12/19/2023 0 Comments Step 2 cs practice cases■ Myocardial ischemia or infarction: The patient has multiple cardiac risk factors, including smoking, hypertension, and hyperlipidemia, and his symptoms are classic for cardiac ischemia. Heart: Apical impulse not displaced RRR normal S1/S2 no murmurs, rubs, or gallops.Ībdomen: Soft, nondistended, nontender, © BS, no hepatosplenomegaly Extremities: No edema, peripheral pulses 2+ and symmetric. VS: BP 165/85 mm Hg (both arms), RR 22/minute.Ĭhest: No tenderness, clear symmetric breath sounds bilaterally. No regular exercise poorly adherent to diet.įH: Father died of lung cancer at age 72. Occasional EtOH, occasional cocaine for 10 years (last used yesterday afternoon). SH: 1 PPD for 25 years stopped 3 months ago. GERD 10 years ago, treated with antacids. PMH: Hypertension for 5 years, treated with a diuretic. Pain during these episodes was less severe, lasted for 5-10 minutes, and disappeared spontaneously or after taking antacids. These episodes were precipitated by walking up the stairs, strenuous work, sexual intercourse, and heavy meals. Similar episodes have occurred during the past 3 months, 2-3 times/week. Nausea, sweating, and dyspnea are also present. The pain woke the patient from sleep at 5:00 a.m. with a steady 7/10 pressure sensation in the middle of his chest that radiated to the left arm, upper back, and neck. The pain started 40 minutes before the patient presented to the ED. In the meantime, I strongly recommend that you stop using cocaine, since use of this drug can lead to a variety of medical problems, including heart attacks. We will start with an ECG and some blood work, but more complex tests may be needed as well. It is crucial that we perform some tests to identify the source of your problem. Short, the source of your pain can be a cardiac problem such as a heart attack or angina, or it may be due to acid reflux, lung problems, or disorders related to the large blood vessels in your chest. □ Examinee asked if the SP had any other questions or concerns. □ Lifestyle modification (diet, exercise). □ Examinee discussed initial management plans: □ Examinee discussed initial diagnostic impressions. □ Examinee did not repeat painful maneuvers. □ Examinee asked permission to start the exam. □ Examinee recognized the SP’s emotions and responded with PEARLS. □ Examinee elicited data efficiently and accurately. □ Examinee summarized the SP’s concerns, often using the SP’s own words. □ Examinee asked the SP to list his/her concerns and listened to the response without interrupting. □ Examinee asked an open-ended question and actively listened to the response. □ Examinee correctly used patient’s name. □ Examinee identified his/her role or position. □ Examinee knocked on the door before entering. We need to learn more about what’s going on to know if your pain is life threatening.”īuilding the Doctor-Patient Relationship Entrance “As you suspect, your symptoms are of significant concern. “Is this a heart attack? Am I going to die?” ■ If ECG is mentioned by the examinee, ask, “What is an ECG?” ■ Place your hands in the middle of your chest. Write the patient note after leaving the room. Explain your clinical impression and workup plan to the patient.Ĥ. Perform a focused physical exam (do not perform rectal, genitourinary, or female breast exam).ģ. Joseph Short, a 46-year-old male, comes to the ED complaining of chest pain.Ģ. First Aid for the USMLE Step 2 CS Section 4.
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