Week 7 - Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System

Hello. I will be interviewing you today, and later conduct a physical exam

Greet 03/25/20 10:27 AM PDT

Good morning.

Please let me know your name (Clarified to Can you verify your identity please?.)

Question 03/25/20 10:28 AM PDT

Brian Robert Foster. (Clarified to to confirm what is my name.)

Welcome Mr Foster. What brings you to the clinic today?

Question 03/25/20 10:29 AM PDT

I have been having some troubling chest pain in my chest now and then for the past month.

I am sorry that you have been having the chest pain. brian foster chest pain shadow health assessment Transcript

Empathize 03/25/20 10:30 AM PDT

Thanks. I appreciate that.

Please tell me what the pain you have been having is like (Clarified to Can you tell me what the pain is like?.)

Question 03/25/20 10:31 AM PDT

Well, it mostly feels tight and uncomfortable right in the middle of my chest. (Clarified to if I can tell you what the pain is like.)

when did the pain start?

Question 03/25/20 10:32 AM PDT

I first noticed it earlier this month. I thought it might just be heartburn and it passed after about a couple of minutes.

does the chest pain radiate?

Question 03/25/20 10:33 AM PDT

The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest.

Do you feel pain in your arm?

Question 03/25/20 10:33 AM PDT

No, when I am having the chest pain, it’s mostly just in middle of my chest.

do you feel pain in your shoulder?

Question 03/25/20 10:36 AM PDT

No, the pain hasn’t been in my shoulder.

do you have back pain?

Question 03/25/20 10:36 AM PDT

I haven’t had back pain, no.

do you have neck pain.

Question 03/25/20 10:37 AM PDT

My neck’s been fine.

how long does the chest pain last ?

Question 03/25/20 10:37 AM PDT

When I feel it, it seems to get better over the course of a couple of minutes or so.

what is the frequency of the chest pain?

Question 03/25/20 10:37 AM PDT

Well, it has happened three times the past month. It usually goes away after about a couple of minutes.

Were episodes of your chest pains related? (Clarified to What were you doing the last time you had chest pain?.)

Question 03/25/20 10:39 AM PDT

Well, the pain seems to start when I’m doing something physical . . . the first time it happened while I was doing yard work, and the second time . . . I had to take the stairs at work because the elevator broke. Both times it got better if I took a break or sat down to rest. (Clarified to what I was doing when I had chest pain last.)

how do you feel when in pain? (No matching questions found.)

Question 03/25/20 10:41 AM PDT

am sorry about that? (No matching questions found.)

Question 03/25/20 10:42 AM PDT

How would you rate the chest pain?

Question 03/25/20 10:43 AM PDT

When I’m having it, it’s really tight and uncomfortable. Maybe like a 5 out of 10. Right now it’s like a zero.

is the pain crushing ?

Question 03/25/20 10:43 AM PDT

No, it’s more tight and uncomfortable.

Am sorry about that. (No matching questions found.)

Question 03/25/20 10:44 AM PDT

Am sorry about that.

Empathize 03/25/20 10:44 AM PDT

Thanks. I appreciate that.

is the pain gnawing?

Question 03/25/20 10:44 AM PDT

No, it’s not like that. [AUDIO COMING SOON]

is the pain burning ?

Question 03/25/20 10:45 AM PDT

Not really.

is the pain aggravated by activity?

Question 03/25/20 10:45 AM PDT

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.

Thats understandable (No matching questions found.)

Question 03/25/20 10:46 AM PDT

Thats understandable

Empathize 03/25/20 10:46 AM PDT

Thanks. I appreciate that.

does eating make your pain get worse ? (Clarified to Do certain foods make the pain worse?.)

Question 03/25/20 10:47 AM PDT

I don’t think that has anything to do with it, but I guess I don’t know. (Clarified to if certain foods make the pain worse.)

does lying down help your pain?

Question 03/25/20 10:48 AM PDT

I’m not sure. I think lying still seems to help a little.

Have you taken medication for the pain?

Question 03/25/20 10:48 AM PDT

No, not yet.

Have you taken any anxiety medication?

Question 03/25/20 10:49 AM PDT

I’ve never taken anxiety meds. My life is pretty easy. [AUDIO COMING SOON]

Have you taken any medication?

Question 03/25/20 10:53 AM PDT

Yeah, let’s see, I take atorvastatin for cholesterol, metoprolol for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. [AUDIO COMING SOON]

True, that good for your cholesterol, continue taking it.

Educate 03/25/20 10:54 AM PDT

Good to know. Thank you.

What dosage of metoprolol do you take?

Question 03/25/20 10:56 AM PDT

I think it’s 100 mg, once a day.

what about the dose of atorvastatin medication? (No matching questions found.)

Question 03/25/20 10:57 AM PDT

what is the dose of atorvastatin medication?

Question 03/25/20 10:58 AM PDT

I think it’s twenty milligrams a day.

How long have you been taking atorvastatin and metoprolol? (No matching questions found.)

Question 03/25/20 10:58 AM PDT

How long have you been taking atorvastatin?

Question 03/25/20 10:59 AM PDT

I think about a year. [AUDIO COMING SOON]

How long have you taken metoprolol?

Question 03/25/20 10:59 AM PDT

I think it’s been about one year.

Are you allergic?

Question 03/25/20 11:01 AM PDT

No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.

Have you been diagnosed with hypertension?

Question 03/25/20 11:02 AM PDT

Yes, I supposedly have moderately high blood pressure.

Am sorry to hear this?

Empathize 03/25/20 11:02 AM PDT

Thanks. I appreciate that.

have you been told your cholesterol is high?

Question 03/25/20 11:03 AM PDT

I’ve been told it’s moderately high. I’ve never noticed any actual symptoms from that though.

Have you been tested for diabetes?

Question 03/25/20 11:04 AM PDT

My mom and my sister both have diabetes, but I don’t have it.

Did you have any treatment for chest pain?

Question 03/25/20 11:06 AM PDT

I don’t have any shortness of breath, just the chest pain.

Have you been monitoring your blood pressure?

Question 03/25/20 11:07 AM PDT

Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.

do you remember your last blood pressure readings?

Question 03/25/20 11:08 AM PDT

I don’t remember. I don’t think it was too bad, though.

have you done an EKG test recently?

Question 03/25/20 11:08 AM PDT

I had one about three months ago. They usually put one on me at my annual physical.

well, an EKG test is all about blood pressure monitoring.

Educate 03/25/20 11:09 AM PDT

Good to know. Thank you.

what was the result of the EKG?

Question 03/25/20 11:09 AM PDT

I don’t remember the actual results, but as far as I know, it was normal.

Do you have a primary care provider?

Question 03/25/20 11:10 AM PDT

Dr. Melinda Smith.

Great.

Educate 03/25/20 11:10 AM PDT

Good to know. Thank you.

When did you last visit your care provider?

Question 03/25/20 11:10 AM PDT

I had a physical about 3 months ago.

Do you have stress?

Question 03/25/20 11:11 AM PDT

Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.

Am sorry about this.

Empathize 03/25/20 11:11 AM PDT

Thanks. I appreciate that.

Do you exercise?

Question 03/25/20 11:12 AM PDT

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.

Am sorry that the chest pain makes you not exercise.

Empathize 03/25/20 11:13 AM PDT

Thanks. I appreciate that.

what is your typical breakfast?

Question 03/25/20 11:13 AM PDT

I usually have something. Most days I drink an instant breakfast, or I’ll have a granola bar. Sometimes Maria will make a big breakfast on weekends with eggs, pancakes, bacon, hash browns, that kind of stuff.

what is your typical lunch?

Question 03/25/20 11:14 AM PDT

There’s a sub shop near the office, so I usually get a turkey or Italian sub from there. Sometimes a salad if I’m feeling healthy . . . or guilty.

what is your typical dinner?

Question 03/25/20 11:14 AM PDT

My wife and I like to grill. We usually have some grilled meats and veggies for dinner.

do you take salt? (No matching questions found.)

Question 03/25/20 11:15 AM PDT

Do you drink water regularly?

Question 03/25/20 11:15 AM PDT

I usually drink water all day at work. At least four glasses, probably more. [AUDIO COMING SOON]

Its good to take water, continue.

Educate 03/25/20 11:16 AM PDT

Good to know. Thank you.

Do you smoke cigarettes?

Question 03/25/20 11:17 AM PDT

Nope, I had a lot of friends who did but I never started.

Do you take alcohol?

Question 03/25/20 11:17 AM PDT

I rarely drink during the week. If I drink at all it’s a couple beers on the weekend while I’m grilling or watching football. Maybe a little bourbon occasionally.

thats moderate drinking.

Educate 03/25/20 11:18 AM PDT

Good to know. Thank you.

Do you have fever?

Question 03/25/20 11:18 AM PDT

I haven’t had a fever, no.

do you have chills?

Question 03/25/20 11:18 AM PDT

I haven’t had chills, no.

Do you have fatigue?

Question 03/25/20 11:18 AM PDT

I’m not more tired than normal.

do you have night sweats ?

Question 03/25/20 11:19 AM PDT

Nope, no night sweats.

Do you feel dizzy?

Question 03/25/20 11:19 AM PDT

No, I haven’t felt dizzy.

Do you have palpitations?

Question 03/25/20 11:19 AM PDT

I don’t think so. I haven’t noticed any.

Have you had angina?

Question 03/25/20 11:20 AM PDT

I’ve never been diagnosed with angina. [AUDIO COMING SOON]

have you ever had edema?

Question 03/25/20 11:20 AM PDT

I haven’t noticed any swelling.

have you had blood clots?

Question 03/25/20 11:20 AM PDT

Not that I know of.

Any history of of rheumatic fever?

Question 03/25/20 11:21 AM PDT

No, I never had that.

do you have history of heart murmur?

Question 03/25/20 11:21 AM PDT

No, none that I know of.

do you have a cough?

Question 03/25/20 11:22 AM PDT

I don’t have a cough.

do you have difficulty breathing?

Question 03/25/20 11:22 AM PDT

My breathing’s fine.

Do you have orthopnea?

Question 03/25/20 11:22 AM PDT

Orthopnea? That sounds like the name of a weird bird. [AUDIO COMING SOON]

Well, Thats shortness of breath?

Educate 03/25/20 11:23 AM PDT

Good to know. Thank you.

Do you have shortness of breath?

Question 03/25/20 11:23 AM PDT

My breathing’s fine.

Do you have sore throat?

Question 03/25/20 11:24 AM PDT

I haven’t had a sore throat in a long time.

Do you have change in sense of taste?

Question 03/25/20 11:24 AM PDT

I can still taste things fine.

Do you have dysphagia?

Question 03/25/20 11:25 AM PDT

I haven’t had any trouble swallowing.

Do you have nausea?

Question 03/25/20 11:25 AM PDT

No, I haven’t felt nauseous. I just had pain in my chest.

do you have diarrhea ?

Question 03/25/20 11:28 AM PDT

I have, but it is very rare for me.

Do you have constipation?

Question 03/25/20 11:29 AM PDT

I haven’t had problems with that. I wish it were only that.

do you have heartburn or GERD?

Question 03/25/20 11:29 AM PDT

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.

Do you have a family history of heart attack? brian foster chest pain shadow health assessment Transcript

Question 03/25/20 11:30 AM PDT

Well, my mom’s dad died of a heart attack. He was pretty young too.

Do you have a family history of stroke?

Question 03/25/20 11:30 AM PDT

No, none that I know of.

Do you have a family history of pulmonary embolism?

Question 03/25/20 11:32 AM PDT

No, nobody had that.

Thank you Mr Foster for answering for answering my questions, I will now do the Physical examination. (No matching questions found.)

Question 03/25/20 11:34 AM PDT

Thank you Mr Foster for answering for answering my questions, I will now do the Physical examination. brian foster chest pain shadow health assessment Transcript

Educate 03/25/20 11:34 AM PDT

Good to know. Thank you.

 Auscultated over spleen brian foster chest pain shadow health assessment Transcript

Exam Action 03/25/20 1:19 PM PDT

 Palpated right carotid pulse: Thrill, 3+

Exam Action 03/25/20 1:21 PM PDT

 Palpated left carotid pulse: No thrill, 2+

Exam Action 03/25/20 1:21 PM PDT

 Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm

Exam Action 03/25/20 1:22 PM PDT

 Palpated right brachial pulse: No thrill, 2+

Exam Action 03/25/20 1:23 PM PDT

 Palpated left brachial pulse: No thrill, 2+

Exam Action 03/25/20 1:23 PM PDT

 Palpated right radial pulse: No thrill, 2+

Exam Action 03/25/20 1:25 PM PDT

 Palpated left radial pulse: No thrill, 2+

Exam Action 03/25/20 1:26 PM PDT

 Palpated right femoral pulse: No thrill, 2+

Exam Action 03/25/20 1:26 PM PDT

 Palpated left femoral pulse: No thrill, 2+

Exam Action 03/25/20 1:27 PM PDT

 Palpated right popliteal pulse: No thrill, 1+

Exam Action 03/25/20 1:27 PM PDT

 Palpated left popliteal pulse: No thrill, 1+

Exam Action 03/25/20 1:27 PM PDT

 Palpated right tibial pulse: No thrill, 1+ brian foster chest pain shadow health assessment Transcript

Exam Action 03/25/20 1:28 PM PDT

 Palpated left tibial pulse: No thrill, 1+

Exam Action 03/25/20 1:28 PM PDT

 Palpated right dorsalis pedis pulse: No thrill, 1+

Exam Action 03/25/20 1:30 PM PDT

 Palpated left dorsalis pedis pulse: No thrill, 1+

Exam Action 03/25/20 1:30 PM PDT

 Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

Exam Action 03/25/20 1:31 PM PDT

 Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

Exam Action 03/25/20 1:31 PM PDT

 Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

Exam Action 03/25/20 1:31 PM PDT

 Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

Exam Action 03/25/20 1:31 PM PDT

 Palpated right upper quadrant with deep pressure: No masses

Exam Action 03/25/20 1:32 PM PDT

 Palpated right lower quadrant: with deep pressure: No masses

Exam Action 03/25/20 1:32 PM PDT

 Palpated left lower quadrant with deep pressure: No masses

Exam Action 03/25/20 1:32 PM PDT

 Palpated left upper quadrant with deep pressure: No masses

Exam Action 03/25/20 1:32 PM PDT

 Palpated liver: Palpable 1 cm below right costal margin

Exam Action 03/25/20 1:33 PM PDT

 Palpated for spleen: Not palpable

Exam Action 03/25/20 1:34 PM PDT

 Palpated for right kidney: Not palpable

Exam Action 03/25/20 1:34 PM PDT

 Palpated for left kidney: Not palpable

Exam Action 03/25/20 1:34 PM PDT

 Tested skin turgor

Exam Action 03/25/20 1:34 PM PDT

 Percussed right upper quadrant

Exam Action 03/25/20 1:36 PM PDT

 Percussed right lower quadrant

Exam Action 03/25/20 1:36 PM PDT

 Percussed left upper quadrant

Exam Action 03/25/20 1:36 PM PDT

 Percussed left lower quadrant

Exam Action 03/25/20 1:36 PM PDT

 Percussed spleen

Exam Action 03/25/20 1:37 PM PDT

 Percussed for liver span: 7 cm in the mid-clavicular line

Exam Action 03/25/20 1:38 PM PDT

 Performed EKG

Exam Action 03/25/20 1:38 PM PDT

 Inspected left side of abdomen

Exam Action 03/25/20 1:43 PM PDT

 Inspected front of abdomen

Exam Action 03/25/20 1:46 PM PDT

 Inspected left side of abdomen

brian foster chest pain shadow health assessment Transcript

Exam Action 03/25/20 1:46 PM PDT