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IHuman Case Study: Florence Blackman (1 Solved Case)

  • Medicine
  • 18 pages
  • Shared February 2025
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    Florence Blackman Ihuman Case Study 66 Year - old Female – Chest Pain 2 DIFFERENT VERSIONS OF THE ANSWER EXPERT FEEDBACK ( SOLUTIONS ) CONTENTS : ALL QUESTIONS, OLD - CARTS for the HPI,(PMH,FH,SH as Needed),PHSICAL EXAM,EXAMS FEEDBACK,CASE FINDINGS,FEEDBACK,DIFFERENTIAL RANKING ,DIAGNOSIS,CASE PLAN

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    VERSION 1 Florence Blackman (66 y/o female) – Chest Pain • CC: Intermittent squeezing chest pain • MSAP: Exertional “squeezing” mid - chest pain radiating to left arm, relieved by rest, worse with cold • Associated dyspnea on exertion • History: HLD, HTN, previous smoker, family hx of heart disease • Stressful work History Questions: - How can I help you today? - Any other symptoms we should discuss? - Do you have any allergies? - Are you taking any OTC or herbal medications? - Any new or recent changes in medications? - What does the pain / discomfort in your chest feel like? (squeezing, pressure, crushing, burning, stabbing, aching, tingling, suffocating) - How severe (scale 1 - 10) is the pain in your chest? - Does anything make the pain in your chest better or worse? - What are the events surrounding the start of your chest pain? - Is there a pattern to your chest pain? - Have you had any trauma to your chest? - Does the pain in your chest radiate someplace else? Where? - Do you have unusual heartbeats (palpitations)? - Does the pain get worse with breathing? - Does your pain awaken you from your sleep? - Is your pain affected by what, when, or how much you eat? - Do you presently have heartburn, a food or acid taste in your mouth? - Do you drink alcohol? If so, what do you drink and how many drinks per day? - Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss or gain, fevers, night sweats? - Do you experience: SOB, wheezing, difficulty catching breath, chronic cough, sputum production? - Does anything make your shortness of breath better or worse? - How long does your SOB last? - Do you have any of the following: heat or cold intolerance, increased thirst, increased sweating, frequent urination, change in appetite? - Do you have any of the following: dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, tremor?

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    - Do you have problems with: N/V, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your BM, early satiety, bloating? - How is your overall health? - Tell me about your work. - Tell me about daily exercise or sports that you play. Physical Exam: - Vitals: pulse, BP, respirations - Examine skin - Neck: measure JVP (jugular venous pressure) - Neck: auscultate carotid arteries - Chest wall & lungs: o Visual inspection of anterior & posterior chest o Palpate anterior & posterior chest o Auscultate lungs - Heart: o Palpate for PMI (Point of Maximal Impact) o Auscultate heart - Abdomen: o Auscultate abdominal/femoral arteries o Palpate abdomen - Extremities: Visual inspection of extremities Assessment note: - F.B. is a 66 y/o Caucasian female presenting with 2 - week h/o new onset, intermittent, stable chest pain which radiates to the L arm, occurs with SOB, is worse with cold temperatures and exertion, and improved by rest. On physical exam she is pain free with stable vital signs. PMH risk factors include: distant history of smoking (5 pack/years), a history of HTN, and high cholesterol, and a family history of coronary vascular disease. - Stress test: 2 - mm ST segment depression in inferior leads, 2, 3, and aVF and V3 - 6 Diagnosis: Coronary artery disease: stable angina Plan: - Determine need for coronary angiography based on stress test results and ECHO. Her Duke score of 10.5 is slightly above moderate risk, and arguments could be made for both a trial at medication intervention since the pt needs improvement on both HTN and HLD o Augment management of preexisting HTN and HLD with a BB (metoprolol 25 mg XR daily); a statin (atorvastatin 40 mg daily); and ASA 81 mg daily - Continue use of HCTZ 25 mg daily - Encourage lifestyle modification: o Decrease intensity of aerobic workouts for next 3 months

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    o D/c alcohol for next 2 months as starts a statin - f/u in 3 - 4 weeks Ben Kapinsky (18 y/o male) – Fever

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    • CC: Fatigue, SOB, productive cough with yellow/green sputum • MSAP: Hypoxia • Tachypnea, dyspnea • Fever and chills • Fatigue and myalgia • Right - sided chest wall pain aggravated by coughing • Productive cough • Right middle and lower lung crackles • Bilateral cervical lymphadenopathy • Tachycardia • Previous hx of the flu 2 weeks ago, but got better • Childhood asthma per history History Questions: - How can I help you today? - Any other symptoms or concerns we should discuss? - Do you have any allergies? - Are you taking any prescription medications? - Are you taking any OTC or herbal medications? - How high is your fever? - When did your cough start? – 4 days ago - Is there a pattern to your cough? – no - Does anything make your cough better or worse? - Are you coughing up any sputum? – yellowish green stuff - What are the events surrounding the start of your cough? – symptoms started without much warning, thought maybe just got tired going to the party, but got worse over time - What treatments have you had for your cough? – cough syrup, doesn’t help - Do you awaken at night coughing? – yes, can’t sleep - Have you had a cough like this before? – no - Do you have any pain in your chest? – yes, here on the right side when I cough or take a deep breath (points to right thorax, 6 - 8 th intercostal space at midaxillary line) - How severe (1 - 10 scale) is the pain in your chest? – 7 - 8 when cough or deep breathe - Have you had any contact with other sick people? – no - Tell me about any current or past medical problems? – none besides mild asthma - Any previous medical, surgical, or dental procedures? – none besides fillings in teeth - Have you ever been hospitalized? – no - Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss or gain, fevers, night sweats? – “some of that stuff for sure”

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