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Dоcument а cоmplete аnd thоrough physicаl examination from your patient encounter Be sure to document any and all specific exam findings that you observed or were provided during the encounter. Below you will find a copy of the information provided during the OSCE: Student Case Information HPI: Ruby Fatima is a 63 y/o F who presents for the complaint of “feeling tired all the time”. She notes this began 2-3 weeks ago and is now constant and has worsened since onset. The symptoms are not focal and feel “all over”, according to the patient. She rates the severity of her symptoms at an “8” or “9” out of 10. Her symptoms are worse when walking up stairs and when attempting to do routine/daily activities, such as going out into the yard or walking to the grocery store. She notes a sensation of feeling lightheadedness, short of breath, tiredness and fatigue at those times. Rest helps with the symptoms that come with activities, but does not fully resolve the general sense of tiredness. Pt denies any preceding trauma, fall, or injury. Reported associated symptoms include transient light-headedness upon standing, particularly first thing in the morning, sense of shortness of breath with exertion, excessive tiredness without sleeping excessively, and generalized fatigue. She denies chest pain, constant dizziness, any leg swelling or discoloration, syncope or passing out, hot/cold intolerance, or nausea/vomiting/diarrhea. The pt is concerned that she cannot do her normal activities anymore and it worries her. She reports that she has to recruit her husband and son to help with daily chores as a result of this issue. Past Medical History: Illnesses/Injuries: Chronic conditions: Hypothyroidism, Osteoarthritis (B/L knees), Degenerative Disc Disease (DDD) of lumbar vertebrae, Osteoporosis, Lactose intolerance, and Vitamin D deficiency. OB-GYN Hx: G2P2. Normal pap smears up to present. Post menopausal. Hospitalizations : For prior deliveries and surgery only as noted above. Surgical History: Total abdominal hysterectomy at age 58 (due to uterine fibroids and irregular postmenopausal bleeding post). Immunizations/Health Maintenance: Patient reports being up-to-date on her vaccines, including COVID, flu, and pneumonia. She reports having a colonoscopy 10 years ago and had one polyp removed. Never has had a COVID infection. Medications (Prescription, Over the Counter, Supplements) Levothyroxine (Synthroid) 50mcg PO daily Vitamin D3 1000 International Units (I/U) PO daily Daily multivitamin PO (Centrum) daily Aspirin 81mg daily PO "to help prevent heart disease." Ibuprofen 400-600mg daily for joint pain, taken about 4-5 times per week Allergies (e.g. environmental, food, medication and reaction) Penicillin-based antibiotics (rash) Family Medical History: (consider the following) Father: deceased, 77 years old, hx of high blood pressure and stroke Mother: deceased, 78 years old, hx of osteoporosis, high blood pressure, high cholesterol Sister: alive, 60 years old, hx of hypothyroidism and "back problems" Child 1 (male): Age 32 - alive and well Child 2 (female): Age 30 - alive and well Social History: Substance Use (past and present) Drug Use (Recreational and medications prescribed to other people): None Tobacco Use: Denies Alcohol Use: Denies Home Environment Lives with husband. She has been married for 35 years. She identifies as heterosexual. Sexually active with husband only, no birth control or barrier protection used. Occupation Retired executive assistant to the executive for United Airlines (retired 5 years ago) Leisure Activities Crochet, painting, reading, and walking Diet Normal American diet Exercise Previously was able to walk in her neighborhood, but not lately Religious Practices Christian, attends church Sleep Sleeps 6-7 hours per night Review of Systems: General See HPI, +fatigue, +poor appetite lately. No known sick contacts at home, no unexpected weight loss or gain. No fever or night sweats. Skin +Occasional easy bruising, “but that’s not new” No unusual dry skin, jaundice, rashes, changes in hair or nails, or pruritus (itching) Head No HA, head trauma or head injury Eyes No visual change, pain, redness, conjunctivitis, or vision loss Ears No hearing loss, tinnitus, otalgia (ear pain) Nose/Sinuses No nosebleeds or rhinorrhea Throat/Mouth/Neck No neck pain, sore throat, hoarseness, swelling, neck stiffness, neck swelling (lymph nodes) Respiratory See HPI. +Sensation of SOB with some activities. No cough, orthopnea, or hematemesis. No orthopnea or PND Cardiovascular/ PV See HPI +Lightheadedness at times. No syncope. No chest pain, palpitations, swelling or edema of the extremities. No extremity discoloration or cold extremities reported. Gastrointestinal No abdominal pain, nausea/vomiting, stool changes (diarrhea or constipation), or bright red blood in stool / dark stools seen. Genitourinary Post-menopausal No dysuria, urinary frequency, urgency, or hematuria. No unusual vaginal discharge, or bleeding Musculoskeletal +Chronic arthralgias in knees and low back. Denies joint swelling, redness, warmth or myalgias. Psychiatric No anxiety, depression, hallucinations, and suicidal ideations Neurologic See HPI +Generalized weakness at times. No speech problems reported. Denies confusion. No changes in sensation. No focal weakness, visual changes, diplopia, or tremor. Hematologic / Lymph See skin ROS. +Easy bruising (a long-standing issue). Denies known easy gum bleeding or nose bleeds. No lymph node swelling known Endocrine No polyuria, polydipsia, heat or cold intolerance