I-Human Exam: Performance Overview For Jessica Rhyan On Case Caleb Metz

I-HUMAN EXAM: Performance Overview for Jessica Rhyan on case Caleb Metz Thefollowingtablesummarizesyourperformanceoneachsectionofthecase,whetheryoucompletedthatsectionornot.Timespent:4hr7min45secStatus:SubmittedCaseSectionStatusYo u rScoreTimespentPerformanceDetailsTo t a lScore100%HistoryDone100%11min14sec34questionsasked,33correct,0missedrelativetothecase'slistPhysicalexamsDone100%21min30sec26examsperformed,11correct,0partiallycorrect,0missedrelativetothecase'slistKeyPindingsorganizationDone2min2sec6Pindingslisted;9listedbythecaseProblemstatementDone13min48sec56wordslong;thecase'swas81wordsDifferentialsDone100%3min55sec6itemsintheDDx,6correct,0missedrelativetothecase'slistDifferentialsrankingDone100%(lead/altscore)100%(mustnotmissscore)48secTestsDone100%18min40sec4testsordered,4correct,0missedrelativetothecase'slistDiagnosisDone100%1min58secManagementplanDone58min6sec207wordslong;thecase'swas193wordsExercisesDone70%(ofscoreditemsonly)17min20sec7of10correct(ofscoreditemsonly)HistoryNotecardbyJessicaRhyanoncaseCalebMetzUsethisworksheettoorganizeyourthoughtsbeforedevelopingadifferentialdiagnosislist.1.Indicatekeysymptoms(Sx)youhaveidentiPiedfromthehistory.Startwiththepatient'sreason(s)fortheencounterandaddadditionalsymptomsobtainedfromfurtherquestioning.2.Characterizetheattributesofeachsymptomusing"OLDCARTS".Capturethedetailsintheappropriatecolumnandrow.3.ReviewyourPindingsandconsiderpossiblediagnosesthatmaycorrelatewiththesesymptoms.(Remembertoconsiderthepatient'sageandriskfactors.)Useyourideastohelpguideyourphysicalexaminationinthenextsectionofthecase.HPISx=Sx=Sx=Sx=Sx=Sx=OnsetLocationDurationCharacteristicsAggravatingRelievingTiming/TreatmentsSeverityProblemStatementbyJessicaRhyanoncaseCalebMetzCalebMetz,13-year-oldmalepresentsforsuddenonsetofleftscrotalpain,twohoursagoduringphysicalactivity.Patientendorsespain,accompaniednauseawithonetimeemesis,withoutfever.PhysicalexamissigniPicantfortachycardia,diaphoresis,lefthemiscrotalswellingandmilderythema,tendernesstotouch,absentleftcremastericrePlexwithoutlymphnodeenlargementandabdominaltenderness.ManagementPlanbyJessicaRhyanoncaseCalebMetzdiagnostictestsscrotaldopplerultrasoundurinalysis(Keays&Rosenberg,2019)medications(Schick&Sternard,2022)painmedicationsandantiemetics-asthepatientwillmostlikelyneedsurgicalcorrectionthepatientwillbeNPO.OndanestronIV4mgq6hPRNnausea/vomitingAcetaminophen1gIVq6hPRNpainand/orketorolac30mgIVq6hPRNforpainIfthesepainmedsarenotstrongenough,morphineordilaudidcanbeorderedAthomepostprocedureacetaminophen650mgq6hPRN(nottoexceed4g/day)suggestedconsults/referralsThisisamedicalemergency.IfthepatientisintheofPice,sendtotheED.Emergencyurologyreferralforcorrection.Necrosisofthetesticlecanoccurafter10-12hours(Keays&Rosenberg,2019).clienteducationEducationforpost-opcarewillbegivenbyurologytothepatient.Patientshouldbeeducatedthatrecurrenttorsionispossibleandtopresentimmediatelyifsigns/symptomsoccur(Schick&Sternard,2022).follow-upfollow-upwithurology1-2weekspostcorrection,annualvisitforappropriatetesticularhealththroughoutadolescence(Schick&Sternard,2022).Keays,M.,&Rosenberg,H.(2019).Testiculartorsion.CanadianMedicalAssociationJournal,191(28).https://doi.org/10.1503/cmaj.190158SchickMA,SternardBT.TesticularTorsion.[Updated2022Jun21].In:StatPearls[Internet].TreasureIsland(FL):StatPearlsPublishing;2022Jan-.Availablefrom:https://www.ncbi.nlm.nih.gov/books/NBK448199/ElectronicHealthRecordbyJessicaRhyanoncaseCalebMetzHistoryofPresentIllnessPastMedicalHistoryMedicationsAllergiesPreventiveHealthFamilyHistoryCategoryDataenteredbyJessicaRhyanReasonforEncounter"Paindowninmyprivatepartsontheleft"LefttesticularpainHistoryofpresentillnessCalebMetzisa13-year-oldmalewhopresentstotheofPice,withhisfather,withsudden-onset9/10ofleftsidedtesticularpain.Thepainbegantwohoursagoduringhisbasketballmatch.Hedescribesthepainassharp,sudden,andpersistent.Associatedsymptomsofnauseaandonetimeemesis.Nothingrelievesthepain,itisworsenedwithmovement/ambulation,andnomedicationhasbeentakenforthepain.CategoryDataenteredbyJessicaRhyanPastMedicalHistorynoneHospitalizations/SurgeriestympanostomytubesasayoungchildCategoryDataenteredbyJessicaRhyanMedicationsNomedicationsCategoryDataenteredbyJessicaRhyanAllergiesNKACategoryDataenteredbyJessicaRhyanPreventivehealthRegularcheckupswithpediatricianCategoryDataenteredbyJessicaRhyanFamilyHistoryfather-hypertensionmother-nomedicalhistorysister-healthySocialHistoryReviewofSystemsPhysicalExamsCategoryDataenteredbyJessicaRhyanSocialHistorydependentadolescent,middle-schoolstudent,livingwithparentsandsister.deniessubstanceuseandnotsexuallyactiveCategoryDataenteredbyJessicaRhyanGeneraldeniesfevers,chillsIntegumentary/BreastHEENT/Neckdeniescongestion,rhinorrhea,sorethroat,eyerednessCardiovasculardenieschestpain,fatigue,lightheadednessRespiratorydenieswheezing,sputum,sobGastrointestinalnauseaandemesisx1Genitourinarysudden-onsetlefttesticularpainMusculoskeletalincreasedpaininscrotalareawithambulationandmovement.DenieschangeingaitorROMAllergic/ImmunologicEndocrineHematologic/LymphaticNeurologicPsychiatricCategoryDataenteredbyJessicaRhyanGeneraldiaphoretic,milddistress,appropriatelydressedSkinmildydiaphoretic,warmHEENT/NeckCardiovascularTa c hyc a r d i a ,regularrhythm,negativebilaterallowerextremityedemaChest/Respiratorynormal/symmetricrespiratoryeffort,noadventitiousbreathsoundsAbdomenPlat,symmetrical,non-tender,nomassesnoted,normalpercussionGenitourinary/RectalLefthemiscrotalswellingandmilderythema,tendernesstothetouch,absentleftcremastericrePlexLefttesticleappearshigherthantheright,scrotumtooswollentodeterminetesticularlieTa n n e rstage3,circumcised,nopeniledischargeMusculoskeletal/OsteopathicStructuralExaminationNeurologicPsychiatricLymphaticnolymphnodeenlargement