Focused Exam: Chest Pain, Brian Foster Shadow health transcript
Focused Exam: Chest Pain, Brian Foster Shadow health transcript
Transcript
Hello
Greet
04/15/23 1:09 PM EDT
Good morning.
What brings you in today?
Question
04/15/23 1:09 PM EDT
I have been having some troubling chest pain in my chest now and then for the past month.
Sorry for the chest problem
Empathize
04/15/23 1:10 PM EDT
Thanks. I appreciate that.
When did the chest pain start?
Question
04/15/23 1:11 PM EDT
I first noticed it earlier this month. I thought it might just be heartburn and it passed after a couple of minutes.
How is the pain like
Question
04/15/23 1:13 PM EDT
Well, it doesn’t hurt right now, but I have been having chest pain now and then for the past month.
Where is the pain located?
Question
04/15/23 1:13 PM EDT
When the pain happens, I feel it mostly in the middle of my chest, over my heart.
Does the chest pain radiate?
Question
04/15/23 1:14 PM EDT
The pain doesn’t radiate anywhere. It’s mostly just right in the middle of my chest.
Do you have back pain?
Question
04/15/23 1:15 PM EDT
I haven’t had back pain, no.
How frequent are the chest pains?
Question
04/15/23 1:16 PM EDT
Well, it has happened three times the past month. It usually goes away after about a couple of minutes.
What relieves the chest pain?
Question
04/15/23 1:17 PM EDT
I’m not sure. I think lying still seems to help a little.
What makes the pain worse
Question
04/15/23 1:17 PM EDT
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.
can you rate the pain on a scale
Question
04/15/23 1:18 PM EDT
I’d say maybe a . . . 5? It’s just really uncomfortable . . . like there’s nothing I can do about it. Right now it’s like a zero though.
Have you taken any medications for the chest pain
Question
04/15/23 1:20 PM EDT
No, not yet.
Which medications do you take currently (Clarified to What medications do you take?.)
Question
04/15/23 1:21 PM EDT
Yeah, let’s see, I take atorvastatin for cholesterol, lisinopril for blood pressure. . . Oh yeah, and I take fish oil too. I hear that’s good for your cholesterol. (Clarified to what medications I am taking.)
Thats good for your cholesterol, continue taking it
Educate
04/15/23 1:22 PM EDT
Good to know. Thank you. Focused Exam: Chest Pain, Brian Foster Shadow health transcript
Any allergies
Question
04/15/23 1:23 PM EDT
No, well . . . I’ve had a bad reaction to codeine before, but that is all I know of.
Any history of chronic illness?
Question
04/15/23 1:24 PM EDT
Besides a little high blood pressure and cholesterol, no.
Have you done EKG test recently?
Question
04/15/23 1:24 PM EDT
I had one about three months ago. They usually put one on me at my annual physical.
What were the results of the EKG?
Question
04/15/23 1:25 PM EDT
I don’t remember the actual results, but as far as I know, it was normal.
Do you have a primary care provider?
Question
04/15/23 1:25 PM EDT
Dr. Melinda Smith.
Great
Educate
04/15/23 1:26 PM EDT
Good to know. Thank you.
When did you last visit your care provider
Question
04/15/23 1:26 PM EDT
I had a physical about 3 months ago.
Any palpitations?
Question
04/15/23 1:27 PM EDT
I don’t think so. I haven’t noticed any.
Any history of heart illness? (Clarified to Do you have a history of heart problems?.)
Question
04/15/23 1:27 PM EDT
All I know is I have high blood pressure and cholesterol, but that’s pretty well-controlled by medicine as far as I know. (Clarified to if I have a history of heart problems.)
Do you feel stressed?
Question
04/15/23 1:28 PM EDT
Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.
I’m sorry about that
Empathize
04/15/23 1:28 PM EDT
Thanks. I appreciate that.
Do you have hypertension?
Question
04/15/23 1:29 PM EDT
Yes, I supposedly have moderately high blood pressure.
Do you exercise?
Question
04/15/23 1:29 PM EDT
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.
I’m sorry you’ve not been able to exercise
Empathize
04/15/23 1:29 PM EDT
Thanks. I appreciate that.
What is your typical diet
Question
04/15/23 1:30 PM EDT
I try to stay conscious of my diet. You know, I watch the fat. I watch the sodium . . . but I’m a dyed-in-the-wool carnivore too. Steaks and burgers find their way in there every once in a while.
Do you drink water regularly?
Question
04/15/23 1:30 PM EDT
I usually drink water all day at work. At least four glasses, probably more.
Do you smoke cigarette?
Question
04/15/23 1:31 PM EDT
Nope, I had a lot of friends who did but I never started.
Smoking is bad for the health
Educate
04/15/23 1:32 PM EDT
Good to know. Thank you.
Do you take alcohol? Focused Exam: Chest Pain, Brian Foster Shadow health transcript
Question
04/15/23 1:32 PM EDT
Sure, but never more than two or three beers on a weekend.
Do you feel fatigued?
Question
04/15/23 1:33 PM EDT
I’m not more tired than normal.
Any dizziness?
Question
04/15/23 1:33 PM EDT
No, I haven’t felt dizzy.
Do you have Angina?
Question
04/15/23 1:33 PM EDT
I’ve never been diagnosed with angina.
Do you have edema?
Question
04/15/23 1:34 PM EDT
I haven’t noticed any swelling.
Have you has blood clots?
Question
04/15/23 1:34 PM EDT
Not that I know of.
Any fever?
Question
04/15/23 1:35 PM EDT
I haven’t had a fever, no.
Do you cough?
Question
04/15/23 1:35 PM EDT
I don’t have a cough.
Any difficulty breathing?
Question
04/15/23 1:35 PM EDT
My breathing’s fine.
Any sore throat?
Question
04/15/23 1:35 PM EDT
I haven’t had a sore throat in a long time.
Do you have diarrhea?
Question
04/15/23 1:36 PM EDT
I have, but it is very rare for me.
Do you have constipation?
Question
04/15/23 1:37 PM EDT
I haven’t had problems with that. I wish it were only that.
Any heartburn?
Question
04/15/23 1:37 PM EDT
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.
Any family history of hear attack?
Question
04/15/23 1:37 PM EDT
No, nobody had that.
Have you been monitoring your blood pressure?
Question
04/15/23 1:38 PM EDT
Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.
Measured vitals
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04/15/23 1:39 PM EDT
Tested blood pressure in left arm with cuff
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04/15/23 1:39 PM EDT
Tested blood pressure in right arm with cuff
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Measured vitals
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Inspected face
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04/15/23 1:39 PM EDT
Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle
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04/15/23 1:40 PM EDT
Inspected anterior chest wall
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04/15/23 1:40 PM EDT
Inspected right side chest wall
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04/15/23 1:40 PM EDT
Inspected posterior chest wall
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Inspected left side chest wall
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04/15/23 1:40 PM EDT
Inspected left side of abdomen
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04/15/23 1:40 PM EDT
Inspected front of abdomen
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04/15/23 1:40 PM EDT
Inspected right hand: no visible abnormal findings
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04/15/23 1:41 PM EDT
Inspected left hand: no visible abnormal findings
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04/15/23 1:41 PM EDT
Inspected fingernails of left hand Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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04/15/23 1:41 PM EDT
Inspected right hand: no visible abnormal findings
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04/15/23 1:41 PM EDT
Inspected left hand: no visible abnormal findings
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04/15/23 1:41 PM EDT
Inspected fingernails of right hand
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04/15/23 1:41 PM EDT
Inspected left leg
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04/15/23 1:41 PM EDT
Inspected right leg Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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04/15/23 1:41 PM EDT
Inspected toenails on left foot
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04/15/23 1:41 PM EDT
Inspected toenails on right foot
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04/15/23 1:41 PM EDT
Inspected left leg
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04/15/23 1:41 PM EDT
Inspected right leg
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04/15/23 1:41 PM EDT
Inspected right leg for edema: No edema
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04/15/23 1:42 PM EDT
Inspected left leg for edema: No edema
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04/15/23 1:42 PM EDT
Checked capillary refill in fingernails
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04/15/23 1:42 PM EDT
Checked capillary refill in fingernails
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Checked capillary refill in fingernails
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04/15/23 1:42 PM EDT
Auscultated right carotid pulse: Bruit present
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04/15/23 1:43 PM EDT
Auscultated left carotid pulse
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04/15/23 1:43 PM EDT
Auscultated aortic area with the bell
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Auscultated aortic area with the diaphragm
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Auscultated pulmonic area with the diaphragm
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Auscultated pulmonic area with the bell
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Auscultated Erb’s point with the bell
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Auscultated Erb’s point with the diaphragm
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Auscultated tricuspid area with the diaphragm
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Auscultated tricuspid area with the bell
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Auscultated tricuspid area with the diaphragm
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Auscultated mitral area with the diaphragm
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Auscultated mitral area with the bell
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Auscultated breath sounds in anterior right upper lobe
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04/15/23 1:44 PM EDT
Auscultated breath sounds in anterior left upper lobe
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Auscultated breath sounds in anterior right middle lobe
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Auscultated breath sounds in anterior left mid-chest (upper lobe)
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Auscultated breath sounds in anterior right lower lobe
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04/15/23 1:44 PM EDT
Auscultated breath sounds in anterior left lower lobe
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Auscultated breath sounds in posterior left upper lobe
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Auscultated breath sounds in posterior right upper lobe
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Auscultated breath sounds in posterior left mid-back (lower lobe)
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Auscultated breath sounds in posterior right mid-back (lower lobe)
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Auscultated breath sounds in posterior left lower lobe
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04/15/23 1:45 PM EDT
Auscultated breath sounds in posterior right lower lobe
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Auscultated breath sounds in posterior left lower lobe on side
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Auscultated breath sounds in posterior right lower lobe on side
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Auscultated aorta in abdomen
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04/15/23 2:12 PM EDT
Auscultated right renal pulse
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04/15/23 2:13 PM EDT
Auscultated left renal pulse
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Auscultated right iliac pulse
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Auscultated left iliac pulse
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Auscultated right femoral pulse
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Auscultated left femoral pulse
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Auscultated right upper quadrant
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Auscultated left upper quadrant
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Auscultated right lower quadrant
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Auscultated left lower quadrant
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Auscultated over liver Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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Auscultated over spleen
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Palpated right carotid pulse: Thrill, 3+
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04/15/23 2:14 PM EDT
Palpated right carotid pulse: Thrill, 3+
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04/15/23 2:14 PM EDT
Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm
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04/15/23 2:15 PM EDT
Palpated right brachial pulse: No thrill, 2+
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Palpated left brachial pulse: No thrill, 2+
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Palpated right radial pulse: No thrill, 2+
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Palpated left radial pulse: No thrill, 2+
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Palpated right femoral pulse: No thrill, 2+
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04/15/23 2:16 PM EDT
Palpated left femoral pulse: No thrill, 2+
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04/15/23 2:16 PM EDT
Palpated right popliteal pulse: No thrill, 1+
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Palpated left popliteal pulse: No thrill, 1+
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Palpated right tibial pulse: No thrill, 1+
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Palpated left tibial pulse: No thrill, 1+
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04/15/23 2:16 PM EDT
Palpated right dorsalis pedis pulse: No thrill, 1+
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04/15/23 2:17 PM EDT
Palpated left dorsalis pedis pulse: No thrill, 1+
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Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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04/15/23 2:17 PM EDT
Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
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Palpated right upper quadrant with deep pressure: No masses
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04/15/23 2:18 PM EDT
Palpated left upper quadrant with deep pressure: No masses
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Palpated right lower quadrant: with deep pressure: No masses
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Palpated left lower quadrant with deep pressure: No masses
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Palpated liver: Palpable 1 cm below right costal margin
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Palpated for spleen: Not palpable
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04/15/23 2:19 PM EDT
Palpated for right kidney: Not palpable
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Palpated for left kidney: Not palpable
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Tested skin turgor
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Percussed right upper quadrant
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04/15/23 2:20 PM EDT
Percussed left upper quadrant
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Percussed right lower quadrant
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Percussed left lower quadrant
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Percussed spleen
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04/15/23 2:21 PM EDT
Percussed for liver span: 7 cm in the mid-clavicular line Focused Exam: Chest Pain, Brian Foster Shadow health transcript
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