Date Posted:

CC:abdominal pain
HPI:22 year old f pt. c/o abdominal pain since last night,sudden onset,started periumbilical and later shifted to rlq,it is 8/10,relieved by rest and aggravated by movement.pt. also c/o fever and nausea along with pain.no h/o of vomitting,light headedness,chest pain,sob,cough.no bladder complaints.no alteration of bowels.no h/o weight loss,no night sweats,no h/o travel.

ROS:negative exept above
PMH:not contributory
Allergies:nkda
Meds:tylenol
SH:student,non smoker,no etoh,no illicit drug use
FH:non contributory
SxH active with single partner,using rythm method
ObsH regular had menstrual period last week

 Gen: conscious,oriented
Vitals:wnl
HEENT:
Neck:
LUNGS:air entry equal on both sides
CVS:s1s2 normal,no murmur,gallop or rub
ABD:s
Ext:
Neuro:

Date Posted:

CC:CP
HPI: A 54 year-old male presents to the emergency department with chest pressure. He was clearing the snow this AM when he noted pressure sensation in the chest which lasted about 15 minutes, it gradually increased in severity, felt like some thing was crushing his chest, 8/10, associated with mild SOB, relieved with rest, no palpitations. He also noted radiation to the left side of the shoulder and to his jaw. He denies any other symptoms such as nuasea, vomiting, cough diaphoresis or dizziness. He had similar episode 2 weeks ago but not as severe. there change in the pain with inspiration or movement. He has had no recent illnesses.

His past medical history is significant for diet controlled diabetes and hypertension. He has a 20 pack year smoking which he quit 5 years ago. He denies drug use but drinks one glass of wine daily. He presently takes HCTZ and states that he is compliant. Family history is significant for a brother who had an acute MI at age 45. He has no known allergies.

 Gen: Anxious
Vitals: BP 145/85, pulse is 82, respirations 24/min, room air oxygen saturation 94%, and temperature 37.1.
Neck: No JVD
Chest: Basilar crackles bilaterally and his chest is nontender to palpation.
Cardiovascular exam reveals no murmurs, gallops or rubs.
His abdomen is soft and non-tender.
His skin is dry and pink.
He has equal bounding pulses in all four extremities.
The rest of his examination is unremarkable.

Date Posted:

A 46 year old AA male presents to the emergency department complaining of pain and swelling of right leg for the past 3 days. He just returned from a business trip to Singapore. He has no significant past medical history and takes no medications. He is a fifteen-pack-year smoker but denies the use of drugs or alcohol. He lives locally with his family and has been with the same job for 15 years. He has felt well otherwise and has no fever, nausea, vomiting, shortness of breath, or chest pain.
He denies any history of cancer, clotting disorders, trauma to the extremity, or previous thromboembolic disease.
Allergies:NKDA
Meds:None
SH:15 pack year smoking, works as a business exetive.
FH:NC

 Gen: NAD
Vitals: Stable
HEENT: PERL
Neck: No JVD
LUNGS: CTAB
CVS: S1, S2 heard, RRR, no M/R/G
ABD: Soft, NT, ND, BS+
Ext: 1+ non-pitting edema of the left leg with positive Homan\'s sign. Good peripheral pulses

Date Posted:

36 year old white male interested to quit smoking. He has a new girl friend who is encouraging him to quit and he needs your help. He smokes 2 packs a day for the past 12 years, started when he was in college. He is very motivated and ready to try anything to quit. He has tried to stop cold turkey but gets tobacco craving, restlessness, anxiety, irritability, difficulty concentrating, headaches etc. when he tried that last time couple of months ago. He heard about new medications and wants your opinion on them. He also tried the patch without much success. The Nicoderm patch. It did nothing for me. He has chronic non productive cough which he thinks is smoker\'s cough. No weight loss, no fever or chills. ROS otherwise negative.

Allergies: NKDA
Medications: None
PMH: None
FH:NC

 Generally: patient is a bit anxious. well nourish male in NAD.
HEENT: NCAT, MMM, PERRLA, no thyromegaly.
CV. RRR no M/G/R S1,S2
Res: CTA B, no W/R/R
Abd: BS present, NTTP, No masses, No organomegaly
Ext: MAEW, +2 pulse PD.

Date Posted:

CC: Abdominal pain, nausea and vomiting
A 38-year-old woman presents with abdominal pain and vomiting 4 days. Her pain is in the upper abdomen, associated with nausea, and vomiting. She describes the pain as crampy, continous pain, no radiation, no aggravating factors or relieving factors. No back pain, flank pain, diarrhea, dysuria, hematuria, or cough. No similar episode of pain before.

She denies eating any unusual foods, and her medications include a hydrochlorothiazide for HTN, Ibuprofen for headaches, and oral contraceptives.

SH: She works in a nonprofit organization, and lives with her daughter and husband. She does not smoke cigarettes and drinks alcohol of 3-4 beers/day, CAGE 2/4.

FH: Her parents died of cancer.

Allergies: NKDA

 Vital signs
Temp 99.7; pulse 120; R 20; BP 100/82.

HEENT: Normal with dry mucosa.

Lymph nodes: No lymph nodes palpable.

Chest: Clear.

Heart: No murmurs, RRR, S1, S2 heard.

Abdomen: Scaphoid with diffuse tenderness to light palpation esp in midepigastrium; voluntary guarding in all quadrants; no rebound; no organomegaly or palpable masses; BS scant.

Date Posted:

CC:CP
HPI:46 year old male executive comes to the ER complaining of substernal chest discomfort. The pain occurs early in the morning when he goes for a walk, and relieved with rest. His CP is a dull ache in his midsternal area. Also has associate SOB. Started 2 months ago, and hasn\'t changed in intensity or frequency but he is concerned becuase his father died of heart attacks at age 55.

He denies headaches, visual problems, cough, upper abdominal pain or any known medical problems. He quit smoking six months ago. He drinks an occasional beer or two with dinner.

He works in a local restaurent and lives at home with his wife and 2 children, all of whom are healthy.

Family history: hypertension and non-insulin dependent diabetes in his brothers. His mother dies of a stroke; his father died of a heart attack at 55.

Allegies: NKDA

No meds

 Gen: NAD
Vitals:
Temp 99.6 degrees; pulse 110; R 20; Blood pressure 160/92.

HEENT: Normal.

Chest: Breath sounds clear.

Heart: no JVD; RRR, No M/R/G.

Abdomen: Soft and non-tender; no organomegaly or mass.

Extremities: No edema

Date Posted:

CC:Sore throat
HPI: Patient is a 18 yo female with sore throat, odynophagia, and SOB for 3 days. Patient was in her usual state of health until 3 days ago when she had slight fever, headache, bodyaches and sore throat. She thought she got the flu, took Tylenol which helped the headache but her sore throat got worse. Now, she is having progressive difficulty to swallow to the point where she is not able to swallow her saliva today. She also has pain while swallowing. Felt warm, did not check temperature, associated chills yesterday, no cough, feels SOB since this morning. Feels like she is choking! No nausea, vomiting. No neck stiffness. ROS other wise negative.
PMH: None

ROS:Neg
PMH:NC
Allergies:NKDA
Meds:None
SH:Student, not sexually active
FH:NC

 VITAL SIGNS
Temp: 98.6 PR - 80 Resp. Rate - 18.

BP: 106/68

- Eyes (Pupils) equal, round, reactive to light and
accommodation
ENT
- Pharnyx - --
- Normal Specific findings anterior cervical lymphadenopathy
R>L
- (+) Abnormal Findings tonsillar enlargment R, tonsillar
enlargement L, tonsillar exudate R
Neck/Thyroid
- Neck supple, no masses, trachea midline
Respiratory
- Auscultation no rales, rhonchi, or wheezes
Cardiovascular - Heart
- Auscultation S1, S2, no murmur, rub, or gallop
Abdomen
- Abdomen soft, non-tender, no masses, bowel
sounds normal
Lymphatic
- Neck --
- (+) Abnormal Findings anterior cervical adenopathy R
Neurological Nonfocal, no neck rigidity

Date Posted:

65 yo male who recently lost his wife 1 year ago in a car accident presents with loss of energery and feelings of depression. He is a retired salesman, has PMH as below. Over the past year, he is disatisfied with life. He describes life as empty. He fears growing old alone. He is not happy most of the time. He feels helpless. He prefers to stay at home rather than go out. He has trouble concentrating. He feels worthless and hopeless. No history of depression. He denies suicidal intentions. He has no hallucinations.

PMH: HTN, Hypercholesterolemia, diverticulitis,
Coronary artery disease s/p angioplastry 2 years ago
FH: Father died age 81 \"natural causes\"
Mother died age 82 \"old age\", hypertension
SH: Retired salesman, lives alone Never smoked
Does not drink alcohol
Medications: Multivitamin, once a day
Aspirin, 81 mg daily
Lipitor 40 and Atenolol 50
Review of Systems: No angina, dyspnea, edema, palpitations, negative otherwise. His functional status is good.

 Gen: NAD
Vitals: Stable
Neck: NO thyromegaly, no JVD
LUNGS: CTAB
CVS: S1, S2, RRR, NO M/R/G
ABD: Soft, NT, ND
Ext: No edema
Neuro: non focal
Minimental: Can spell world backwards, count serial sevens OK. Flat affect.

Date Posted:

Patient is 17 years old female presenting with 5 years history of irregular periods and worsening facial hair. Her periods last 3-4 days, very irregular, varies between 20 days to 35 days, no menstrual pain but has occasional menstrual cramps. Never been pregnant. LMP 2 months ago.

Her menarche occured at age of 13 years old and her cycle always been irregular, approximately 4-5 cycles per year.
She not using any form of contraception

Family history: Her mother had \'hysterectomy\' at age of 41 because of heavy periods.

SH: No smoking or drinking, she is a nursing student.
Sexual History: Sexually active with one boyfriend, no contraception

 Gen: NAD
Vitals:
Clinical examination: Body mass index 35
Blood pressure 110/70
There is facial hirsutism and acne
Abdominal examination were normal.
Chest CTA
Cor S1, S2, RRR, no M/R/G

Date Posted:

CC:Rectal bleeding
Pt. is an 75yo AAF presents with 3 bloody stools. BMs loose stool mixed with blood. No abd pain. On ASA, Plavix for stent. Negative colonoscopy 4 yr ago. C/o lightheadedness and dizziness during BM
Soc No tobacco or ETOH use
Lives at home with wife
No Allergies
PMH HTN, Hypercholesterolemia
Meds Atenolol 50 daily, lipitor 40 daily, ASA 81 daily

 
Gen: well, NAD, AOx3
VS: 117/67 86 19 98.4
HEENT: NC/AT, EOMI, PERRLA
CV: S1S2, RRR, no m/r/g
Lungs: CTAB/L
Abd: soft, NT, ND, +bs
Ext: MAEW, warm, no edema

Date Posted:

CC:Rectal bleeding
Pt. is an 75yo AAF with PMH CAD s/p MI w/ PTCA & stent, osteoporosis, asthma, presents with 3 bloody stools. BMs loose stool mixed with blood. No abd pain. On ASA, Plavix for stent. Negative colonoscopy 4 yr ago. C/o lightheadedness and dizziness during BM
Soc No tobacco or ETOH use
Lives at home with wife
No Allergies
PMH HTN, Hypercholesterolemia
Meds Atenolol 50 daily, lipitor 40 daily, ASA 81 daily

 
Gen: well, NAD, AOx3
VS: 117/67 86 19 98.4
HEENT: NC/AT, EOMI, PERRLA
CV: S1S2, RRR, no m/r/g
Lungs: CTAB/L
Abd: soft, NT, ND, +bs
Ext: MAEW, warm, no edema

Date Posted:

55 y.o. AAM presents with one day history of Nausea/vomiting/Diarrhea and abdominal pain. Pt. was eating lunch with wife and son, 1 day PTA, when he had sudden onset generalized abdominal pain with vomiting and diarrhea. Pt. states the vomitus started out as the food he ate and became clear, denies green color, denies blood. Pt. states that diarrhea was loose and watery, without blood. Pt. was turned away from HD today due to symptoms. Pt. c/o lethargy, malaise for >1day PTA. Denies F/C. No blood in stool.
ROS: Denies F/C. No headache, dizziness, palpitations. Denies Chest pain.
SOC: Hospice nursing asst.
T: ex-smoker x5yr. smoked when others smoked around him
E: denies
D: -denies
LIVES: Lives with wife, son.

 
VITALS: T: 97.6 BP: 132/96 HR: 78 RR: 20

GEN: Awake, Alert, Oriented, Moderate distress
HEENT: PERRL, EOMI
CV: S1S2-S3 – gallop RRR no m/r
PULM: CTAB/L
ABD: (+)BS, firm, distended, globally tender
EXT: min edema
NEURO: CN 2-12 grossly intact