Chief complaint- A 75-year-old female reports experiencing pain in her chest while walking up steps today.
Subjective- Could not sleep previous night. Feels like an ache or a burning sensation at the center of sternum. Denies any arm pain, pain was at a scale of 8 in the AM now it is at a 2. Suffers from History of hypertension, denies heart disease, denies leg swelling up, denies pain feeling worse when taking deep breath.
Vital signs- BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%
General – obese female, alert, in no acute distress.
HEENT- Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.
Respiratory- CTA AP&L
Neck/Throat- carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy
Heart- S1 and S2 normal without murmur, gallop. Rub
1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.