iHuman Case Study: Constance Barn

iHuman Case Study: Constance Barn

70Yrs Old Female Cc: (Chronic Dyspnea)

Shortness of Breath

2023-2024

Questions – 100 %

• How can I help you today?
• Are there any other symptoms or concerns we should discuss?
• When did your difficulty breathing start?
• Does anything make your difficulty breathing better or worse?
• Are you short of breath when lying down?
• Are you short of breath at rest?
• Do you sleep with pillows to help you breathe?
• Do you have any pain or symptoms associated with your difficulty breathing?
• How severe is your difficulty breathing?

10 Do you wheeze?11 Do you become short of breath with exertion?12 Do you awaken at night short of breath?13 Does anyone in your family have difficulty breathing?14 Do you feel faint or like you might faint?15 Do you have a problem with fatigue/tiredness?16 Have you been having fevers?17 Have you noticed any swelling in any part of your body?18 Do you have a problem with generalized weakness?19 Do you have a cough?20 Do you have unusual heartbeats?21 Do you have a sensation of a “pounding heart” in your chest?22 Do you have any pain in your chest?23 Does your chest feel tight or heavy?24 Can you tell me about any current or past medical problems you have had?25 Do you have high cholesterol?26 Do you have heart disease and/or have you ever had a heart attack?27 Do you have a history of heart failure?28 Have you ever been told that you have a murmur or valve problems?29 Do you have asthma?30 Do you have a history of lung disease?31 Do you now or have you ever had cancer?32 Any previous medical, surgical, or dental procedures?33 Have you ever been hospitalized?34 Do you have any allergies?35 Are you taking any over the counter or herbal medications?36 Are there any disease that run in your family?37 Are you taking any prescription medications?38 Do you drink alcohol? If so, what do you drink and how many drinks per day?39 Do you now or have you ever smoked or chewed tobacco?40 Do you have diabetes?41 Have you ever fainted?42 Were you short of breath just before you fainted?43 Have you had tuberculosis?44 Do you have a family history of blood clots in your legs or lungs?45 Do you have a history of deep vein thrombosis or pulmonary embolism?46 Have you ever been diagnosed with thyroid problems?47 Have you recently traveled? Where?48 Have you ever been diagnosed with a bleeding disorder?

49 Do you have chills?50 Have you had chicken pox, Measles, or Rheumatic fever?51 Are you eating a lot of salty foods?52 Do you have muscle pain or cramping?53 Do you have problems with movement?54 Do you have any difficulty performing activities of daily living?55 Do you have a problem with swallowing?56 Do you have a family history of heart disease?57 Do you have arthritis?58 Do you have difficulty chewing?59 Do you feel your muscles are tense?60 Did you have strep throat as a child?61 Have you eaten anything out of the ordinary lately?62 Have you noticed any trouble with your speech?63 Did you ever have involuntary strange dance like movements?64 Is your voice hoarse?

Physical Exams – 93% 31 of these are correct (3 were performed incorrectly somehow *probably something with taking the blood pressure because iHuman is stupid*, so this section should score 100% if you do everything right) unsure which of the 31 are correct, so if you choose to eliminate exams, it cannot be guaranteed that you will earn full credit.

• Cognitive status
• Blood pressure, R&L arms (normal)
• Blood pressure R&L arms (orthostatic)
• RR
• Pulse
• Temperature
• SpO2
• Ask patient to swallow
• Inspect skin overall

10 Capillary refill 11 Inspect face 12 Inspect/palpate head 13 Palpate neck 14 Inspect neck 15 Inspect nails 16 Look up nostrils 17 Inspect mouth/pharynx 18 Inspect nose 19 Inspect eyes 20 Examine pupils 21 Ophthalmoscope 22 eTCO2 23 Auscultate carotid arteries

24 JVP

25 PMI

26 Auscultate Lungs 27 Inspect ears

28 Otoscope 29 Auscultate heart 30 Dynamic auscultation 31 Palpate AP chest 32 Quincke’s Test 33 Percuss AP chest 34 Dix-Hallpike Maneuver 35 Breast Exam 36 Visual inspection AP chest 37 Visual inspection abdomen 38 Ocular motor test 39 Evaluate mandible muscles and mastication 40 Auscultate abdomen 41 Femoral arteries 42 Percuss abdomen 43 Palpate abdomen 44 Palpate back and spine 45 Eyelid icepack test 46 Visual inspection of the spine 47 Inspect for muscle bulk and tone 48 Test strength 49 Test stability 50 Palpate extremities 51 Assess pharynx movement and phonation 52 Visual inspection of extremities 53 Range of motion 54 Balance test

55 MMSE

56 Romberg and pronator drift test 57 Assess gait and stance 58 Palpate all lymph nodes 59 Look for involuntary movements 60 Ankle brachial pressure index 61 DTR’s 62 Assess head rotation against resistance/shoulder elevation 63 Gross pain stimulus 64 Facial strength/expression 65 Rapid alternating movements – hands 66 Rapid alternating movements – fingers

MSAP – Not graded

• Dyspnea
• Fatigue
• Ankle swelling
• Vasovagal 2 months prior
• 1+ BL pretibial edema
• Abnormal carotids
• Abnormal abdominal/femoral arteries
• Murmur