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Florence Blackman 66 Year-old Female – Chest Pain 2 DIFFERENT VERSIONS OF THE ANSWER EXPERT FEEDBACK (SOLUTIONS)
- Florence Blackman 66 Year-old Female – Chest Pain 2
- DIFFERENT VERSIONS OF THE ANSWER EXPERT FEEDBACK
- (SOLUTIONS)
- CONTENTS : ALL QUESTIONS, OLD-CARTS for the HPI,(PMH,FH,SH as
- Needed),PHSICAL EXAM,EXAMS FEEDBACK,CASE
- FINDINGS,FEEDBACK,DIFFERENTIAL RANKING ,DIAGNOSIS,CASE PLAN
- 1
- This study source was downloaded by 100000853504600 from CourseHero.com on 01-14-2026 14:03:38 GMT -06:00
- https://www.coursehero.com/file/67771889/Oral-Comprehensivedocx/
- VERSION 1
- Florence Blackman (66 y/o female) – Chest Pain
- • CC: Intermittentsqueezing chest pain
- • MSAP: Exertional “squeezing†mid-chest pain radiating to left arm, relieved by rest,
- worse with cold
- • Associated dyspnea on exertion
- • History: HLD, HTN, previous smoker, family hx of heart disease
- • Stressful work
- History Questions:
- - How can I help you today?
- - Any othersymptoms we should discuss?
- - Do you have any allergies?
- - Are you taking any OTC or herbal medications?
- - Any new or recent changes in medications?
- - What doesthe pain / discomfort in your chest feel like? (squeezing, pressure, crushing,
- burning, stabbing, aching, tingling, suffocating)
- - How severe (scale 1-10) is the pain in your chest?
- - Does anything make the pain in your chest better or worse?
- - What are the events surrounding the start of your chest pain?
- - Is there a pattern to your chest pain?
- - Have you had any trauma to your chest?
- - Doesthe pain in your chest radiate someplace else? Where?
- - Do you have unusual heartbeats(palpitations)?
- - Doesthe pain get worse with breathing?
- - Does your pain awaken you from yoursleep?
- - Is your pain affected by what, when, or how much you eat?
- - Do you presently have heartburn, a food or acid taste in your mouth?
- - Do you drink alcohol? If so, what do you drink and how many drinks per day?
- - Do you have any of the following problems: fatigue, difficulty sleeping, unintentional
- weight loss or gain, fevers, night sweats?
- - Do you experience: SOB, wheezing, difficulty catching breath, chronic cough,sputum
- production?
- - Does anything make yourshortness of breath better or worse?
- - How long does your SOB last?
- - Do you have any of the following: heat or cold intolerance, increased thirst, increased
- sweating, frequent urination, change in appetite?
- - Do you have any of the following: dizziness, fainting, spinning room, seizures, weakness,
- numbness, tingling, tremor?
- 2
- This study source was downloaded by 100000853504600 from CourseHero.com on 01-14-2026 14:03:38 GMT -06:00
- https://www.coursehero.com/file/67771889/Oral-Comprehensivedocx/
- - Do you have problems with: N/V, constipation, diarrhea, coffee groundsin your vomit,
- dark tarry stool, bright red blood in your BM, early satiety, bloating?
- - How is your overall health?
- - Tell me about your work.
- - Tell me about daily exercise or sportsthat you play.
- Physical Exam:
- - Vitals: pulse, BP, respirations
- - Examine skin
- - Neck: measure JVP (jugular venous pressure)
- - Neck: auscultate carotid arteries
- - Chest wall & lungs:
- o Visual inspection of anterior & posterior chest
- o Palpate anterior &posterior chest
- o Auscultate lungs
- - Heart:
- o Palpate for PMI (Point of Maximal Impact)
- o Auscultate heart
- - Abdomen:
- o Auscultate abdominal/femoral arteries
- o Palpate abdomen
- - Extremities: Visual inspection of extremities
- Assessment note:
- - F.B. is a 66 y/o Caucasian female presenting with 2-week h/o new onset, intermittent,
- stable chest pain which radiates to the L arm, occurs with SOB, is worse with cold
- temperatures and exertion, and improved by rest. On physical exam she is pain free with
- stable vital signs. PMH risk factors include: distant history of smoking (5 pack/years), a
- history of HTN, and high cholesterol, and a family history of coronary vascular disease.
- - Stresstest: 2-mm ST segment depression in inferior leads, 2, 3, and aVF and V3-6
- Diagnosis: Coronary artery disease: stable angina
- Plan:
- - Determine need for coronary angiography based on stress test results and ECHO. Her
- Duke score of 10.5 is slightly above moderate risk, and arguments could be made for
- both a trial at medication intervention since the pt needsimprovement on both HTN and
- HLD
- o Augment management of preexisting HTN and HLD with a BB (metoprolol 25 mg
- XR daily); a statin (atorvastatin 40 mg daily); and ASA 81 mg daily
- - Continue use of HCTZ 25 mg daily
- - Encourage lifestyle modification:
- o Decrease intensity of aerobic workoutsfor next 3 months
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