Shadow Health Assignments
Focused Exam: Chest Pain, Brian Foster Shadow health transcript
Transcript
Hello
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Good morning.
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What brings you in today?
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I have been having some troubling chest pain in my chest now and then for the past month.
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Sorry for the chest problem
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Thanks. I appreciate that.
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When did the chest pain start?
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I first noticed it earlier this month. I thought it might just be heartburn and it passed after a couple of minutes.
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How is the pain like
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Well, it doesn’t hurt right now, but I have been having chest pain now and then for the past month.
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Where is the pain located?
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When the pain happens, I feel it mostly in the middle of my chest, over my heart.
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Does the chest pain radiate?
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The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest.
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Do you have back pain?
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I haven’t had back pain, no.
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How frequent are the chest pains?
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Well, it has happened three times the past month. It usually goes away after about a couple of minutes.
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What relieves the chest pain?
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I’m not sure. I think lying still seems to help a little.
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What makes the pain worse
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Well, I think it’s when I’m doing something physical most of the time. The first time it happened, my chest started hurting after I was doing some yard work. The second time happened when the elevator broke at work so I had to take the stairs. My office is on the 5th floor.
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can you rate the pain on a scale
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I’d say maybe a . . . 5? It’s just really uncomfortable . . . like there’s nothing I can do about it. Right now it’s like a zero though.
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Have you taken any medications for the chest pain
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No, not yet.
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Which medications do you take currently (Clarified to What medications do you take?.)
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Yeah, let’s see, I take atorvastatin for cholesterol, lisinopril for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. (Clarified to what medications I am taking.)
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Thats good for your cholesterol, continue taking it
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Good to know. Thank you. Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Any allergies
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No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.
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Any history of chronic illness?
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Besides a little high blood pressure and cholesterol, no.
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Have you done EKG test recently?
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I had one about three months ago. They usually put one on me at my annual physical.
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What were the results of the EKG?
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I don’t remember the actual results, but as far as I know, it was normal.
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Do you have a primary care provider?
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Dr. Melinda Smith.
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Great
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Good to know. Thank you.
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When did you last visit your care provider
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I had a physical about 3 months ago.
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Any palpitations?
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I don’t think so. I haven’t noticed any.
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Any history of heart illness? (Clarified to Do you have a history of heart problems?.)
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All I know is I have high blood pressure and cholesterol, but that’s pretty well-controlled by medicine as far as I know. (Clarified to if I have a history of heart problems.)
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Do you feel stressed?
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Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.
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I’m sorry about that
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Thanks. I appreciate that.
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Do you have hypertension?
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Yes, I supposedly have moderately high blood pressure.
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Do you exercise?
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Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having.
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I’m sorry you’ve not been able to exercise
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Thanks. I appreciate that.
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What is your typical diet
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I try to stay conscious of my diet. You know, I watch the fat. I watch the sodium . . . but I’m a dyed-in-the-wool carnivore too. Steaks and burgers find their way in there every once in a while.
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Do you drink water regularly?
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I usually drink water all day at work. At least four glasses, probably more.
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Do you smoke cigarette?
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Nope, I had a lot of friends who did but I never started.
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Smoking is bad for the health
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Good to know. Thank you.
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Do you take alcohol? Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Sure, but never more than two or three beers on a weekend.
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Do you feel fatigued?
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I’m not more tired than normal.
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Any dizziness?
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No, I haven’t felt dizzy.
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Do you have Angina?
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I’ve never been diagnosed with angina.
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Do you have edema?
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I haven’t noticed any swelling.
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Have you has blood clots?
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Not that I know of.
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Any fever?
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I haven’t had a fever, no.
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Do you cough?
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I don’t have a cough.
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Any difficulty breathing?
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My breathing’s fine.
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Any sore throat?
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I haven’t had a sore throat in a long time.
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Do you have diarrhea?
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I have, but it is very rare for me.
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Do you have constipation?
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I haven’t had problems with that. I wish it were only that.
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Any heartburn?
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No, I’ve never had problems with heartburn. I sure hope that’s all this is, but it’s pretty intense if it’s heartburn.
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Any family history of hear attack?
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No, nobody had that.
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Have you been monitoring your blood pressure?
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Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.
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Measured vitals
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Tested blood pressure in left arm with cuff
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Tested blood pressure in right arm with cuff
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Measured vitals
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Inspected face
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Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle
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Inspected anterior chest wall
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Inspected right side chest wall
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Inspected posterior chest wall
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Inspected left side chest wall
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Inspected left side of abdomen
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Inspected front of abdomen
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Inspected right hand: no visible abnormal findings
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Inspected left hand: no visible abnormal findings
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Inspected fingernails of left hand Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Inspected right hand: no visible abnormal findings
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Inspected left hand: no visible abnormal findings
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Inspected fingernails of right hand
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Inspected left leg
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Inspected right leg Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Inspected toenails on left foot
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Inspected toenails on right foot
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Inspected left leg
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Inspected right leg
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Inspected right leg for edema: No edema
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Inspected left leg for edema: No edema
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Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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Auscultated right carotid pulse: Bruit present
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Auscultated left carotid pulse
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Auscultated aortic area with the bell
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Auscultated aortic area with the diaphragm
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Auscultated pulmonic area with the diaphragm
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Auscultated pulmonic area with the bell
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Auscultated Erb’s point with the bell
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Auscultated Erb’s point with the diaphragm
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Auscultated tricuspid area with the diaphragm
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Auscultated tricuspid area with the bell
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Auscultated tricuspid area with the diaphragm
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Auscultated mitral area with the diaphragm
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Auscultated mitral area with the bell
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Auscultated breath sounds in anterior right upper lobe
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Auscultated breath sounds in anterior left upper lobe
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Auscultated breath sounds in anterior right middle lobe
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Auscultated breath sounds in anterior left mid-chest (upper lobe)
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Auscultated breath sounds in anterior right lower lobe
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Auscultated breath sounds in anterior left lower lobe
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Auscultated breath sounds in posterior left upper lobe
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Auscultated breath sounds in posterior right upper lobe
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Auscultated breath sounds in posterior left mid-back (lower lobe)
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Auscultated breath sounds in posterior right mid-back (lower lobe)
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Auscultated breath sounds in posterior left lower lobe
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Auscultated breath sounds in posterior right lower lobe
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Auscultated breath sounds in posterior left lower lobe on side
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Auscultated breath sounds in posterior right lower lobe on side
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Auscultated aorta in abdomen
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Auscultated right renal pulse
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Auscultated left renal pulse
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Auscultated right iliac pulse
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Auscultated left iliac pulse
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Auscultated right femoral pulse
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Auscultated left femoral pulse
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Auscultated right upper quadrant
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Auscultated left upper quadrant
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Auscultated right lower quadrant
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Auscultated left lower quadrant
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Auscultated over liver Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Auscultated over spleen
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Palpated right carotid pulse: Thrill, 3+
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Palpated right carotid pulse: Thrill, 3+
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Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm
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Palpated right brachial pulse: No thrill, 2+
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Palpated left brachial pulse: No thrill, 2+
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Palpated right radial pulse: No thrill, 2+
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Palpated left radial pulse: No thrill, 2+
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Palpated right femoral pulse: No thrill, 2+
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Palpated left femoral pulse: No thrill, 2+
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Palpated right popliteal pulse: No thrill, 1+
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Palpated left popliteal pulse: No thrill, 1+
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Palpated right tibial pulse: No thrill, 1+
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Palpated left tibial pulse: No thrill, 1+
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Palpated right dorsalis pedis pulse: No thrill, 1+
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Palpated left dorsalis pedis pulse: No thrill, 1+
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Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated right upper quadrant with deep pressure: No masses
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Palpated left upper quadrant with deep pressure: No masses
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Palpated right lower quadrant: with deep pressure: No masses
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Palpated left lower quadrant with deep pressure: No masses
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Palpated liver: Palpable 1 cm below right costal margin
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Palpated for spleen: Not palpable
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Palpated for right kidney: Not palpable
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Palpated for left kidney: Not palpable
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Tested skin turgor
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Percussed right upper quadrant
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Percussed left upper quadrant
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Percussed right lower quadrant
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Percussed left lower quadrant
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Percussed spleen
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Percussed for liver span: 7 cm in the mid-clavicular line Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Title: Focused Exam: Chest Pain, Brian Foster Shadow Health Transcript
Introduction:
– Greeted Brian Foster.
– Asked about reason for visit.
– Brian Foster mentioned having troubling chest pain for a month.
Chest Pain Details:
– Brian Foster talked about chest pain starting earlier this month, initially thought it was heartburn.
– Pain located in the middle of chest, over heart.
– Pain doesn’t radiate, mainly stays in the middle of chest.
– No back pain experienced.
– Pain occurs about three times a month, lasts a few minutes.
– Physical activity seems to worsen the pain.
– Pain level around 5, uncomfortable.
– Lying still provides slight relief.
Medications:
– Brian Foster takes atorvastatin for cholesterol, lisinopril for blood pressure, and fish oil.
– Mentioned possibility of continuing fish oil for cholesterol.
Medical History:
– No allergies except a reaction to codeine.
– Only history of high blood pressure and cholesterol.
– Recent EKG done, believed to be normal.
– Primary care provider is Dr. Melinda Smith.
Lifestyle and Symptoms:
– No palpitations, no history of heart illness.
– Feeling anxious due to uncertainty about chest condition.
– Hypertension present, moderately high blood pressure.
– Used to exercise by cycling, but stopped after bike was stolen.
– Conscious of diet, occasionally eats steaks and burgers.
– Drinks water regularly, about four glasses at work.
– Non-smoker, aware of smoking’s negative impact.
– Moderate alcohol consumption.
– No increased fatigue, dizziness, angina, edema, or blood clots.
– No fever, cough, difficulty breathing, sore throat, diarrhea, constipation, or heartburn.
– No family history of heart attack.
Physical Examination:
– Various palpations and auscultations performed for pulse and organ assessment.
– No masses, tenderness, guarding, or distension observed.
– Liver palpable about 1 cm below right costal margin.
– Spleen not palpable.
– Liver span measured at 7 cm in mid-clavicular line.
Conclusion:
– Conducted thorough physical examination.
– Gathered detailed information about chest pain and medical history.
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