IHUMAN CASE STUDY: IM PEEING ALL THE TIME- DISSECTING URINARY, Exams of Nursing

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IHUMAN CASE STUDY: IM PEEING ALL THE TIME-

DISSECTING URINARY FREQUENCY IN A 62 -

YEAR – OLD MALE LATEST UPDATE

Performance Overview for Lester Trastoy on case Ava

Pilar

The following table summarizes your performance on each section of the case, whether you completed that section or not. Time spent: 2hr 9min 3sec Status: Submitted Case Section Status Your Score Time spent Performance Details Total Score 71% History Done 86% (^) 28min 37sec 63 questionsasked, 12 to the case'slist correct, 2 missed relative Physical exams Done 69% 23min 52sec 144 exams performed, partially correct, 6 missed list

relative correct, to

the case's Key findings organization Done 33sec 1 finding listed; 15 listed by the case Problem Statement Done (^) 4min 55sec 79 words long; the case's was 89 words Differentials Done 50% (^) 20min 43sec 6 items in the missed relative to DDx, the

case's list correct, 2

Differentials ranking Done 100% (lead/alt score) 100% (must not miss score) 54sec Tests Done 44% 16min 28sec 9 tests correct, relative ordered, 4 0 harmful to the correct, 0 to patient, case's list partially 5 missed Diagnosis Done 100% 10sec Management Plan Done (^) 12min 54sec 187 words long; the case's was 152 words Attempt: 3388740 Report generated on 1/5/2025, 4:57: PM Europe/Madrid

History Notecard

by

Lester

Trastoy

on

case

Ava

Pilar

Use this to collect your thoughts to develop a differential diagnosis list. Step 1: Write symptoms ( Sx ) you have identified in the appropriate column and row. Step 2: Characterize the symptoms using " OLDCARTS " (ie., O nset, L ocation, C haracteristics...etc) in the HPI section. Step 3: Record your thoughts in the space labeled " What this means ". Is the disease acute or Timing/treatments chronic? Infectious or other?... Hx Categories Sx= Sx= Sx= Sx= Sx= Sx= CC Provided

Problem Statement

by

Lester

Trastoy

on

case

Ava

Pilar

The patient presents for a few months of tiredness,shortnessof breath, fatigue, and headaches. Reports heavy menses for 1 year. Menses last 7 - 8 days, 2 - 3 of heavy bleeding, having to change tampon and pad every 2 - 4 hours. FMH is significant for the father, deceased of colon cancer at age 50, and the mother with chron's disease. Pt has no history of a colonoscopy. Today's exam showed skin pallor, conjunctival pallor, faintly positive guaiac stool, and orthostatic hypotension 100/60. Attempt: 3388740 Report generated on 1/5/2025, 4:57: PM Europe/Madrid

Management Plan

by

Lester

Trastoy

on

case

Ava

Pilar

Oral Iron preparation: 1150 to 200 mg of elemental iron per day. Educate the patient on a diet, including iron-rich foods, and educate on vegetarian and vegan diets. Possible refer to a dietician. Take iron tablets on an empty stomach if possible. However,because iron tablets can upset your stomach, you may need to take your iron tablets with meals. Don't take Take take antacids. iron iron tablets with with antacids. vitamin Take C. iron two Vitamin C hours before or four improves the absorption hours of after you iron. Iron supplements can cause constipation, so a stool softener is is also recommended. a harmless side Iron effect. may turn your stools black, which Iron deficiency can't be correctedovernight. You may need to take iron supplements for several months or longer to replenish your iron reserves. You'll start to feel better after a week or so of treatment. Treating underlying causes of iron deficiency. you should come for a follow up within the next 4 weeks and take your suplements for a period of time of 6 months or more depending on your iron reserve replenish.

IHUMAN CASE STUDY: IM PEEING ALL THE TIME- DISSECTING URINARY FREQUENCY IN A 62 - YEAR –

OLD MALE, WEEK 10

Category Data entered by Lester Trastoy Past Medical History Hospitalizations / Surgeries

Medications

Category Data entered by Lester Trastoy Medications

Allergies

Category Data entered by Lester Trastoy Allergies

Preventive Health

Category Data entered by Lester Trastoy Preventive health

Family History

Category Data entered by Lester Trastoy Family History

Social History

Category Data entered by Lester Trastoy Social History

Review of Systems

Category Data entered by Lester Trastoy

General Integumentary / Breast HEENT / Neck Cardiovascular Respiratory Gastrointestinal Genitourinary Musculoskeletal Allergic / Immunologic Endocrine Hematologic / Lymphatic Neurologic Psychiatric

Physical Exams

Category Data entered by Lester Trastoy General Skin HEENT / Neck Cardiovascular Chest / Respiratory Abdomen Genitourinary / Rectal Musculoskeletal / Osteopathic Structural Examination Neurologic

lOMoAR cPSD| 10861635

Ihuman-Ava Pilar

50 y/o female

Height: 5’6” (168 cm)

Weight: 153 lbs (69.5 kg)

Reason for visit: Fatigue and shortness of breath Location: Emergency room with full imaging and laboratory capabilities Visual: Alert, slight pallor, dress in gown Note: There is a prior chart in the EHR HISTORY QUESTIONS: 24 How can I help you today? Well, I have been unusually tired recently and a bit short of breath , but I just thought I was overworking. Then today I was out working in the yard and got extremely lightheaded. I felt like I was about to pass out and I think if I hadn’t sat down, I actually might have passed out. I wasn’t doing anything strenuous…just planting some owers. Do you have any other symptoms or concerns we should discuss? Yes, more and more frequently I’ve been getting lightheaded. Oh, I also am getting headaches. I used to never get headaches, so all of this is new for me. I just thought I was out of shape and working too hard. That’s all I can think of this minute. When did you rst notice feeling short of breath? Several months ago. I thought it was just getting older. Does anything make your shortness of breath better or worse? It did get better when I sat down. It’s worse with house and yard work now. How severe is your shortness of breath? I have not been able to do routine things without getting short of breath Do you have a cough? No Do you wheeze? No Are you short of breath when laying down? No What are the events surrounding the start of your fatigue/tiredness? I rst noticed feeling tired during a round of golf several months ago. I had to stop walking after the rst none holes and nish the round with a cart. Now that had never happened to me before. Again, I just thought I was working too hard. When did your fatigue/tiredness start? Several months ago Does anything make your fatigue/tiredness better or worse? Rest, taking it easy, limiting my activities. Those all seem to help. How severe is your fatigue/tiredness? Bad enough that it’s di cult to get through my daily responsibilities Does your fatigue/tiredness improve after a good night’s rest? Not really Does your fatigue/tiredness come and go? Yes, with exertion What treatments have you had for your fatigue/tiredness? Nothing When did your lightheadness start? I guess maybe a couple of months ago but I really took notice a few days ago when I was crawling under the bed cleaning my oors and then stood up to quickly, I felt lightheaded. That episode passed fairly quickly. Then I happened again this morning before I came in. Does anything make your lightheadedness better or worse? I sometimes get lightheaded when I do housework or exercise…and then today when I was doing yard work. How long does your lightheadedness last? It’s just a few seconds. A minute or two at the most.

lOMoAR cPSD| 10861635 What does the pain in your head feel like? I don’t have pain there now but when I get a headache, it is just an ache all over my head. Does anything make your headache better or worse? I usually just take some ibuprofen and that seems to help. They are worse with any exertion. How long does your headache last? A couple hours until the ibuprofen kicks in When did your headache start? Over the last few months. I don’t have one now. Do you have any awareness or warning symptoms that occur before the headache begins? No What treatments have you had for your headache? I just take some ibuprofen when I get one Does your headache come and go? Yes,. I don’t have one right now. How severe (1-10) is your headache? I’d say mild Where more precisely is the pain in your head? Kind of all over. Just garden variety headache. Does the pain in your head radiate someplace else? Where? I don’t have a headache now but when I have one, it stays in one place. How long do your periods last? I have heavy bleeding for 2 - 3 days, but the total duration is usually around 7 - 8 days. How many tampons or pads do you use daily? I use both simultaneously; I double up using both tampons and pads for the rst 2 - 3 days and I change my tampon every two to four hours. Now that I think about it, it is heavier than it was a couple of years ago. When did your last period begin? About 4 weeks ago When did your abnormal vaginal bleeding start? It’s been a little heavier for about 10 months or a year Do you have any pain in your chest? No Any changes in the frequency of your bowel movements? I have loose stools occasionally and have been having them over the past year or so. Otherwise, nothing new. How often do you have headaches like this? iHuman does not have this question anymore How often do you feel lightheaded? iHuman does not have this question anymore How much of your medication did you take? Do you have problems with heat or cold intolerance, increased thirst, increased sweating, frequent urination, or change in appetitie? iHuman does not have this question anymore, so I broke it up to get the answers I needed. See the next four questions. Do you have trouble with hot or cold temperatures? No, I don’t think so. Any changes in your thirst? No increased thirst, urination or appetite. All good. How is your appetite? Any recent change? Oh, my appetite is ne. Always is. Has there been a change in your urination frequency? No Do you have night sweats? No Do you bruise or bleed easily? Nope Tell me about your work? I’m a radiology tech. I work in private practice Do you now or have you ever smoked or chewed tobacco? Never Are your immunizations up to date? Yes, they are Have you ever had a Pap smear? Yes. I stay on top of that and they are always normal. Over the last two weeks, how often have you been bothered by feeling down, depressed, or hopeless? Don’t have that problem Have you ever been hospitalized? Just for the deliveries of my kids Is there any blood in your stools or with your bowel movements? Nope. Do you have pain/discomfort when you urinate? Nope Have you been having fevers? No

lOMoAR cPSD| 10861635 Inspect eyes: PHYSICAL EXAMS: 25 Cognitive status: A&O x 4

Vital Signs: Looked in chart for credit

BP: Left: 126/72, right: 128/74, assessment: normotensive, pulse pressure: normal Orthostatic BP 104/60, upon standing Pulse: 82 bpm, rhythm: regular, strength: normal Resp: 16 bpm, rhythm: regular, e ort: unlabored SPo2: 97%, RA Temp: 98.6 F (37 c), oral Height: 66” Weight: 153 lb BMI: 24.

SKIN:

patient gender and age. Test skin turgor : Back of hand-skin snaps back rapidly Test cap re ll- ngers: Capillary re ll less than three seconds Slight pallor. No jaundice, petechiae, ecchymoses, rashes, or lesions. Thickness and distribution pattern typical for e ll less than three seconds bilaterally Inspect nails: Nails without ridging, pitting, or peeling.

HEENT/NECK

Inspect/palpate head (including scalp): Normocephalic, atraumatic. No deformities. Facial features symmetric. Palpate sinuse : Temporal arteries non-tender o scleral icterus. Mild conjunctival pallor. No pe to^ palpation^ Maxillary^ and Examine pupils PERRLA Perform ocular motor test: Normal eye movement. Perform fundoscopic exam with ophthalmoscope: sharp. frontal sinuses non-tender on both sides. riorbital edema. Red re ex bilaterally. Optic disks Test visual acuity: Visual acuity with Snellen pocket cared: right eye (OD) 20/20, left eye (OS) 20/20. Inspect external ears: No cauli ower deformation, lesions, masses, or erythema to external ears. Look in ears with otoscope: External auditory canals without erythema or cerumen. Tympanic membrane translucent, non-injected, and pinkish-gray in color. No scarring, discharge or purulence noted. Landmarks visible. Inspect nose external/internal: Inspect mouth/pharyn Nose is free of discharge or polyps. Lips dry. Mild ssures bilateral angles of the mouth, slightly erythematous. No mucosal lesions. Inspect neck: No visible scars, deformities, or other lesions. Trachea is midline and freely mobile. Palpate neck: Palpate thyroid: Thyroid^ mobile^ without^ masses,^ tenderness,^ nodules, Evaluate cervical spine range of motion (non-meningeal) : lateral bending, and rotation bilaterally.

CARDIO:

Auscultate heart: or enlargement. Full and painless active range of motion in exion, extension, Inspect hair color, distribution, thickness: Inspect skin overall: Test capillary re ll-toes: Capillary r

lOMoAR cPSD| 10861635 Measure JV S1 and S2 regular rate and rhythm. No rubs, clicks or gallops No JVD Palpate for PMI: PMI in 5 th^ intercostal space at midclavicular line. Single, brisk impulse. Auscultate carotid arteries: No bruits bilaterally

Chest/Respiratory:

Visual inspection-anterior & posterior chest (including breasts): No lifts or accessory muscle use. No scars, moles, rashes, erythema, or ecchymosis Palpate anterior & posterior chest: No tenderness, masses, heaves, thrills, or crepitus on palpation. Percuss anterior & Posterior chest: Anterior lung elds are resonant. The left anterior chest (heart) and right lower chest (liver) are dull to percussion. The rest fo the lung elds are resonant and are not hyper-resonant. Auscultate lungs: Bilateral lung sounds are clear anterior and posterior. No adventurous breath sounds noted. Inspect breast: No masses, erythema, rashes, discharge, dimpling, or retraction upon inspection with patient seated, arms raised, hands on hips, or supine. Palpate breast tissue : Measure thoracic expansion: No masses or tenderness bilaterally at four quadrants and tails. Symmetric expansion bilaterally

Abdomen

Inspect abdomen: Nondistended. Scar consistent with appendectomy. No moles, masses, rashes, erythema, or ecchymosis. Auscultate abdomen: Bowel sounds normoactive and present in all four quadrants. Percuss abdomen/Palpate abdomen: iHuman no longer has these exams Perform initial light/deep abdominal palpation +/- percussion (4 quards): No tenderness or masses palpable upon light or deep palpation. Percuss/palpate liver: Liver is 8 cm at the midclavicular line, edge palpable just below costal margin. Percuss/palpate spleen : Auscultate abdominal/femoral arteries: Spleen not palpable No bruits noted to renal, femoral or aortic arteries.

Genitourinary/Rectal:

Inspect rectal area: No visible ssures, induration, or lesions Rectal exam: Genitourinary exam: Inspect vulva and urethral meatus: Mons with expected hair growth without excoriation, erythema, or rash. Labia majora and minora without erythema, masses, tenderness, or discharge. Meatus without discharge. Perform vaginal speculum examination: Vaginal walls pink without lesions, discharge, dryness, or erythema. Cervical os without erythema, bleeding, or discharge. Perform bimanual pelvic exam: No uterine masses or tenderness. Ovaries not palpable at adnexae. No adnexal tenderness or masses.

Musculoskeletal/Osteopathic:

Inspect upper extremities: Arms without rashes, lesions, moles, erythema, swelling or ecchymosis. No fasciculations or loss of muscle bulk. Inspect lower extremities: No swelling, pallor, hair loss, erythema, rashes, ulcerations, lesions, or ecchymosis bilaterally.

Neurologic (A&O x 4)

Assess cranial nerves Assess biceps re exes (DTR): 2+ bilaterally Assess triceps re exes (DTR): 2+ bilaterally Assess brachioradialis re exes (DTR): 2+ bilaterally Assess patellar re exes (DTR): 2+ bilaterally Assess achilles re exes (DTR): 2+ bilaterally