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FACTS/PROBLEMS FACTS/PROBLEMS

HYPOTHESES
-Pericarditis -Atrial Septal Defect/Ventricular Septal Defect -Endocarditis -Pneumonia -Drugs (cocaine) -MI -Trauma (stabbing?) -Costocondritis -Cardiac Tamponade -Aortic Dissection -GERD -Stable/Unstable Angina -Pulmonary Embolism -Asthma -WPW

NEED TO KNOW
-HPI: Onset: Ill/Tired during school yesterday. Awoke this morning with chest pain Extremities: Inguinal adenopathy Assoc. Symp: Fever, chills, SOB, dizziness -CBC Quality: Sharp, severe, constant -Blood culture (sepsis) Aggrav. Fact: (can show an -EchocardiographyTaking a deep breath, lying down enlarged pericardium) Allev. Fact: Sitting up, leaning forward Radiation: Shoulders -PMH: Illnesses: Atopic dermatitis, skin infections in knees, URI 7 days ago Medications: Hydrocortisone cream Immunizations: Up to date Surgeries/Hospitalizations: None -PP: 11th grade at Iolani, hardworking student, paddles, not sexually active, doesn’t smoke, drink alcohol, or use illicit drugs, parents are lawyers -Gen App:

LI’S
-DDX for sharp central chest pain in 16 year olds -N9 Pericarditis (explain cardiac findings, mention constrictive pericarditis) -N9 Cardiac Tamponade (what is pulsus paradoxicus? Explain pericardiocentesis) -Atopic Dermatitis (brief overview. Pertain to paddlers? Explain skin PE findings) -Hydrocortisone cream (What is it? What does it do? Dosage? What is BID?) -SLE (systemic lupus erythematosus) What is Antinuclear Antibody (dilutions?)? -What microorganisms cause URIs? -CBC: Explain the differential WBC count (band forms? Segmented neutrophils? Etc.) -Microbio of Staph aureas in relation to pericarditis; MRSAs; Pharm of vancomycin -Explain pericardial fluid analysis -Anatomy of the pericardium -How do you decrease the risk of malpractice lawsuits -Pharm of methicillin

-16 yo -Caucasian -Female -Single -Brought to ER by parents -CC “sharp pain in the center of chest”

HYPOTHESES

NEED TO KNOW

LI’S

-VS: T: 40C RR: 26/min P: 110 BP: 100/70mmHg -PE: Skin: tan, course, flaking, atrophic, shiny, superficial vessels more apparent, no nodules, petechiae, roth hemorrhages HEENT: Normal Neck: JVD apparent Lungs: Clear (no wheezes. Crackles, or ronchi) Cardiac: Soft and distant sound, friction rub Abdomen: Muscular, soft to palpation

Pharm of vancomycin. what is it?) What is Antinuclear Antibody (dilutions?)? -JIN: Atopic Dermatitis (brief overview. Explain pericardial fluid analysis. and cephalosporins don’t work). Hydrocortisone cream (What is it? What does it do? Dosage? What is BID?).LI’S (cont’d) -KRISTEN: N9 Pericarditis (explain cardiac findings.) . SLE (systemic lupus erythematosus. Pertain to paddlers? Explain skin PE findings). CBC: Explain the differential WBC count (band forms? Segmented neutrophils? Etc. Briefly. Pharm of methicillin -ASH: Anatomy of the pericardium. mention constrictive pericarditis) -MARN: N9 Cardiac Tamponade (what is pulsus paradoxicus? Explain pericardiocentesis) -TREVOR: Microbio of Staph aureas in relation to pericarditis. How do you decrease the risk of malpractice lawsuits. MRSAs (why methicillin. penicillin.

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