Physical Examination

General Appearance Respiratory distress, dehydration. Note whether the patient appears septic, ill, well, or malnourished. Vital Signs Temperature (fever), respiratory rate (tachypnea), pulse (tachycardia), BP (hypotension). HEENT Tympanic membranes, pharyngeal erythema, lymphadenopathy, neck rigidity. Chest Dullness to percussion, tactile fremitus (increased sound conduction) rhonchi end-inspiratory crackles bronchial breath sounds with decreased intensity whispered pectoriloquy (increased...

Cholecystitis

Chief Compliant The patient is a 50 year old white male with obesity who complains of right upper quadrant pain for 6 hours. History of the Present Illness Biliary colic (constant right upper quadrant pain, 30-90 minutes after meals, lasting several hours). Radiation to epigastrium, scapula or back nausea, vomiting, anorexia, low-grade fever fatty food intolerance, dark urine, clay colored stools bloating, jaundice, early satiety, flatulence, obesity. Previous epigastric pain, gallstones,...

Pelvic Pain and Ectopic Pregnancy

Chief Compliant The patient is a 50 year old female with hypertension who complains of chest pain for 4 hours. History of the Present Illness Positive pregnancy test, missed menstrual period, pelvic or abdominal pain (bilateral or unilateral), symptoms of pregnancy (nausea, breast tenderness) abnormal vaginal bleeding (quantify). Last menstrual period, menstrual interval, duration, age of menarche, obstetrical history. Characteristics of pelvic pain onset, duration shoulder pain. Rupture of...

Anorexia and Weight Loss

Chief Compliant The patient is a 50 year old white male with diabetes who complains of loss of appetite and weight loss for one week. History of the Present Illness Time of onset, amount and rate of weight loss (sudden, gradual) change in appetite, nausea, vomiting, dysphagia, abdominal pain exacerbation of pain with eating (intestinal angina) diarrhea, fever, chills, night sweats dental problems restricted access to food. Polyuria, polydipsia skin or hair changes 24-hour diet recall dyspepsia,...

Conditions That Mimic or Provoke Heart Failure

Coronary artery disease and myocardial infarction C. Aortic or mitral valve disease D. Cardiomyopathies Hypertrophic, idiopathic dilated, postpartum, genetic, toxic, nutritional, metabolic E. Myocarditis Infectious, toxic, immune G. Tachyarrhythmias or bradyarrhythmias J. High output states Anemia, hyperthyroidism, arteriovenous fistulas, Paget's disease, fibrous dysplasia, multiple myeloma K. Renal failure, nephrotic syndrome Factors Associated with Heart Failure A. Increase Demand Anemia,...

Pyelonephritis and Urinary Tract Infection

Chief Compliant The patient is a 50 year old female with diabetes who complains of flank pain for 8 hours. History of the Present Illness Dysuria, frequency repeated voiding of small amounts , urgency suprapubic discomfort or pain, hematuria, fever, chills, pyelonephritis back pain, nausea, vomiting. History of urinary infections, renal stones or colicky pain. Recent antibiotic use, prostate enlargement. Diaphragm use. Risk factors Diaphragm or spermicide use, sexual intercourse, elderly,...