Helen McDonald 11/5/09 Thoracic/lung H.G. DOB: 10/28/77 CC: ! a" here #or a chec$u%.& HO'!

: '( i) a *2+,ear+old #e"ale -ho %re)en() (o (he clinic #or a -ellne)) .i)i(. '( )(a(e) her la)( chec$u% -a) in 2000. /O0: '( denie) di##icul(, 1rea(hing during )lee%2 nor"al ac(i.i(, and e3erci)e. '( denie) )noring -hen )lee%ing. '( )(a(e) no one ha) (old her )he )(o%) 1rea(hing a( nigh(. '( denie) che)( %ain2 coughing )%u(u" %roduc(ion or -hee4ing. '( denie) ga)(roin(e)(inal ),"%(o")2 hear(1urn2 #re5uen( hiccu%) or chronic cough. 'MH: '( denie) %rior re)%ira(or, %ro1le")2 (horacic )urger,2 1io%), or (rau"a. '( ha) 1een (e)(ed #or allergie) in 2006 and -a) #ound (o ha.e no en.iron"en(al allergie). '( ha) had her in#luen4a .accine Oc(o1er o# 2009. '( had a ''D 0e%(e"1er o# 2009 and -a) #ound (o 1e nega(i.e #or TB. '( denie) ha.ing a che)( 3+ra, or o(her %ul"onar, )(udie) in (he %a)(. '( )(a(e) her onl, (ra.el ou()ide o# (he 7ni(ed 0(a(e) -a) in 1999 (o Canada. '( denie) con(ac( -i(h an,one -i(h 08/0. '( )(a(e) )he i) a #or"er )"o$er and 5ui( -i(h (he di)co.er, o# her #ir)( %regnanc, in 2000. '( )(a(e) )he )"o$ed .5+1 %ac$ o# cigare((e) %er da,. '( )(a(e) )he -a) a -ai(re)) 1e#ore 1eco"ing a nur)e and -a) e3%o)ed (o )"o$e. 9H: '( denie) #a"il, hi)(or, o# lung Ca or o(her lung di)ea)e. '( )(a(e) her "o(her )"o$e) in her o-n ho"e and a.oid) )"o$ing around (he %a(ien( -hen )he .i)i(). '( denie) #a"il, hi)(or, o# o(her %ul"onar, illne))e)/di)order) in (he #a"il,. :i#e)(,le and heal(h %rac(ice): '( )(a(e) )he i) a #or"er )"o$er and 5ui( -i(h (he di)co.er, o# her #ir)( %regnanc, in 2000. '( )(a(e) )he )"o$ed .5+1 %ac$ o# cigare((e) %er da,. '( )(a(e) )he -a) a -ai(re)) 1e#ore 1eco"ing a nur)e and -a) e3%o)ed (o )"o$e. '( denie) an, re)en( e3%o)ure (o )"o$e. '( )(a(e) her curren( )(re)) i) her #a"il,2 )chool and -or$. '( )(a(e) (hi) )(re)) ha) no a##ec( on her 1rea(hing. '( denie) an, curren( "edica(ion) #or 1rea(hing. '( )(a(e) )he (a$e) one "ul(i.i(a"in dail,. '( denie) (a$ing an, o(her %re)cri%(ion) or o.er (he coun(er "edica(ion). '( denie) u)e o# alcohol and illici( drug u)e. 'h,)ical a))e))"en( General: ;o na)al #laring2 %ur)ed li% 1rea(hing no(ed. %( ha) e.enl, colored )$in. ;o c,ano)i) i) no(ed. The %a(ien(<) nail1ed) are %in$ -i(h a 1=0+degree angle no(ed. 'o)(erior/%o)(erior (hora3: The )ca%ulae are ),""e(ric and no %ro(ruding. The )houlder) and )ca%ulae are ar e5ual hori4on(al %o)i(ion). The an(ero%o)(erior (o (ran).er)e dia"e(er i) 1:2. The )%inou) %roce))e) are )(raigh(. Thora3 a%%ear) ),""e(ric -i(h ri1) )lo%%ing

do-n-ard a( a 65+degree angle. The )(ernu" i) "idline and )(raigh(. ;o re(ra(ion) are no(ed. (he co)(al angle i) -i(hin 90>degree). 7)e o# acce))or, "u)cle) i) no( no(ed. The %a(ien( i) )i((ing erec( and rela3ed2 1rea(hing ea)il, -i(h ar") a( )ide). /e)%ira(ion) are rela3ed2 e##or(le)) and 5uie(. /egular rh,(h" i) no(ed -i(h re)%ira(or, ra(e o# 18 %er "inu(e. 7%on %al%a(ion no (enderne))2 %ain2 or unu)ual )en)a(ion) no(ed. 0$in (e"%era(ure i) no(ed (o 1e e5ual 1ila(erall,. ;o cre%i(u)2 le)ion) or "a))e) no(ed. 9re"i(u) i) no(ed (o 1e ),""e(rical and e5ual (o 1ila(eral %o)i(ion). Che)( e3%an)ion i) no(ed (o 1e ),""e(rical and a1ou( 5+10c". 7%on %ercu))ion re)onance i) no(ed o.er lung (i))ue. Dia%hrag"a(ic e3%an)ion i) no(ed (o 1e 5.5c" on (he righ( and 5c" on (he le#(. 7%on a)cul(a(ion 1ronchial 1rea(h )ound) are no(ed o.er (he (rachea and (hora3 and are no(ed (o 1e )hor( during in)%ira(ion and long on e3%ira(ion. Broncho.e)icular 1rea(h )ound) are no(ed 1e(-een (he )ca%ulae and are no(ed (o 1e e5ual in dura(ion on in)%ira(ion and e3%ira(ion. ?e)icular 1rea(h )ound) are no(ed in (he %eri%heral lung #ield) and are no(ed (o 1e long on in)%ira(ion and )hor( on e3%ira(ion. Dullne)) i) a)cul(a(ed o.er (he li.er and (,"%an, o.er (he )(o"ach an(eriorl,. ;o ad.en(i(iou) )ound) are no(ed. Broncho%hon, i) %re#or"ed and (he %( a)$ed (o )a, nine(,+nine&. The .oice )ound i) a)cul(a(ed in (he lung #ield) a) "u##led )o#( and indi)(inc(. @go%hon,: (he %( i) a)$ed (o re%ea( (he le((er @&. The .oice )ound i) au)cul(a(ed a) a )o#( "u##led di)(ingui)ha1le e )ound in all lung #ield). Ahi)%ered %ec(orilo5u,: (he %( re%ea() one2 (-o2 (hree&. The .oice au)cul(a(ed i) .er, #ain( and "u##led in all lung #ield). ;D: Heal(h+)ee$ing 1eha.ior) r/( i"%ro.ing re)%ira(or, )(a(u) 8@B %( )(a(e) )he -a)n<( in#or"a(ion on e3erci)e. /i)$ #or ine##ec(i.e heal(h "ain(enance r/( no( recei.ing (he H1;1 .accine 8@B 'MH.