icarus
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Topics: 27
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Please guys ,is this a good patient note for a blood in stool case , would it pass ?is it too long,or too short, would it pass? please answer me
History
55yo W M c/o blood in stool. patient had constipation for the past 6m consisting of 2 bowel movements/week ,used laxatives,and then he noticed blood mixed with every stool a month ago.he had diarrhea 2 days ago for 3times/day.No abdominal pain or with defecation.No urgency.Mild Tenesmus.No Melena.No Fever/chills/Nausea/vomiting.No changes in appetite/sleep.Lost 10LBS for the past 6m.Diet very low in fiber.Little exercise.No recent travel or sick contact.PMH:Bronchitis 3w ago,treated c amoxicillin.PSH:Hemorrhoids resectio 5y ago.NKDA.Medications:Laxatives(besacodyle,phenolphaleine).family Hx:Father died of colorectal cancer at55.Social history:NO alcholo/tobacco/illicit use.Sexually active with wife only.works as a lawyer.
Physical Exam:
Patient is no acute distress
Vs:WNL
CHEST:No tenderness,Clear breath sounds bilaterally,NO wheezing/rhonchi/crackles.
HEART:RRR;Normal S1/S2,PMI not displaced,NO Murmurs/gallops/rubs.
Abdomen:Soft,nondistended,+BS,NO organomegaly,NO tenderness or rebound,-Murphy's sign,- mcburny's sign
Colorectal Cancer
Diverticulosis
Hemorrhoids
Angiodysplasia
Inflammatory Bowel Disease
Rectal exam, Stool for occult blood ???
CBC
Leukocytes in stool
Lower endoscopy
Abdominal CT
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The Maestro says its Mozart...but it sounds like bubble gum
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| icarus
Forum Senior
Topics: 27
Posts: 171
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come on veterans ,help me out here !!!! 
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The Maestro says its Mozart...but it sounds like bubble gum
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| kochs
Forum Senior
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I think its perfect ,thats short and sweet yet descrpitive. Hope we are coolheaded during the exams to write so.
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| icarus
Forum Senior
Topics: 27
Posts: 171
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thanks my friend kochs , but i forgot to ask abt mucus in stool and so many other things , and i think the history is kinda messes up .... what do u think ?? do u think this would pass ??
i have an advice : WHEN U START WRITING PN START WITH DD AND W/U THEN PE ,AND AT LAST WRITE The history , cuz this way , even if u had a long History , if the time finished u would still get the points for these other sections ... dont let urself be stuck in history ... write DD , W/U , PE to guarantee their marks then move to History ...
what do u think ? is it reasonable ?
please comment on the history mistakes in the note i have sent here ...
thanks so much brother
best of luck
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The Maestro says its Mozart...but it sounds like bubble gum
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| kochs
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YES, very correct about writing dd,w/u and then history,pe.
Regarding points missed in history are-- TRAUMA, PRIOR COLONOSCOPY, MEDICATIONS ( warfarin) ,H/O EASY BLEEDING OR ATHEROSCLEROTIC DISEASE ....IN ISCHEMIC BOWEL DISEASE
and can add CBC, PT/APTT, CEA ,bARIUM ENEMA, AST/ALT.BILIRUBIN/ALKALINE PHOSPHATASE (....UPPER gi bleeding),,,,All these in W/U.
any orifice bleeding, ask nose bleeding or skin easy bruises to r/o bleeding tendencies plus imp is medications like warfarin and aspirin.
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| icarus
Forum Senior
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so u think i wouldnt pass based on my PN ?
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The Maestro says its Mozart...but it sounds like bubble gum
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| abanoz
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hey icarus did you take the exam?
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| icarus
Forum Senior
Topics: 27
Posts: 171
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No not yet ... just practicing
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The Maestro says its Mozart...but it sounds like bubble gum
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| werther
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EXCELLENT INSIGHT KOCHS!
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