HPI-Christine Smith is a 33 year old female that presents with 2 days of consistentdeep aching flank pain
that started out mild as she awakened and was
... [Show More] severe by theafternoon. The pain is a 8/10 in the general
region of the 12thrib on the right sideposteriorly. Nausea began after breakfast 2 days ago and she has
.vomited 3 x’s. Shehas loss of appetite
:Questions
- How can I help you today
- Do you have any other symtpoms or concerns we should discuss
- When did your flank pain start
- Does anything make your flank pain better or worse
- What does your flank pain feel like
- How sever (1-10) is your flank pain
- Are you taking any medications for your symtpoms
- Where more precisely is your flank pain
- Any change in your flank pain since it began
- Has there been a change in your urination frequency
- Does your flank pain radiate somepalace else? Where?
- Does your flank pain come and go
- Are you sexually active
- Is your urine pink or red in color
- Tell me about the health of your grandparents, parents …
- Do you havve any allergies
- Are your immunizations up to date
- Are you taking any prescription medications
- Are you taking any over-the-counter or herbal medications
- Is your period late
- When did your last period begin
- When did your fever start
- How high is your fever
- Do you have pain/ discomfort when you urinate
- Are you having any problems with your periods
- Can you tell me about any current or past medical problems...
- Any previous medical, surgical....
- Have you ever had abdominal surgyer
- When you urinate, have you noticed any pain, burning...
- Do you have any problems with gatigue, difficulty sleeping....
- Do you have any problems with an itchy scalp, skin changes...
- Do you have any problems with headaches that don’t go away with aspirin...
- Have you noticed any breast discharge, lumps....
- Do you experience chest pain discomfort or pressure...
- Do you experience shortness of breath, wheezing, difficulty catching your breath....
- Do you have problems with nausea, vomiting, constipation...
- Do you have problems with muscle or join pain, redness...
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- Have you noticed any bruising, bleeding gums...
- Do you have problems with heat or cold intolerance, increased thirst...
- Do you have problems with dizziness, fainting, spinning room...
Key findings
1. Recurrent bladder infections
2. Flank pain
3. Nausea/ vomiting
4. Fever
5. Tachycardia
DDx
:Physical Exam
- Fever, tachycardia, right CVA tenderness to percussion
o Temp 101F
o HR 114
o BP: supine 120/60
o RR: 14
o Cognitive : A and OX 4
- HEENT Neck: EOMI, normal visual fields, normal sclerae, Normal dentition, Pupils
- equally round and reactive to light with accommodation, Atraumatic.
- Eyelids: no ptosis erythema or swelling. Conjunctivae: pink, no discharge.
- Sclera: anicteric. Orbital area: no edema, redness, tenderness, or lesions noted.
- Neck: No visible scars, deformities, or other lesions. Trachea is midline and freely
- mobile. No asymmetry or accessory respiratory muscle use with quiet breathing.
- Respiratory: The anterior chest on the left and right lower chest are dull to percussion. [Show Less]