Week 9 I-human Interview: Patient with a Rash

Week 9 I-human Interview: Patient with a Rash

Week 9 I-human Interview

Week 9 I-human Interview: Patient with a Rash

  1. How can I help you today? I haven’t been feeling great lately, I feel really tired. I’ve had a rash on my face for about a month. I have also felt feverish, and my hands and knees have really been stiff and hurting.
  2. Any other symptoms/concerns we should discuss? Yeah, now my chest’s been hurting, and I’ve been feeling kind of short of breath. I don’t know what is happening! I must sound like a total mess! I sure feel that way.
  3. Do you have pain anywhere, if so, where? Yeah, both my hands and my knees hurt a lot. I also have some pain my chest. But I think I told you all that.
  4. When did your fatigue/tiredness start? About 2 weeks ago.
  5. What are the events surrounding the start of your rash? Well, I was in FL. It was sunny and I was on the beach a lot. At first I thought I got a sunburn, but it is just over my cheeks and nose, maybe a bit of forehead and doesn’t look or act like a sunburn.
  6. Are you using any new lotions or soaps? No.
  7. Have you ever been exposed to poison ivy/oak/sumac? No.
  8. How severe is your rash? I don’t know how to answer that question. I call it severe since everyone can see it on my face and it sure isn’t normal.
  9. Is your rash painful or itchy? No, it is not painful but sometimes it does seem itchy, especially if I get a lot of sun. Week 9 I-human Interview: Patient with a Rash
  10. Have you ever had rashes like this before? I think so… I remember something like this. It happened when I had been in the sun.
  11. Does your rash come and go? No, the rash is there all the time.
  12. Is there a pattern to when your rash occurs? I’m not sure what you mean because it hasn’t gone away since it started.
  13. What treatments have you had for your rash? Nothing, really.
  14. On what part of your body did the rash start and where did it spread? It started on my cheeks and over my nose, and kind of on my forehead. Now I seem to have it on the lower part of my arms and on my upper chest.
  15. Does your rash have a central clearing? I don’t think so. What’s that?
  16. When did your fever start? It is really hard to remember, but I think about 2 weeks ago.
  17. Does your fever come and go? Yeah, I guess so.
  18. Is your fever better/worse at any time day, week, or year? I can’t tell.
  19. What treatments have you taken for your fever? I’ve been taking Tylenol and it helps for a short time, and then my fever comes back. I haven’t tried anything else. Do you think I ought to try aspirin instead?
  20. When did you first notice feeling short of breath? About 2 weeks ago
  21. How long does your short of breath last? It depends.
  22. Does anything make your short of breath better or worse? Yes definitely.
  23. Do you become SOB with exertion? Yes, how did you know? I feel especially SOB if I walk more than a block or go up stairs.
  24. Are you short of breath when lying down? No
  25. Are you SOB at rest? No. But, the other day my breathing got worse after laughing. That was really weird.
  26. Has there been any changes in SOB over time? Yes.
  27. Does lying on one side or the other increase the SOB? No.
  28. When did your chest pain first start? The chest pain was the last thing to start. Maybe a couple of days ago? At first it was really mild, but now it’s impossible to ignore.
  29. What are the events surrounding the start of your chest pain? I can’t think of any particular event. It just seems that since getting back from Florida, it’s been one thing after another with me.
  30. Does anything make your chest pain better or worse? It happens when I take a deep breath. I guess it’s a little better if I sit up.
  31. What does the pain/discomfort in your chest feel like? It’s a sharp stabbing like pain. I’m really worried.
  32. Is your pain superficial or deep? It seems to come from deep inside.
  33. Does the pain in your chest radiate to somewhere else? If so, where? Like do I feel it somewhere else? No.
  34. Does your chest pain come and go? Yes
  35. What treatments have you had for the chest pain? I haven’t really tried anything for my chest pain. Do you have a recommendation?
  36. How long does the chest pain last? For a few seconds after I take a deep breath or cough to clear my throat.
  37. How severe is the pain in your chest? Now? At least a 7, sometimes more.
  38. When did the pain in your hands start? About 2 weeks ago.
  39. Does anything make your pain better or worse? Well, it’s worse when I try to grab a glass or open a door. Tylenol doesn’t do much.
  40. Do you have pain/discomfort at rest? Yes.
  41. How quickly does the pain come on? It’s there all the time.
  42. Have you had this pain in your hands before? No, I don’t think so.
  43. Was there a popping sensation? No.
  44. Events surrounding knee pain? I have no idea. I mean I haven’t done anything I know to hurt myself or anything like that.
  45. Does the pain in your knee come and go? No.
  46. Pain superficial or deep? It seems to come from deep inside.
  47. What does the pain feel like? Like an ache.
  48. When did the pain in your knees start? About 2 weeks ago.
  49. How severe? Not as bad as the chest pain. Maybe a 3/10.
  50. Do you have any problems with movement? No, not really, despite the stiffness.
  51. Tell me about any current or past medical problems. I’ve always been super healthy! I used to get a lot of colds when I was little, but I think I outgrew all that.
  52. Have you ever had chicken pox, measles, mumps, or rheumatic fever? Nope.
  53. Have you ever been diagnosed with an autoimmune disease? No. I’m not totally sure what that is.
  54. Do you have a history of Wegner’s? No
  55. Do you have a history of SLE? No
  56. Any previous medical/surgical/dental procedures? No. Well I get my teeth cleaned, but that really isn’t a procedure, I guess.
  57. Have you ever been hospitalized? Never
  58. Have you ever had any significant injuries or accidents? Nope
  59. Do you have any allergies? Not that I know of.
  60. Do you take any prescriptions? No
  61. Are you taking any OTC medications or herbal remedies? Yea, I’m taking Tylenol.
  62. Aspirin/NSAIDs? How much and how often? I don’t take that
  63. How much of your medication did you take? I never take more than one tablet of Tylenol at a time. I think that’s 500mg.
  64. Have you changed your caffeine intake? No.
  65. Are you using any form of birth control. No.
  66. Are your immunizations up to date? Yeah, sure, and I had the flu vaccination this year.
  67. Do you perform self breast examination? Yes.
  68. Have you ever had a pap smear? Yes. The last one was fine. I’m not due for another year.
  69. Have you recently traveled? Where did you go? Yeah. I was in Florida around 4 weeks ago.
  70. Have you had any contact with sick people? No.
  71. Tell me about the health of your grandparents, parents, and children. Parents are really healthy. All grandparents are still alive. Siblings are healthy.
  72. Are there any diseases that run in your family? No
  73. Tell me about your work. I’m a part time student and get part time jobs now and then.
  74. Do you drink alcohol? No, every time I’ve tried it, I hate the feeling.
  75. Use Recreational drugs? No
  76. Smoke/chew tobacco? No
  77. IV drugs? No
  78. Any diet changes since your last appointment? What? Why are you asking this?
  79. Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss/gain, fevers, night sweats? Some of that. No problems with sleeping or weight though.
  80. Do you have any problems with itchy scalp, skin changes, moles, thinning hair, brittle nails? Other than this rash? None of that. I don’t normally have skin problems.
  81. Do you have any problems with headaches that don’t go away with aspirin or Tylenol, double/blurred vision, difficulty w/ night vision, problems hearing, ear pain, sinus problems, chronic sore throats, difficulty swallowing? Wow. That’s a big long list. I have a lot wrong with me, but none of that at least. Week 9 I-human Interview: Patient with a Rash
  82. Have you noticed any breast discharge, lumps, scaly nipples, pain, swelling or redness? No
  83. Do you experience chest pain discomfort/pressure, pain/pressure/dizziness with exertion or getting angry; palpitations; decreased exercise tolerance; blue/cold fingers and toes? I already told you about the chest pain and I don’t have any of that other stuff.
  84. Do you experience SOB, wheezing, difficulty catching your breath, chronic cough, sputum production? I think I told you about the breathing stuff. Do you need to know more? I don’t have a cough.
  85. Do you have problems with N/V, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your BMs, early satiety, bloating? No digestive problems. I guess I can be grateful for that at least.
  86. When you urinate, have you noticed pain, burning, blood, difficulty starting/stopping, dribbling, incontinence, urgency during day/night, or any changes in frequency? Blood? Oh my, no. Thank God I at least don’t have any of those problems.
  87. Do you have problems with muscle/joint pain, redness, swelling, muscle cramps, joint stiffness, joint swelling/redness, back pain, neck/shoulder pain, hip pain? All kinds of joint pain. Did I tell you about that?
  88. Have you noticed any bruising, bleeding gums, nose bleeds, or other sites of increased bleeding? No
  89. Do you have any of the following heat/cold intolerance, increased thirst, increased sweating, frequent urination, change in appetite? No
  90. Do you have any of the following dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, tremor? No
  91. Do you have any problems with nervousness, depression, lack of interest, sadness, memory loss, or mood changes, or ever hear voices or see things that you know are not there? Voices? Are you serious? And I’m not a hypochondriac or a drama queen!
  92. Tell me about your diet. Seems normal to me.
  93. Are you sexually active? No, I haven’t been in a relationship for quite a while, but that’s sort of private anyway.
  94. Do you have medical insurance? Yes
  95. Where do you live? I live at home with my parents.
  96. Have you noticed swelling in any part of your body? Yes.
  97. Do you have inflammation in one or more of your joints? Same as swelling?

Physical Examination (Week 9 I-human Interview: Patient with a Rash)

Skin– Erythematous, raised, confluent rash over cheeks (malar distribution) and forehead; sparing of nasolabial folds. Similar rash affecting forearms and upper/anterior chest.

Hair- Thickness and distribution pattern atypical for patient gender and age.

Nails- Nails normal, no clubbing. Capillary refill normal in fingers/toes.

HEENT-

Head: No visible scaliness, edema, masses, lumps, deformities, scars, rashes, nevi or other lesions. Non-tender

Face: Erythematous, raised, confluent rash over cheeks (malar distribution) and forehead.

Eyes: No ptosis erythema or swelling. Pink conjunctivae, no discharge. Sclera anicteric. Orbital area-no edema, redness, tenderness, or lesions noted. Visual acuity 20/20 bilaterally.

Ears: Normal appearing external structures. No deformities or edema. No discharge noted. Normal appearing external auditory canals. Tympanic membrane translucent, non-injected, and pinkist gray in color. No scarring, discharge, or purulence noted. Normal landmarks. Normal mobility with inflation.

Nose: No discharge or polyps. No edema or tenderness over the frontal or maxillary sinuses.

Mouth: No oral mucosal lesions. No tonsillar injection or exudate.

Neck: No visible scars, deformities, or lesions. Trachea is midline and freely mobile. No asymmetry or accessory respiratory muscle use with quiet breathing. Thyroid firm, an acceptable size for patient gender and age. No nodules palpated. Normal swallowing. Thyroid moves with swallowing. Full ROM. Normal JVP.

Breast: Normal breast exam. Breasts and nipples are non-tender. There are no masses, lumps, deformities, ulcerations, or discharge.

Lymph: Bilateral distribution of palpable, small (<1cm), soft, mobile, nontender lymph nodes in cervical, axillary, and inguinal.

Chest/Lungs: Normal respiratory effort and excursion at rest. Bilateral guarding w/ deep inspiration. Raised erythematous rash on upper anterior chest in a V-distribution. Nontender to palpation of costochondral joints, or thorax in general. Normal tactile fremitus. Thorax normal to percussion.

Heart: PMI 5th ICS MCL.

Gastrointestinal: Abdomen is flat and symmetric with no scars, deformities, striae, or lesions. Abdomen lean, nondistended. Soft, nontender throughout. Spleen tip palpable. No hepatomegaly or palpable mass. No tympany or shifting dullness.

Extremities: Erythematous, raised, confluent rash over forearms. Symmetric swelling and erythema of the metacarpophalangeal and proximal interphalangeal joints. Bilateral anterior knee swelling. Symmetric edema and tenderness of the metacarpophalangeal and proximal interphalangeal joints. Small bilateral knee effusions. +1 Bilateral pitting edema of the level of the knees.

MS: Normal bulk and tone. No rigidity. No asymmetry or deformity of the back. No tenderness or spasm of the paraspinal muscles. No localized tenderness of the spinous processes or pelvic structures. Nontender to percussion. Reduced active ROM: MCPs, PIPs, and knees due to tenderness, not obstruction. Normal stability. Strength is 5/5 bilaterally. Week 9 I-human Interview: Patient with a Rash

Vascular: Normal ABI.

Neuro: CN I-XII intact. Normal balance test. Normal gait and posture. Normal bulk and tone. No rigidity. No involuntary movements noted. Reduced active ROM: MCPs, PIPs, and knees due to tenderness, not obstruction. DTR @+ bilaterally triceps, biceps, brachioradialis, knee/patella, and ankle/achilles. Light tough, pain, temperature, vibration, and proprioception are grossly intact.

GU: Normal external genitalia. No masses or tenderness. Normal pelvic exam.

Rectal: No visible fissures, induration or lesions. Normal sphincter tone. No masses or tenderness. Guaiac negative.