Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the  resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

 

 

 

 

Cognition and the Neurologic System

 

 

CASE STUDY 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

 

CASE STUDY 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

 

CASE STUDY 4: Forgetfulness

A 70-year-old female comes to your clinic with complaints of forgetfulness. She noticed it about a year ago and it has progressively gotten worse. She sometimes forgets what she is going to do when she gets to another room. Her family has noticed the problem with her forgetfulness but she is still able to manage her finances and drive, per her report.

 

•  Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to
• Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

With regard to the case study you were assigned:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

 

The Case Study Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the  resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

 

 

 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

 

• Chapter 7, “Mental Status”This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.

 

• ·Chapter 23, “Neurologic System”The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 4, “Affective Changes”
This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.

Chapter 9, “Confusion in Older Adults”
This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history as well as what to look for in a physical examination.

Chapter 13, “Dizziness”
Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.

Chapter 19, “Headache”
The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam.

Chapter 31, “Sleep Problems”
In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.

 

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)

Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.

 

Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Mental status: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

 

Bearden , S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. American Journal of Electroneurodiagnostic Technology, 51(2), 92–104.

 

This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.

Athilingam, P ., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: Challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127

 

Sinclair , A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001

 

Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036230/

 

 

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

 

• Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.

 

• Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.

Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318.

 

 

 

 

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 Episodic/Focused SOAP Note Template   Patient Information: Initials, Age, Sex, Race S. CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”. HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example: Location: head Onset: 3 days ago Character: pounding, pressure around the eyes and temples Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia Timing: after being on the computer all day at work Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better Severity: 7/10 pain scale Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products. Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance). PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes neededSoc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system. Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent. ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe. Example of Complete ROS: GENERAL:  Denies weight loss, fever, chills, weakness or fatigue. HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat. SKIN:  Denies rash or itching. CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema. RESPIRATORY:  Denies shortness of breath, cough or sputum. GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY. NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness. HEMATOLOGIC:  Denies anemia, bleeding or bruising. LYMPHATICS:  Denies enlarged nodes. No history of splenectomy. PSYCHIATRIC:  Denies history of depression or anxiety. ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia. ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis. O. Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc. Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines) A. Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines. P.   This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. References You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.     © 2021 Walden University, LLC Page  PAGE \* MERGEFORMAT 1 of  NUMPAGES \* MERGEFORMAT 3  # $ & : ; S T V W Y ø ù ü
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<xsd:element ref=”dc:subject” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element ref=”dc:description” minOccurs=”0″ maxOccurs=”1″/>
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<xs:element ref=”pc:EntityId5″ minOccurs=”0″></xs:element>
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<xs:element name=”EntityDisplayName” type=”xs:string”></xs:element>
<xs:element name=”EntityInstanceReference” type=”xs:string”></xs:element>
<xs:element name=”EntityId1″ type=”xs:string”></xs:element>
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<xs:element name=”EntityId3″ type=”xs:string”></xs:element>
<xs:element name=”EntityId4″ type=”xs:string”></xs:element>
<xs:element name=”EntityId5″ type=”xs:string”></xs:element>
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<xs:element name=”TermInfo”>
<xs:complexType>
<xs:sequence>
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<xs:element ref=”pc:TermId” minOccurs=”0″></xs:element>
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<xs:element name=”TermName” type=”xs:string”></xs:element>
<xs:element name=”TermId” type=”xs:string”></xs:element>
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<xsd:import namespace=”05949e95-f826-48d7-a533-b053b3e74e65″/>
<xsd:element name=”properties”>
<xsd:complexType>
<xsd:sequence>
<xsd:element name=”documentManagement”>
<xsd:complexType>
<xsd:all>
<xsd:element ref=”ns2:MediaServiceMetadata” minOccurs=”0″/>
<xsd:element ref=”ns2:MediaServiceFastMetadata” minOccurs=”0″/>
<xsd:element ref=”ns3:SharedWithUsers” minOccurs=”0″/>
<xsd:element ref=”ns3:SharedWithDetails” minOccurs=”0″/>
</xsd:all>
</xsd:complexType>
</xsd:element>
</xsd:sequence>
</xsd:complexType>
</xsd:element>
</xsd:schema>
<xsd:schema targetNamespace=”777bf4b2-9a30-4b21-b57e-32afb2e08c7a” elementFormDefault=”qualified” xmlns:xsd=”http://www.w3.org/2001/XMLSchema” xmlns:xs=”http://www.w3.org/2001/XMLSchema” xmlns:dms=”http://schemas.microsoft.com/office/2006/documentManagement/types” xmlns:pc=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls”>
<xsd:import namespace=”http://schemas.microsoft.com/office/2006/documentManagement/types”/>
<xsd:import namespace=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls”/>
<xsd:element name=”MediaServiceMetadata” ma:index=”8″ nillable=”true” ma:displayName=”MediaServiceMetadata” ma:hidden=”true” ma:internalName=”MediaServiceMetadata” ma:readOnly=”true”>
<xsd:simpleType>
<xsd:restriction base=”dms:Note”/>
</xsd:simpleType>
</xsd:element>
<xsd:element name=”MediaServiceFastMetadata” ma:index=”9″ nillable=”true” ma:displayName=”MediaServiceFastMetadata” ma:hidden=”true” ma:internalName=”MediaServiceFastMetadata” ma:readOnly=”true”>
<xsd:simpleType>
<xsd:restriction base=”dms:Note”/>
</xsd:simpleType>
</xsd:element>
</xsd:schema>
<xsd:schema targetNamespace=”05949e95-f826-48d7-a533-b053b3e74e65″ elementFormDefault=”qualified” xmlns:xsd=”http://www.w3.org/2001/XMLSchema” xmlns:xs=”http://www.w3.org/2001/XMLSchema” xmlns:dms=”http://schemas.microsoft.com/office/2006/documentManagement/types” xmlns:pc=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls”>
<xsd:import namespace=”http://schemas.microsoft.com/office/2006/documentManagement/types”/>
<xsd:import namespace=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls”/>
<xsd:element name=”SharedWithUsers” ma:index=”10″ nillable=”true” ma:displayName=”Shared With” ma:internalName=”SharedWithUsers” ma:readOnly=”true”>
<xsd:complexType>
<xsd:complexContent>
<xsd:extension base=”dms:UserMulti”>
<xsd:sequence>
<xsd:element name=”UserInfo” minOccurs=”0″ maxOccurs=”unbounded”>
<xsd:complexType>
<xsd:sequence>
<xsd:element name=”DisplayName” type=”xsd:string” minOccurs=”0″/>
<xsd:element name=”AccountId” type=”dms:UserId” minOccurs=”0″ nillable=”true”/>
<xsd:element name=”AccountType” type=”xsd:string” minOccurs=”0″/>
</xsd:sequence>
</xsd:complexType>
</xsd:element>
</xsd:sequence>
</xsd:extension>
</xsd:complexContent>
</xsd:complexType>
</xsd:element>
<xsd:element name=”SharedWithDetails” ma:index=”11″ nillable=”true” ma:displayName=”Shared With Details” ma:internalName=”SharedWithDetails” ma:readOnly=”true”>
<xsd:simpleType>
<xsd:restriction base=”dms:Note”>
<xsd:maxLength value=”255″/>
</xsd:restriction>
</xsd:simpleType>
</xsd:element>
</xsd:schema>
<xsd:schema targetNamespace=”http://schemas.openxmlformats.org/package/2006/metadata/core-properties” elementFormDefault=”qualified” attributeFormDefault=”unqualified” blockDefault=”#all” xmlns=”http://schemas.openxmlformats.org/package/2006/metadata/core-properties” xmlns:xsd=”http://www.w3.org/2001/XMLSchema” xmlns:xsi=”http://www.w3.org/2001/XMLSchema-instance” xmlns:dc=”http://purl.org/dc/elements/1.1/” xmlns:dcterms=”http://purl.org/dc/terms/” xmlns:odoc=”http://schemas.microsoft.com/internal/obd”>
<xsd:import namespace=”http://purl.org/dc/elements/1.1/” schemaLocation=”http://dublincore.org/schemas/xmls/qdc/2003/04/02/dc.xsd”/>
<xsd:import namespace=”http://purl.org/dc/terms/” schemaLocation=”http://dublincore.org/schemas/xmls/qdc/2003/04/02/dcterms.xsd”/>
<xsd:element name=”coreProperties” type=”CT_coreProperties”/>
<xsd:complexType name=”CT_coreProperties”>
<xsd:all>
<xsd:element ref=”dc:creator” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element ref=”dcterms:created” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element ref=”dc:identifier” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element name=”contentType” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string” ma:index=”0″ ma:displayName=”Content Type”/>
<xsd:element ref=”dc:title” minOccurs=”0″ maxOccurs=”1″ ma:index=”4″ ma:displayName=”Title”/>
<xsd:element ref=”dc:subject” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element ref=”dc:description” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element name=”keywords” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string”/>
<xsd:element ref=”dc:language” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element name=”category” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string”/>
<xsd:element name=”version” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string”/>
<xsd:element name=”revision” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string”>
<xsd:annotation>
<xsd:documentation>
This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision.
</xsd:documentation>
</xsd:annotation>
</xsd:element>
<xsd:element name=”lastModifiedBy” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string”/>
<xsd:element ref=”dcterms:modified” minOccurs=”0″ maxOccurs=”1″/>
<xsd:element name=”contentStatus” minOccurs=”0″ maxOccurs=”1″ type=”xsd:string”/>
</xsd:all>
</xsd:complexType>
</xsd:schema>
<xs:schema targetNamespace=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls” elementFormDefault=”qualified” attributeFormDefault=”unqualified” xmlns:pc=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls” xmlns:xs=”http://www.w3.org/2001/XMLSchema”>
<xs:element name=”Person”>
<xs:complexType>
<xs:sequence>
<xs:element ref=”pc:DisplayName” minOccurs=”0″></xs:element>
<xs:element ref=”pc:AccountId” minOccurs=”0″></xs:element>
<xs:element ref=”pc:AccountType” minOccurs=”0″></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name=”DisplayName” type=”xs:string”></xs:element>
<xs:element name=”AccountId” type=”xs:string”></xs:element>
<xs:element name=”AccountType” type=”xs:string”></xs:element>
<xs:element name=”BDCAssociatedEntity”>
<xs:complexType>
<xs:sequence>
<xs:element ref=”pc:BDCEntity” minOccurs=”0″ maxOccurs=”unbounded”></xs:element>
</xs:sequence>
<xs:attribute ref=”pc:EntityNamespace”></xs:attribute>
<xs:attribute ref=”pc:EntityName”></xs:attribute>
<xs:attribute ref=”pc:SystemInstanceName”></xs:attribute>
<xs:attribute ref=”pc:AssociationName”></xs:attribute>
</xs:complexType>
</xs:element>
<xs:attribute name=”EntityNamespace” type=”xs:string”></xs:attribute>
<xs:attribute name=”EntityName” type=”xs:string”></xs:attribute>
<xs:attribute name=”SystemInstanceName” type=”xs:string”></xs:attribute>
<xs:attribute name=”AssociationName” type=”xs:string”></xs:attribute>
<xs:element name=”BDCEntity”>
<xs:complexType>
<xs:sequence>
<xs:element ref=”pc:EntityDisplayName” minOccurs=”0″></xs:element>
<xs:element ref=”pc:EntityInstanceReference” minOccurs=”0″></xs:element>
<xs:element ref=”pc:EntityId1″ minOccurs=”0″></xs:element>
<xs:element ref=”pc:EntityId2″ minOccurs=”0″></xs:element>
<xs:element ref=”pc:EntityId3″ minOccurs=”0″></xs:element>
<xs:element ref=”pc:EntityId4″ minOccurs=”0″></xs:element>
<xs:element ref=”pc:EntityId5″ minOccurs=”0″></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name=”EntityDisplayName” type=”xs:string”></xs:element>
<xs:element name=”EntityInstanceReference” type=”xs:string”></xs:element>
<xs:element name=”EntityId1″ type=”xs:string”></xs:element>
<xs:element name=”EntityId2″ type=”xs:string”></xs:element>
<xs:element name=”EntityId3″ type=”xs:string”></xs:element>
<xs:element name=”EntityId4″ type=”xs:string”></xs:element>
<xs:element name=”EntityId5″ type=”xs:string”></xs:element>
<xs:element name=”Terms”>
<xs:complexType>
<xs:sequence>
<xs:element ref=”pc:TermInfo” minOccurs=”0″ maxOccurs=”unbounded”></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name=”TermInfo”>
<xs:complexType>
<xs:sequence>
<xs:element ref=”pc:TermName” minOccurs=”0″></xs:element>
<xs:element ref=”pc:TermId” minOccurs=”0″></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name=”TermName” type=”xs:string”></xs:element>
<xs:element name=”TermId” type=”xs:string”></xs:element>
</xs:schema>
</ct:contentTypeSchema> metaAttributes”/><ds:schemaRef ds:uri=”http://www.w3.org/2001/XMLSchema”/><ds:schemaRef ds:uri=”http://schemas.microsoft.com/office/2006/metadata/properties”/><ds:schemaRef ds:uri=”777bf4b2-9a30-4b21-b57e-32afb2e08c7a”/><ds:schemaRef ds:uri=”05949e95-f826-48d7-a533-b053b3e74e65″/><ds:schemaRef ds:uri=”http://schemas.microsoft.com/office/2006/documentManagement/types”/><ds:schemaRef ds:uri=”http://schemas.microsoft.com/office/infopath/2007/PartnerControls”/><ds:schemaRef ds:uri=”http://schemas.openxmlformats.org/package/2006/metadata/core-properties”/><ds:schemaRef ds:uri=”http://purl.org/dc/elements/1.1/”/><ds:schemaRef ds:uri=”http://purl.org/dc/terms/”/><ds:schemaRef ds:uri=”http://schemas.microsoft.com/internal/obd”/></ds:schemaRefs></ds:datastoreItem> <?xml version=”1.0″ encoding=”UTF-8″ standalone=”no”?><b:Sources SelectedStyle=”/APA.XSL” StyleName=”APA” xmlns:b=”http://schemas.openxmlformats.org/officeDocument/2006/bibliography” xmlns=”http://schemas.openxmlformats.org/officeDocument/2006/bibliography”></b:Sources> <?xml version=”1.0″ encoding=”UTF-8″ standalone=”no”?>
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