Question

RETYPE THE FOLLOWING (do NOT cut and paste, but type it yourself) INTO H&P FORMAT, RUN SPELL CHECK, AND SUBMIT TO THE DROP BOX. Sun Low Chung, #1182 History. Chief complaint. Palpitations for 1 week. Present illness. This patient has had known hypertension for 4 years. He has been taking Serpasil 0.25 mg daily. About 1 month ago, the medication was changed to Dyazide 250 mg, one tablet per day. Since that time, the patient has felt more nervous and anxious, with occasional chest tightness. One week ago the patient noted some skipped heartbeats occurring in the evening. There were no other associated symptoms and no history of paroxysmal nocturnal dyspnea, orthopnea, or ankle edema. Palpitation subsided spontaneously but recurred the following night, with a fast throbbing sensation in his right ear. He was seen by Dr. Chan 2 weeks later and had a chest x-ray and cardiac enzymes done. These were normal values. An electrocardiogram showed normal sinus rhythm, with nonspecific ST abnormalities. He experiences palpitations in the evening. The patient has been asked to avoid any strenuous exercise and to stay at home until he is seen by the undersigned physician. Past history. The patient was born in Hankow, China, but has lived in the United States since 1952. He has worked in the Air Force and airplane industry but lately is working for civil service at Port Davis. He has been subjected to some work pressure recently. There was no history of coronary artery disease, heart murmurs, rheumatic fever, or joint problems in childhood. Malaria in his youth in China. Hypothyroidism diagnosed about 10 years ago, and he has been on thyroid 1 grain q.d. Operations none. Allergies none. Medication as stated above, and Valium 5 milligrams one b.i.d. to t.i.d. p.r.n., Thyroid 1 grain q.d. Social history. The patient smoked one pack of cigarettes per day for 10 years but has discontinued for about 15 years. He does not drink. He consumes about two cups of coffee per day and very little tea. The family history. Most of the family members were separated during the war, and their health conditions are not known. Mother died from an unknown illness at the age of 35. The patient has two children, 36 and 27, both in good health. No known diabetes, hypertension, or heart problems in the family. The review of systems. General. No recent weight gain or weight loss. No unusual fatigue. No recent fevers. The patient has myopia in both eyes. Glasses have not been checked for the past 5 years, and distant vision is not good. EENT. Negative. CR. As in PI. No history of hemoptysis or chronic cough. GI. Negative. GU. Nocturia once a night for many years. NP. No history of headache, syncope, or light-headedness. No history of paralysis. MS. No history of joint problems. Physical examination. General. This patient is an elderly Asian male in no acute distress. Blood pressure is right arm 148 over 80 and left arm 138 over 88. Pulse 80 and regular. Respirations 18. Height 5 feet, 7 inches. Weight 176 1/4 pounds. The patient is afebrile. HEENT. Not pale or cyanotic. Tympanic membranes

Answer 1

Patient name : Sun Low Chung
MR# 1182

Chief complaint : Palpitations for 1 week.

History of present illness : This patient has had known hypertension for 4 years. He has been taking Serpasil 0.25 mg daily. About 1 month ago, the medication was changed to Dyazide 250 mg, one tablet per day. Since that time, the patient has felt more nervous and anxious, with occasional chest tightness. One week ago the patient noted some skipped heartbeats occurring in the evening. There were no other associated symptoms and no history of paroxysmal nocturnal dyspnea, orthopnea, or ankle edema. Palpitation subsided spontaneously but recurred the following night, with a fast throbbing sensation in his right ear. He was seen by Dr. Chan 2 weeks later and had a chest x-ray and cardiac enzymes done. These were normal values. An electrocardiogram showed normal sinus rhythm, with nonspecific ST abnormalities. He experiences palpitations in the evening. The patient has been asked to avoid any strenuous exercise and to stay at home until he is seen by the undersigned physician.

Past history : The patient was born in Hankow, China, but has lived in the United States since 1952. He has worked in the Air Force and airplane industry but lately is working for civil service at Port Davis. He has been subjected to some work pressure recently. There was no history of coronary artery disease, heart murmurs, rheumatic fever, or joint problems in childhood. Malaria in his youth in China. Hypothyroidism diagnosed about 10 years ago, and he has been on thyroid 1 grain q.d. Surgeries none. Allergies none.

Medication : as stated above, and Valium 5 milligrams one b.i.d. to t.i.d. p.r.n., Thyroid 1 grain q.d.

Social history : The patient smoked one pack of cigarettes per day for 10 years but has discontinued for about 15 years. He does not drink. He consumes about two cups of coffee per day and very little tea.

Family history: Most of the family members were separated during the war, and their health conditions are not known. Mother died from an unknown illness at the age of 35. The patient has two children, 36 and 27, both in good health. No known diabetes, hypertension, or heart problems in the family.

Review of systems :
General : No recent weight gain or weight loss. No unusual fatigue. No recent fevers.
Eyes : The patient has myopia in both eyes. Glasses have not been checked for the past 5 years, and distant vision is not good.
EENT : Negative.
CARDIO-RESPIRATORY : As in HPI. No history of hemoptysis or chronic cough.
GI : Negative.
Genito-Urinary : Nocturia once a night for many years.
Neuro-Psychiatric : No history of headache, syncope, or light-headedness. No history of paralysis.
Musculoskeletal: No history of joint problems.

Physical examination :
General : This patient is an elderly Asian male in no acute distress.
Height : 5 feet, 7 inches. Weight : 176 1/4 pounds.
Vital signs : Blood pressure is right arm 148 over 80 and left arm 138 over 88. Pulse 80 and regular. Respirations 18.
The patient is afebrile.
HEENT : Not pale or cyanotic.