NR601 Week 2 iHuman: Hua Lin

Health History Feedback

• Performed X Missed

Pivotal Concept Addressed	Category	Question	Response
•	HPI	How can I help you today?	I’ve been having chest pain.
•	HPI	Do you have any other symptoms or concerns we should discuss?	Sometimes I also get winded and tired.
•	Symptom	Does your chest feel tight or heavy?	I would say heavy, but it’s not in one area. It’s all over my chest.
•	HPI	When did the pain in your chest start?	About 5 days ago.
•	HPI	What are the events surrounding the start of your chest pain?	\| It first started when I was walking about the neighborhood on my afternoon walk about 5 days ago.
	HPI	Does the pain in your chest come and go?	Yes, when I exercise or exert myself it happens. When I stop and rest, it goes away.

Physical Exam Feedback

• Performed Correctly * Not Required, Not Inappropriate & Partially Correct

X Missed

Preferred Exams	My Exams	Feedback TE
• cognitive status O	* cognitive status	* Not Required, Not Inappropriate
• height	* height	* Not Required, Not Inappropriate
• weight	•weight	* Not Required, Not Inappropriate
• blood pressure	• blood pressure	• Performed Correctly
• pulse	• pulse	• Performed Correctly
• respiration	• respiration	• Performed Correctly

Case Findings

Intermittent episodes of diffuse chest pain for 5 days
Episodes last < 5 minutes
Chest pain worsened with mild exertion
Chest pain relieved within 3-5 minutes of rest
Dyspnea and fatigue on exertion
No recent URI or viral illnesses
PMH: coronary artery disease (CAD), aortic stenosis, hyperlipidemia, and hypertension
Lack of hypoxemia with unlabored breathing and mild tachycardia (otherwise normal vitals)
Murmur (known prior), otherwise unremarkable physical exam
No reproduction of pain when flat or with chest palpation
Medications/Allergies
Family history (FH)
Social history (SH)
ROS: Inquiry into general or constitutional symptoms
ROS: Inquiry into additional cardiovascular symptoms
ROS: Inquiry into additional pulmonary symptoms
ROS: Inquiry into gastrointestinal symptoms
ROS: Inauirv into neuroloaical smotoms

Case Problem Statement

The patient is a 69-year-old female with PMH of overweight BMI, CAD, HTN, hyperlipidemia, and aortic stenosis presenting with intermittent, less than 5-minute episodes of diffuse chest pain that began 5 days ago. Symptoms are worsened with mild exertion, relieved with rest within 3-5 minutes, and accompanied by dyspnea and fatigue on exertion. She denies tobacco, alcohol, and drug use as well as recent URI or viral illness, fever, weight loss, nausea, or vomiting. Vitals reveal mild tachycardia but are otherwise stable, and physical exam shows pre-existing grade Il systolic murmur without other abnormalities……………………………….purchase this entire iHuman simulation at $30 only