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I HUMAN CASE STUDY (WEEK 7) FOR A 49-

YEAR OLD PATIENT REASON FOR

ENCOUNTER; INTERMITTENT SQUEEZING

CHEST PAIN|| ACTUAL COMPREHENSIVE

CASE STUDY (RESEARCH ANALYSIS AND

RESULTS) LATEST AND COMPLETE VERSION

2024 - 2025 ALREADY GRADED A+||

The following table summarizes your performance on each section of the case, whether you completed that section or not. Time spent: 1dy 13hr 58min 29sec Status: Submitted Case Section Status Your Score Time spent Performance Details History Done 63% 12hr 5m i n 12sec 60 correct, 13 missed relative questions asked,22 to the case's list Physical exams Done 83% 13hr 52mi n 55se c 53 exams performed, 0 partially correct, case's list

correc t, missed relative

to the Key findin gs organization Done 34min 40sec 14 findings listed; 16 listed by the case Problem stateme nt Done 1hr 9m i n 29sec 150 words long; the case's was 117 words Differentials Done 88% 13min 14sec

items in misse relativ the to e DDx, 7 the case's list correct, 1 d

Differenti als ranking Done 88% (lead/a lt score) 88% (must not miss score) 7mi n 38se c Tests Done 89% 50min 23sec ordere missed 10 tests d, to 8 the correct, relativ e 1 case's list Diagnosis Done 100% 21sec Manageme nt plan Done 46min 0sec 1645 words long; the case's was 79 words Exercises Done 68% (of scored items only) 32mi n 51se c 3 of 5 (of scored items only) correct 1 partially correct AA History Notecard by AA on case Use this worksheet to organize your thoughts before developing a differential diagnosis list.

1. Indicate key symptoms ( Sx ) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning.
2. Characterize the attributes of each symptom using details in the appropriate column "OLDCARTS". Capture the and row.
3. Review your findings and consider possible diagnoses that may correlate with these symptoms.(Remember to consider the patient's age and ris factors.) Use k you r ideas to help guide your examinati the case. in the next section of physical on

**HPI Sx = chest pain Sx

Sx

Sx

Sx

Sx

Onset** 2.5 hours^ ago Location deep in through chest, back pierces Duration Characteristics worsens with deep inspiration Aggravating worsens^ when down, moving, and breathing laying Relieving eased pain when forward leaning Timing / Treatments Severity 8/ History of Present Illness

Category Data entered by AA Reason for Encounter pain Chest Histor of y presen illness t A 57 - year-old female 10 days status post inferolateral STEMI with stent placement, presents to the ED with a 2.5-hour history of progressively worsening chest pain. The pain is sharp and stabbing, gets to pierce through her back with inspiration. Pain is relieved by sitting up and leaning partiall forward. y She mild nausea vomiting, denies report without fever/chills, s

palpitations, lightheadedness/syncop SOB, cough, URI, or e, extremity/catheterization site or swelling. She reports pain compliance with her antiplatelet medications (ASA clopidogrel), pantoprazole, and aspirin since and

Data entered by

Category AA discharge. On exam, patient is febrile, shallow respirations at norma l rate, low-normal oxygen saturation, and has pericardial friction rub. PMH is significant for hypertension, tobacco hyperlipidemi a, abuse, obesity, and type- 2 diabetes. family history of heart attack and

Family History Fathe r

• Heart attack, 59 years old Past Medical History Category Data entered by AA Past Medical History Hypertension Hyperlipidemia Hospitalizations / Surgeries Acute inferolateral wall ST-elevation myocardial infarction with PCI/stenting of the righ t coronary artery

(RCA).

Balloo angioplasty of the left n circumflex artery. Medications Category Data entered by A A Medications Clopidogrel 75 mg QD Atorvastatin (^80) mg QD at bedtime Pantoprazole 40 mg QD Aspirin 81 mg QD Allergies Category Data entered by AA Allergies Bactrim (rash) Preventive Health Category Data entered by AA Preventive health Up to date including flu shots immuniz atio n annually. normal. Reports gynecology exam was Family History

Mothe - Type 2 Diabetes r Social History Category Data entered by AA Social History Freelance worker, telephone sales. Smoked a pack and a half for the past 25 years Quitte. d since she’d the heart attac k and takes a health heart diet. y Review of Systems Category (^) Data entered by AA General Slightl fatigued. Laying still to avoid movement, y breathing slowly. Brea Integume ntar / y st Warm skin; no significant diaphoresis. HEENT / Neck Denies any problems night vision, hearing with headaches, double vision, difficulty with problems, ear pain, sinus problems, ic sore or difficulty swallowing. chron throat s, Sister - Type 2 Diabetes

Cardiovascular Chest pain. Heart attack 10 days ago. Denies history of irregular heartbeats palpitations. nor Hypertension Hyperlipidemia Respiratory Denies wheezing and production. m sputu Gastrointestinal Report mild nausea and reflux. s Genitourinary Denies urinary frequency, pain, incontinence, or difficulty. Musculoskeletal Denies chest injury. No with muscle and problems s joints. Allergic / Immunologic Endocrine Denies problems with heat or cold intolerance, increased thirst, increased sweating, frequent urination, change in or appetite. Hematologic / Lympha tic No reports of bruising, bleeding nose bleeds, gums, sites of increased bleeding. or other Neurologic Denies dizziness, seizures, numbness, or weakness.

Psychiatric Report nervousness s due to chest pain. Physical Exams Category Data entered by AA

General Obese with a BMI of AOx4 and febril Skin is dry e.

29.4.

Skin Skin warm and dry with no lesions.

Nails withou ridgin pitting or t g, , Capillary refill < 2 sec. Quincke’s Blanching observed. Test: peeling.

tenderness or spasm of the paraspinal muscles.

No localized tenderness processes or pelvic l O M oA R c P S D | 4 6 0 2 0 6 7 0 of the structures. spinous