Tag: HPI practice

Scribe Series: HPI Practice Case 3

Hey all,

I’m back with some more HPI practice! This will be text practice; I’m not technologically fancy enough to do a voiceover. These cases are long, so I will do 1 per post. Let me know if you find this helpful in the comments below!

Also, here is a drive worksheet you can use. Feel free to make a copy of it or print it out so you can work through this on your own. I will not be giving edit access out simply to allow others to come across a blank worksheet. Worksheet here.

Diarrhea

Here are the list of complaints given to you in no particular order.

  • 27 y/o M
  • Diarrhea, having several episodes a day
  • Watery, not much mucus. No blood.
  • Stomach hurts all over. 
  • Some nausea and vomiting. Vomited 2 times.
  • Symptoms started 3 days ago. 
  • Having abdominal cramps that seem to get better after going to the bathroom. Cramps and pain are a 6/10. 
  • He’s been taking pepto bismol with slight relief of cramps and diarrhea. He hasn’t been eating much as he just gets sick when he does. 
  • He doesn’t have a thermometer at home to take his temperature. 
  • He was travelling recently before he got sick.

Task 1: Can you pick out the elements of this HPI?

Age/Sex
Chief Complaint
Onset
Location
Duration
Characteristic
Alleviating factors
Aggravating factors
Associated Symptoms
Radiation
Timing
Severity
(anything else you can add at the bottom of your paragraph).

Answer:

Age/Sex: 27 y/o M
CC: Diarrhea
Onset: 3 days ago
Location: Abdomen
Duration: episodic. Having several episodes a day.
Characteristic: watery, no mucous or blood.
Alleviating factors: going to the bathroom to relieve himself. pepto bismol. Not eating.
Aggravating factors: eating
Associated symptoms: abdominal pain and cramping. Nausea and vomiting x2.
Radiation: None.
Severity: 6/10
Everything else: He recently travelled prior to symptoms seeming to start.

Task 2: Write an HPI!

Write an HPI so that your order, flow and story makes sense. Use medical terminology as if you were writing this in a chart. The blessing is this is text, and you aren’t converting it from what you are hearing down into text form.

My version of this HPI:

Patient is a 27 y/o M presenting with 3 days of diarrhea. It is watery, but no mucous or blood noted. He is experiencing several episodes a day with associated cramps and generalized abdominal pain rated a 6/10. This improves briefly with bowel movements. Patient is also experiencing nausea and has had vomiting x2 since onset. He has been taking pepto bismol and not eating as much with some improvement in symptoms. Of note, he was recently traveling before symptoms started.

Bonus!

On exam, he appears uncomfortable. HR is 103, RR is 18, Temp is 99.7’F, BP is 115/87. Conjunctiva are pink. Mucous membranes are slightly dry. Heart is slightly tachycardia, but regular rhythm. No murmurs, rubs, or gallops. Pulses equal and bilateral to upper and lower extremities. Abdomen: Generalized tenderness without rebound or guarding. Hyperactive bowel sounds noted. in all four quadrants. Negative Murphy’s and McBurney’s sign. The remainder of exam is non-contributory.

Labs show a slightly elevated white count. But normal hemoglobin. Slightly elevated hematocrit. BMP shows a slightly elevated BUN and creatinine, but still within normal range. Negative liver panel. Stool studies were sent off and are pending.

Task 3: Can you guess what happened?

Now this is just for funsies as I certainly didn’t give you all of the clues or everything that I would order for this patient. You also wouldn’t be asked to do this as a scribe! But just for fun, what do you think this patient has?

Answer:

I was going for a viral gastroenteritis here. There are lots of different presentations for this and it could be viral or bacterial. This is a very common thing to get in the winter (viral) and popular in the summer at cookouts (bacterial). You see this frequently in both outpatient clinics, urgent cares, and ER’s. Since this one is likely viral from his recent travel, he will probably get some fluids and some anti-emetics and left to ride it out. The biggest concern with diarrhea is dehydration. Depending on someones baseline of hydration will depend on how much diarrhea will cause dehydration to that patient.

So our diagnoses (or Assessment!) is as follows:

  1. Diarrhea, likely viral.
  2. Gastroenteritis, likely viral.
  3. Mild dehydration.

Hopefully you enjoyed this practice HPI post! Let me know if this helped in the comments below.

Cheers!

Scribe Series: HPI Practice Case 2

Hello medhatters!

I have another case for you all! Like the previous post, I will give you a scenario with a few questions to answer. The goal is to improve your HPI writing. Again, since this isn’t audio recorded, this will not help with your listening & typing skills. It will however, help you improve your flow and if you can properly pick out which elements are what. Since looking at the problem is easier when trying to solve it than listening to it, we will do that again today.

Like the last practice, I have a practice worksheet for you. Please feel free to either copy it and pull it up and work on it, or print it out. I will not be allowing editing access simply so it stays blank for others when they come across it. Worksheet Here.

Courtesy of giphy.com

Case: Chest Pain

Complaints:

  • 61 y/o
  • M
  • Chest pain while watching television earlier tonight
  • Sharp
  • Substernal
  • Squeezing
  • 9/10
  • Goes to left arm
  • Goes up to jaw
  • Nausea, he vomited once.
  • Has not improved with drinking water. Nothing made it better or worse at home.
  • Called EMS, they gave him some medicine that he doesn’t know the name of that seemed to help a little bit, but now his chest pain is back.
  • He has never had this before.
  • H/o HTN, CAD.

Task 1: Can you pick out the elements of this HPI?

Age/Sex
Chief Complaint
Onset
Location
Duration
Characteristic
Alleviating factors
Aggravating factors
Associated Symptoms
Radiation
Timing
Severity
(anything else you can add at the bottom of your paragraph).

Now, there are actually two problems here. But we are going to lump the lesser problem into the main problem, simply because I’m going for one caused the other.

Answer:

Age/Sex: 61 y/o M
CC: Chest pain
Onset: earlier tonight while watching television
Location: substernal
Duration: constant (implied here).
Characteristic: sharp and squeezing
Alleviating factors: nothing at home, including attempting to drink water. But some improvement with EMS medication administration
Aggravating factors: none
Associated symptoms: nausea & vomiting x1
Radiation: to left arm and jaw
Timing: since pain is constant we don’t really have a timing specific element in this story.
Severity: 9/10
Everything else: We have some backstory here. The main thing to look at is the history of (h/o) hypertension (HTN) and coronary artery disease (CAD). We also know he has never had this before.

I want you to stop and think about what this might be.  What might the medication have been that EMS gave?

Task 2: Write an HPI!

Write an HPI so that your order, flow and story makes sense. Use medical terminology as if you were writing this in a chart. The blessing is this is text, and you aren’t converting it from what you are hearing down into text form.

My version of this HPI:

Patient is a 61 y/o M with a h/o HTN and CAD, presenting for sudden onset substernal chest pain while sitting down watching television tonight. He describes his pain as a sharp and squeezing sensation, rated a 9/10 which radiates to his L arm and jaw. He has had nausea and vomiting x1. The patient noted no improvement with drinking water at home, but upon EMS arrival he was given sublingual NTG with brief improvement before his pain returned. No reported aggravating factors. He denies having this previously and has no other concerns or complaints.

Bonus!

On exam, he is diaphoretic, tachycardic, and in distress. You immediately hook him up to an EKG and find he is in normal sinus rhythm. His heart rate is 105 BPM. On his strip, he has ST depression in leads 2,3, and AVF.

His radial and DP pulses are 2+ and equal. His lungs are clear to auscultation bilaterally. Abdomen is benign. He is alert and oriented, but nervous.

You order a chest X-ray (CXR), a troponin, CBC, & CMP. You start him on oxygen, IV morphine, and give him a baby ASA. He was started in a Nitro drip.

Task 3: Can you guess what happened?

This is a pretty classic case here. I hope even if you don’t know what some of this medical treatment is, you would be able to guess it!

Answer:

He is having a STEMI, or an ST elevated myocardial infarction. This is an inferior MI, which means it is likely affecting the RCA or right coronary artery. So we are essentially not getting enough blood flow to the right atrium and right ventricle right now. Not good!

Since we started his initial treatment, and the doctor gave him pain medications and more nitroglycerin in attempts to relax his arteries to get more blood flow to the heart. The next step is to call the cardiologist in hopes of getting him to the Cath lab. We want to open those arteries up as quickly as possible before damaging more tissue.

So our diagnoses (or Assessment!) is as follows:

  1. Chest pain, Inferior STEMI
  2. H/o HTN
  3. H/o CAD

You may also hear the terms ACS or acute coronary syndrome which encompasses both MI’s and angina.

Hopefully you enjoyed this practice HPI post! Let me know if this helped in the comments below.

Cheers!