I forgot!!!

[jmac]

any family Hx of huntingtons or multiple schlerosis

also on his summer time off did he do any water sports ie scuba and is he part of a swim team ??

[SA_Medic]

Ok, let me ask my few questions.

First let me recap a little:

The patient is 15 years old, has a history of asthma and was treated with MDI. Although it has not been used in several years.

September in your area would mean autumn early winter.

Questions:

1) Complete set of vitals please...

2) Upon checking the patient, was there any signs of nausea, headache?

3) If not, did he experience it after the event?

4) Did he have any meals that day, if so what?

5) Any allergies?

That is about it for now.

Just for information sake, usually the one everone expects it least of is the one that uses narcotics, and parents are also the last ones to admit there is a problem.

Regards

S

[brock8024]

Is the patient White, African American, Native American, Hispanic?

I would ask him to remember 3 things and see if he could repeat them to me.

Does he have any siblings?

Any thoughts of suicide?

Shots UTD?

Any allergies to foods or meds?

Family Medical Hx?

Does he take any supplements meaning for sports supplements or vitamins?

Does he wear contacts or glasses?

Any night sweats, new weight gain or loss?

Any change in bowel or bladder habits?

Any new skin changes, bites, rashes?

Any new SHOB, Chest Pain, Palpitations?

Any new muscle weakness or cramping?

Any new drainage from nares or ears?

Any change in taste, bleeding gums?

Any change in hearing?

Any new visual changes?

Balance problems?

Skin Turger?

After all of this lets see if he remembers the three things I asked.

Lets check all 12 cranial nerves, cardiac monitor, 12 lead, IV, set of vital signs please.

[ERDoc]

What exactly does this mean? Short term (i.e. items to recall after 5 mins)? Long term (can't remember certain past events he could before)? Selective (can remember his birthday at times)?

Any pattern to this memory loss? Events? Environments?

Any other noted "balance problems" or issues of him appearing "absent" or "starring into space"?

He seems to be having problems with his short term memory. He remembers going camping over the previous summer in upstate NY. He remembers starting school in Sept. He evens remembers some things from this morning (This is about 9pm in late September on Long Island, NY). There does not seem to be any pattern. There does not seem to be any selective about the memory loss. The parents have not noticed any balance problems. They have not noticed any staring episodes. As you question him he seems to try to fill in the details that he cannot remember. He seems a little embarrassed about the entire situation.

[ERDoc]

How are his pupils presenting? Hitting a soccer ball with your head can have a cumulative effect.

We will come back to the physical exam. Medicine is 90% history and 10% exam.

[ERDoc]

straight a students use drugs too........

any blurred vision or spots in the eyes double vision any visual changes at all? Does he remeber what you talked about when asked again?

any hx of this happening before any recent infections

Agreed, but this is what the parents tell you. He does not notice any blurred spots or other visual disturbances. He says he can remember your conversation, but when you ask him to repeat it he is unable to. No history of similar episodes. There have been no recent infections.

[ERDoc]

hx of asthma, is pt on allergy meds rx or otc?

I know you said none in hx but not bad to ask again

ear infections? tick bites? not sure region but other types of insect bites?

No meds, nothing OTC. No ear infections. The parents state that he might have had a tick bite during the camping trip over the summer. No one remembers any other bug bites of any significance. To answer the next question, there have been no rashes.

[ERDoc]

any family Hx of huntingtons or multiple schlerosis

also on his summer time off did he do any water sports ie scuba and is he part of a swim team ??

No family history of neuro problems. Other than the camping previously discussed, nothing exciting over the summer.

[ERDoc]

Ok, let me ask my few questions.

First let me recap a little:

The patient is 15 years old, has a history of asthma and was treated with MDI. Although it has not been used in several years.

September in your area would mean autumn early winter.

Questions:

1) Complete set of vitals please...

2) Upon checking the patient, was there any signs of nausea, headache?

3) If not, did he experience it after the event?

4) Did he have any meals that day, if so what?

5) Any allergies?

That is about it for now.

Just for information sake, usually the one everone expects it least of is the one that uses narcotics, and parents are also the last ones to admit there is a problem.

Regards

S

Nausea and headache are symptoms, so I will be more than happy to tell you that there have been none, before and after the event on the soccer field. The parents state that he eat cereal and juice for breakfast, which is normal for him. He does not remember what he had for lunch. He has no allergies.

[ERDoc]

Is the patient White, African American, Native American, Hispanic?

I would ask him to remember 3 things and see if he could repeat them to me.

Does he have any siblings?

Any thoughts of suicide?

Shots UTD?

Any allergies to foods or meds?

Family Medical Hx?

Does he take any supplements meaning for sports supplements or vitamins?

Does he wear contacts or glasses?

Any night sweats, new weight gain or loss?

Any change in bowel or bladder habits?

Any new skin changes, bites, rashes?

Any new SHOB, Chest Pain, Palpitations?

Any new muscle weakness or cramping?

Any new drainage from nares or ears?

Any change in taste, bleeding gums?

Any change in hearing?

Any new visual changes?

Balance problems?

Skin Turger?

After all of this lets see if he remembers the three things I asked.

Lets check all 12 cranial nerves, cardiac monitor, 12 lead, IV, set of vital signs please.

Wow, are you an internal medicine resident??? He is the youngest of 3 kids, no suicidal ideations, immunizations UTD, does not take any supplements, no contacts or glasses, no night sweats or weight changes, no change in bowel habits. To save space, the rest of the answers are negative. We will cover skin tugor when we get to the PE.