances, fatigue
- Less likely: Timing correlates with menstrual changes
Sleep Disorder
- Rationale: Sleep disturbances contributing to fatigue
- Secondary to: Hormonal changes causing night sweats

Step 7: Diagnostic Test Interpretation

Interpret provided test results to support your diagnosis:

Expected Key Findings:

FSH: Elevated (>25 IU/L in perimenopause)
Estradiol: Decreased (<50 pg/mL)
TSH: Normal (rules out thyroid dysfunction)
Complete metabolic panel: Normal

Clinical Correlation: Use hormone levels to confirm perimenopausal status and rule out other endocrine causes.

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Perimenopause with Associated Mood and Sleep Disturbances

Justification:

Age-appropriate timing (average age 47-52)
Classic symptom constellation
Hormonal laboratory confirmation
Exclusion of other causes

MSAP Selection: Choose “Perimenopause” as your Most Significant Active Problem, as this represents the underlying condition causing the presenting symptoms.

Step 9: Comprehensive Management Plan

Develop a holistic treatment approach:

Immediate Assessment:

Hormone level confirmation
Sleep quality evaluation
Mood assessment tools

Treatment Options:

Hormonal: Discuss HRT benefits and risks
Non-hormonal: SSRIs for mood, gabapentin for vasomotor symptoms
Lifestyle: Exercise, nutrition, stress management

Patient Education:

Perimenopause explanation and expected duration
Treatment options discussion
Lifestyle modification importance

Follow-up Plan:

Return visit in 4-6 weeks
Monitor symptom improvement
Assess treatment tolerance

Step 10: Documentation and Submission Tips

Writing Your Summary:

Create a concise 350-word summary explaining your clinical reasoning
Include how you differentiated between hormonal and psychiatric causes
Cite specific assessment findings and lab correlations
Use appropriate medical terminology

Key Documentation Elements:

Assessment Statement: Age-appropriate perimenopausal transition
Clinical Reasoning: Hormone-driven symptom complex
Evidence Correlation: Link symptoms to hormonal changes
Management Rationale: Justify treatment approach

Final Submission Checklist:

✓ Complete hormonal and psychiatric history
✓ Comprehensive physical exam including endocrine assessment
✓ Appropriate differential diagnoses with rationales
✓ Correct final diagnosis and MSAP
✓ Evidence-based management plan addressing hormonal and symptomatic treatment
✓ Professional documentation with proper medical terminology

Camilla Franklin iHuman Case Summary

Grading Criteria: The Camilla Franklin iHuman case evaluates students across several critical domains to ensure comprehensive assessment of hormonal and psychiatric symptoms in middle-aged women. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points):

You must ask targeted questions about hormonal symptoms to get full credit. Essential questions include: menstrual pattern changes, vasomotor symptoms (hot flashes, night sweats), sleep quality, mood changes, and energy levels. Don’t miss asking about: family history of thyroid disease, current stress levels, changes in concentration or memory, and impact on daily functioning. The rubric specifically rewards students who ask about the timing of symptoms in relation to menstrual changes.

(2) Physical Examination (High Weight):

Focus your exam on endocrine and psychiatric assessment. Must-do components: vital signs, thyroid palpation, mental status examination, and general appearance assessment. Pro tip: The rubric awards points for thorough thyroid examination and mood assessment – many students forget to adequately assess affect and mental status.

(3) Differential Diagnosis (Critical for Scoring):

You need to propose at least 3 appropriate differentials with rationales. Expected differentials include: perimenopause, hypothyroidism, major depressive disorder, and sleep disorders. Scoring secret: The rubric rewards students who can distinguish between primary hormonal causes and secondary mood symptoms.

(4) Final Diagnosis & MSAP:

You must correctly identify perimenopause with associated symptoms as your Most Significant Active Problem. Justification is key – cite the age-appropriate onset, hormonal symptoms, and laboratory findings as supporting evidence.

(5) Management Plan (Heavily Weighted):

The rubric expects comprehensive management including: hormone level interpretation, discussion of treatment options (both hormonal and non-hormonal), lifestyle modifications, and appropriate follow-up. High-scoring responses mention: patient education about perimenopause, consideration of both HRT and alternative treatments, and addressing sleep and mood symptoms.

(6) Patient Communication:

Demonstrate empathy and understanding of the patient’s concerns about life changes. Bonus points for: discussing the normalcy of perimenopausal symptoms, explaining treatment options clearly, and addressing concerns about hormone therapy.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Camilla Franklin

Situation: 48-year-old female presenting with 8-week history of progressive fatigue and irritability with associated sleep disturbances and menstrual irregularities.

Background: Previously healthy woman with recent onset of symptoms consistent with perimenopausal transition. Significant findings include irregular menses, vasomotor symptoms, and mood changes. Family history positive for maternal thyroid disease.

Assessment: Physical examination notable for normal vital signs with slightly elevated blood pressure. Thyroid examination normal. Mental status shows mildly depressed affect but no suicidal ideation. Laboratory findings: elevated FSH (45 IU/L), decreased estradiol (25 pg/mL), normal thyroid function tests.

Primary Diagnosis: Perimenopause with associated mood and sleep disturbances.

Recommendation:

Patient education regarding normal perimenopausal transition
Discuss treatment options including hormone replacement therapy vs. alternative treatments
Lifestyle modifications: regular exercise, stress management, sleep hygiene
Consider low-dose SSRI for mood symptoms if HRT contraindicated
Calcium and vitamin D supplementation for bone health
Follow-up in 4-6 weeks to assess symptom improvement and treatment tolerance

Patient Education Provided: Explained perimenopause as normal transition, discussed duration and expected symptoms, reviewed treatment options with risks and benefits, emphasized importance of lifestyle modifications, and provided clear instructions for follow-up care and when to seek immediate attention.

Conclusion

By following this comprehensive approach to the Camilla Franklin case, you’ll demonstrate the clinical reasoning skills that iHuman evaluates for complex hormonal and psychiatric presentations. Remember, success in perimenopausal cases requires understanding the interconnection between hormonal changes and their systemic effects. The key is treating each iHuman simulation as you would a real patient encounter – be thorough in your hormonal assessment, consider the psychological impact of life transitions, and provide compassionate, evidence-based care. With this guide, you’re well-prepared to excel in this challenging but important case simulation.

Frequently Asked Questions

What is the correct diagnosis for Camilla Franklin’s fatigue and irritability?

Camilla Franklin’s primary diagnosis is perimenopause with associated mood and sleep disturbances. The key distinguishing features include her age (48 years), irregular menstrual periods, vasomotor symptoms (hot flashes), and laboratory findings showing elevated FSH and decreased estradiol levels. Students often struggle between perimenopause and depression, but remember that perimenopausal mood changes are typically related to hormonal fluctuations and occur in conjunction with other menopausal symptoms.

What are the critical physical exam components I need to perform to score well?

Essential physical exam elements include comprehensive vital signs, thorough thyroid palpation (checking for size, consistency, and nodules), mental status examination including mood and affect assessment, and general appearance evaluation for signs of hormonal changes. Many students miss points by not adequately assessing the patient’s mental status or skipping the thyroid examination. Don’t forget to evaluate for signs of depression while recognizing that mood changes may be hormonally driven.

How do I pass the Camilla Franklin case and meet the 70% requirement?

To achieve the required 70% score, focus on thorough history-taking using targeted questions about menstrual changes, vasomotor symptoms, and mood changes. Complete all recommended physical exam components including endocrine and psychiatric assessments. Propose appropriate differential diagnoses (perimenopause, hypothyroidism, depression, sleep disorders) with clear rationales. Develop a comprehensive management plan addressing both hormonal and symptomatic treatment options, including patient education about the normal perimenopausal transition.

What management interventions should I include in my treatment plan?

The comprehensive management plan should address both immediate symptom relief and long-term health considerations. Include discussion of hormone replacement therapy (with risks and benefits), alternative treatments for vasomotor symptoms (such as SSRIs or gabapentin), lifestyle modifications (exercise, nutrition, stress management), sleep hygiene counseling, and bone health considerations (calcium, vitamin D, future DEXA screening). Students often forget to address the educational component – explaining perimenopause as a normal life transition and providing realistic expectations for symptom duration and management options.