FLORENCE BLACKMAN IHUMAN CASE STUDY 66 YEAR -OLD FEMALE –
CHEST PAIN 2-ALL VERSIONS
Student Worksheet for iHuman Case Debrief Think about the clinical presentation that you would expect for each diagnosis. What signs & symptoms did the patient present with that were consistent with/expected for that diagnosis? (Include history findings (HPI, ROS, SH, FH, PMH), physical exam findings, and diagnostic tests). What history/signs/symptoms/diagnostics would you expect for that diagnosis that was lacking?
DIAGNOSIS: Unstable Angina
Pertinent Positives List the Findings Rationale Subjective findings
(HPI, ROS, PMFSH)
• Constriction in middle of chest • Chest discomfort started during exercise.• Pain radiating to left arm • Shortness of breath • History of hypertension • History of hyperlipidemia • History of smoking • Diagnosis of coronary artery disease • Stressful work environment • Family history of heart • These symptoms that the patient experienced are associated with unstable angina. The risk factors also align with the diagnosis of unstable angina.
disease Objective findings (Physical Exam & Diagnostics) • Lipid profile showed a cholesterol level of 200 and an HDL of 45 • No evidence of cardiomegaly seen on CXR • No evidence of ischemia seen on 12 lead ECG • Troponin was not elevated • TEE showed no evidence of structural or functional abnormality • CK-MB was not elevated • BMP was normal • CBC was normal • The findings of the lipid profile show an elevated cholesterol and unchanged HDL after six months of lipid lowering therapy. This finding can contribute to the cause of unstable angina. The other diagnostics showed negative findings which rules out other diagnoses.Pertinent Negatives
Subjective findings
(HPI, ROS, PMFSH)
• Pain was not relieved by rest but started during rest.• Chest pain lasted for 10 minutes • Unstable angina is known to occur with exertion and cease with rest, so this is an abnormal finding when considering this diagnosis.• The chest discomfort that occurs with unstable angina lasts for 2-5 minutes, so this is an abnormal finding for this diagnosis.Objective findings (Physical Exam & Diagnostics) • N/A • There were no findings during the physical examination or diagnostic tests that ruled out unstable angina.
Why did you ultimately rule in this diagnosis?I chose this diagnosis due to the fact that the diagnostic tests were unremarkable except for the lipid profile. With this knowledge and knowing the symptoms that the patient is experiencing, a myocardial infarction can easily be ruled out for the patient.
DIFFERENTIAL DIAGNOSIS #1: Myocardial Infarction
Pertinent Positives List the Findings Rationale
Subjective findings
(HPI, ROS, PMFSH)
• Constriction in middle of chest • Chest discomfort started during exercise.• Pain radiating to left arm • Shortness of breath • Chest pain lasted for 10 minutes • Pain was not relieved by rest • History of hypertension • History of hyperlipidemia • History of smoking • Diagnosis of coronary artery disease • Family history of heart disease • Stressful work environment • These symptoms that the patient is experiencing are classic symptoms of myocardial infarction. The risk factors also align with the diagnosis of myocardial infarction.Objective findings (Physical Exam & Diagnostics) • N/A • There were no findings during the physical examination or diagnostics tests that ruled in favor of myocardial infarction.Pertinent Negatives
