Mr. S Case Study

Mr. X is a 46-year-old, Latino-American, married male who was referred for an psychological evaluation by his physician for numerous health concerns that are mostly unfounded. Mr. X was oriented times three.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

Mr BW was a 74-year-old man who had a fall due to a new onset of seizures, which resulted, to a direct impact of his head on the ground while at home. While at the hospital, MR BW underwent a CT and MRI brain scan and showed a haematoma, which resulted to commencing of the patient on Keppra and Bezodiapenes. Moreover, Mr BW also developed a sudden onset of pleuretic chest pain, which was confirmed by CTPA as a small pleural effusion on the left lungs; while there was also pulmonary embolism on both upper and lower lobes of the left lung. Due to the development of a provoked pulmonary embolism, patient commenced on Clexane injection. In September 2015, an elective open abdominoperineal resection was performed on Mr BW, which resulted to prolonged stay in the hospital due to delayed wound healing.

The patient is a 76-year-old Hispanic gentleman brought to the ED by his wife because the patient has been anxious for 2 weeks and now unable to sleep much of the night. He denies any chest pain but has had on-and-off palpitations that seemed not to be related to activity or a particular time of day. He denies any shortness of breath, lightheadedness or loss of consciousness. He had two episodes of syncope three years ago. He was diagnosed with having an MI. He was at that time treated at St. Mary's Hospital in Passaic and underwent cardiac catheterization and he has had some stenting done to his coronary arteries. He saw his PMD approximately a week ago who prescribed some sleeping medicine and neurology consult which the patient has

Mr. Howard, a 57-year-old man, had a 3-month history of progressive typical anginal chest pain. He reported that the symptoms first occurred with heavy exertion and involved what he described as“heaviness” in his chest. The symptoms were promptly relieved with rest. Over the past weeks, he had been experiencing increasingly frequent episodes of chest pain and diaphoresis. The episodes had become more prolonged, and he had experienced one episode of pain occurring at rest after a heavy meal. Mr. Howard was moderately obese and had a 20-year history of hypertension, which was being treated. Other risk factors in Mr. Howard’s history include hypercholesterolemia (350 mg/dL), which he was attempting to treat with dietary modifications, and a 30-year two-pack-a-day smoking history which continued up to the present time. Mr. Howard previously had surgery for a bilateral inguinal hernia repair, cholecystectomy, and arthroscopic surgery on his left knew. He also gave a history of problems with gastric reflux and was currently taking cimetidine (Tagamet).

We present a case of 51-year-old male who presented to emergency room with complaints of typical chest pain.

He reported that he had a cardiac cath done at Tampa General Hospital this year with no intervention. He has had a history of hypertension since the age of 19. He was not adherent to medications, but for the last three years, he has been adherent to all his medical care. No history of stroke or peripheral vascular

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

c. 34 years old male who complained of shortness of breath. He was obese and had a history of COPD. He was on two liters nasal cannula. After admitting at the ER, he was tranfered to med-surge floor for further evaluation.

The patient is 66 year-old male who is brought to St. Joe's ER by BLS after being found with altered mental status at home. The patient reports he used heroin 2 days prior to admission. The patient was found by his brother hallucinatin with bladder or bowel incontinence the morning of presentation. The patient has not eating in approximately 4 days. The patient himself denies having any complaints, but he is a very poor historian. His medical history is significant for prior heroin and cocaine abuse, alcohol abuse of unknown duration, hypertension, cirrhotic liver, he has had an anterior cervical discectomy of C5-C7 with anterior compression in May of 2012 and a closed reduction of C6-C7 billateral dislocation , cholecystectomy in the

The patient is a 52-year-old gentleman who did restart his lisinopril/hydrochlorothiazide, which he had run out of previously. He continues on his amlodipine 10 mg one p.o. daily. He tolerates these medications well. He does have a history of nephrolithiasis. His blood pressure has been well controlled at home.

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

The patient is a 51-year-old gentleman who was recently hospitalized from the 8/10-8/14, at which time he was admitted because of dizziness. He had a complete workup. He represents to the ED with the same complaint of dizziness. Medical history is significant for diabetes, hypertension, coronary disease, end-stage renal disease on hemodialysis, peripheral arterial disease (he had CABGs done. On this admission he undergoes to repeat testing. It was the feeling that the previous admission the patient was diagnosed with vasodepressive syncope and was placed on Metropolol ,as well as his Florinef. He claims he has been taking the medicine. The symptoms have not improved. The neurology consult done shortly after admission. It is the the