General medicine 7

GM Case 

Case scenario.....

Hi, this is K. Sahalya, 3 rd BDS student. This is an online eblog book to discuss our patient's health data after taking his consent. This also reflects my patient centered online learning portfolio.

CASE SHEET:

A 24 year male came with chief complaint of chest pain since one month.

CHIEF COMPLAINT:

chest pain since one month.

HISTORY OF PRESENT ILLNESS:

Patient was asymptomatic one month ago.

Since one month he is suffering from chest pain.

It was radiating pain from left right.

The pain was on and off .

The pain was sudden it lasted for 3 to 4 hours.

One week ago, he had fever which is on and off.

Fever is is not associated with chills.

He was feeling weak.

He was feeling breathlessness since one week.

It is grade1 from MMRC classification.

He had no cough or cold.

HISTORY OF PAST ILLNESS:

He has no history of diabetes, hypertension, asthma, tuberculosis, thyroid disorders.

FAMILY HISTORY:

No significant complaint.

PERSONAL HISTORY:

Occupation: agriculture

Diet: mixed

Appetite: normal

Sleep : normal

Bowl and bladder: normal

Addiction: no

Allergy: no

GENERAL EXAMINATION


Pallor: no

Cyanosis: no

Icterus: no

Clubbing: no

Lymphadenopathy: no

Oedema: no

Questions from patient:
Does this pain lead any other disease?
How long will I have to continue my medication?

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