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ShmuelReisman
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57 yo m f c/o abd pain chest pain SOB
Sharp dull crampy pulling pressure-like constant intermittent worsening pain in epigastrium retrosternal lumbar area periumbilical LLQ RUQ RLQ
Sudden onset Gradual onset 5 h ago after heavy meal, lifting box, in rest, during sleep
Irradiates to neck L arm back jaw groin
Alleviates by nothing rest nitroglycerin NSAIDS, aggravated by strenuous activity exercises loud noise light.
Accompanied by N/V SOB numbness tingling dizziness
PMH: HTN 7 y, controlled by meds, compliant with meds, no DM, no hypercholesterolemia
Allergies: NKA NKDA
Meds: propranolol lisinopril HCTZ
FH: Father died of colon cancer, mother has IHD, no h/o early coronary disease, no h/o colon cancer
Ob/Gyn: LMP 1 week ago 6 weeks ago dyspareunia oligomenorrhea metrorrhagia menometrorrhagia amenorrhea, regular irregular, painful
SH: lives alone, no drugs, rarely ETOH 2-3 drinks on weekends, smoking 20 y 30 PPD
Sex Hx: sexually active with girlfriend husband male female both, 8 partners for last 6 months, inconsistently uses condoms. No h/o STD, h/o of PID
Head - NC/AT
Eyes - EOMI intact, PERRLA, Fundoscopy WNL, no papilledema, vision WNL, no visual field defects, sclera not injected
Ears - canals WNL, TM clear b/l
Nose - nasal turbinates not congested
Throat - No tonsillar enlargement, erythema, exudates or vesicles
Oropharynx - poor N dentition
Neck - supple stiff, no thyroid enlargement, no LAD
CV: RRR, tachycardia (126/min), no r,m,g,
Abd - soft non-tender, pain & tenderness on palpation in RLQ
Patellar and Achilles DTR 2+ intact b/l
Myocardial Infarction Extrauterine pregnancy Major depressive disorder Trauma Foreign body Nasal polyps Crohn's disease Bronchial asthma Domestic abuse Cocaine-induced nasal septum perforation Juvenile angiofibroma
Epistaxis
Rhinorrhea
Palpitations
Sweating
Cough
Numbness
Tremor
Shuffling gait