Good morning. My name is I will be assessing you today.
Hello
what is your name Brian Robert Foster.
what is your date of birth
August 17 . . . [Mr. Foster reports the correct year.] [AUDIO COMING SOON]
how old
...
Good morning. My name is I will be assessing you today.
Hello
what is your name Brian Robert Foster.
what is your date of birth
August 17 . . . [Mr. Foster reports the correct year.] [AUDIO COMING SOON]
how old are you I'm 58 going on 30. how tall are you
I'm five foot eleven. how much do you weigh
As of this morning, a buck ninety-seven. Measured vitals
Tested blood pressure in left arm with cuff Tested blood pressure in right arm with cuff Tested blood pressure in left arm with cuff Tested blood pressure in right arm with cuff Tested blood pressure in right arm with cuff Measured vitals
why are you here today
I have been having some troubling chest pain in my chest now and then for the past month.
i am sorry you are experiencing that Thanks. I appreciate that.
how much do you weigh in pounds
As of this morning, a buck ninety-seven.
can you rate your pain
I'd say maybe a . . . 5? It's just really uncomfortable . . . like there's nothing I can do about it. Right now it's like a zero though.
when did the pain start
I first noticed it earlier this month. I thought it might just be heartburn and it passed after about a couple of minutes.
what aggravates your pain
Well, I think it's when I'm doing something physical most of the time. The first time it happened, my chest started hurting after I was doing some yard work. The second time happened when the elevator broke at work so I had to take the stairs. My office is on the 5th floor.
what relieves your pain
I'm not sure. I think lying still seems to help a little. where is your pain
When the pain happens, I feel it mostly in the middle of my chest, over my heart.
how long does your pain last
When I feel it, it seems to get better over the course of a couple of minutes or so.
describe your pain
Well, it mostly feels tight and uncomfortable right in the middle of my chest.
how are you treating your pain
I haven't taken anything for the chest pain yet. What medications do you take
Yeah, let's see, I take atorvastatin for cholesterol, metoprolol for blood pressure. . . Oh yeah, and I take fish oil too. I hear that's good for your cholesterol. [AUDIO COMING SOON]
do you take any over the counter medicines
Oh, just ibuprofen or Tylenol occasionally for pain. what dose of metoprolol do you take
I think it's 100 mg, once a day.
how long have you taken metoprolol I think it's been about one year.
what is the dose for your cholesterol medicine (
It's 20 mg, once a day. (Clarified to what the dosage of my cholesterol medication is.)
how long have you taken cholesterol medicine I think about a year. [AUDIO COMING SOON] how much ibuprofen do you take
Just a couple when I get a headache, which is not very often. what is the dose of ibuprofen
Just whatever the bottle recommends for an adult. when was the last time you took ibuprofen
I don't recall. Been a few weeks at least. [AUDIO COMING SOON]
how much tylenol do you take
Just a couple when I get a headache, which is not very often. what dose of tylenol do you take
Just whatever the bottle recommends for an adult. when was the last time you took tylenol
I don't recall. Been a few weeks at least. [AUDIO COMING SOON]
when was the last time you took your cholesterol medicine 3 months ago.
why did you stop taking your cholesterol medicine Yes, I get it tested every couple of years.
when was the last time you took your blood pressure pill I usually only get it checked when I visit the doctor. when did you last take metoprolol
I think it's been about one year. what is your past medical history
The doctors told me I have a little bit of high blood pressure
and cholesterol, but that's it. do you smoke
Nope, I had a lot of friends who did but I never started. are you exposed to second hand smoking
Almost never.
do you drink alcohol
Sure, but never more than two or three beers on a weekend. what kind of alcohol do you drink
Oh, mostly light beer, just a couple on the weekends. I'll have a bourbon with my son or on special occasions sometimes, too.
do you do drugs Nope.
do you smoke marijuana
I'll put it this way: the last time I touched the stuff, Carter was in office.
when did you last smoke marijuana
I'll put it this way: the last time I touched the stuff, Carter was in office.
tell me about your mom
She has type 2 diabetes and some high blood pressure, but I think she's doing pretty well for 80.
tell me about your dad (Clarified to Can you tell me about your father's health?.)
He really wasn't doing so great in the last few years. He died when he was 75 of colon cancer, but even before that, his weight and his blood pressure and cholesterol were getting the best of him. It was rough. He didn't last too long after the cancer diagnosis, unfortunately. I think he was tired of fighting. (Clarified to how my dad's health was.)
do you have siblings
I have a sister, and I had a brother but he died many years ago.
im sorry about your brother's death (No matching questions
found.)
im sorry about your brother's death Thanks. I appreciate that.
tell me about your brothers health (No matching questions found.)
tell me about your brother (No matching questions found.) how did your brother die
It was a car accident. He was 24. tell me about your sister
She has the same health problems as our mom. Diabetes and hypertension.
how old is your sister She's fifty-two.
tell me about your mom's dad
My grandfather on my mom's side died of a heart attack. He was in his mid-fifties.
tell me about your mom's mom
She had breast cancer. She was in her 60s when she died. tell me about your dad's dad
He was healthy right up until he died. He went in his sleep at 85, and we just called it old age.
tell me about your dad's mom
She died of pneumonia when she was almost 80. 78 or 79, I think.
im sorry about your loss Thanks. I appreciate that.
does anybody in your family have health problems (Clarified to Do you have a family history of psychiatric illness?.)
Thankfully, no. (Clarified to if I have a family history of psychiatric illness.)
tell me about any health problems in your family
Well, my dad died of colon cancer, my mom and sister have
diabetes . . . my daughter has asthma, we all have slightly high blood pressure, my mom's mom died of breast cancer, and my mom's dad died of a heart attack.
do you have children
Yes, I have two great kids. Well, they're not kids. Sam is 26 and Allie is 19.
tell me about Allie (Clarified to Who is your daughter?.)
My daughter's name is Allie. [AUDIO COMING SOON] (Clarified to who my daughter is.)
does allie have health problems
Allie's doing great. She has asthma, but she's got a handle on it. [AUDIO COMING SOON]
does sam have any health problems
Sam's health is wonderful. [AUDIO COMING SOON] is sam a boy or a girl
Yep, my son Sam. And I have a daughter Allie. [AUDIO COMING SOON]
tell me about your social history
My social life is mostly my family now. My wife and I are together all the time, and my son and his family lives in town. My daughter is in college so she's home at least once a month. We try to have big family dinners when she's home. I go fishing with my friend Smitty and his brother every once in a while.
are you married
You bet. Happily married to my hot wife for, let's see, 27 years now.
do you travel
My wife and I went to Paris a couple years ago, but I haven't been anywhere else recently.
do you go to church
Usually only on holidays or when my mom is visiting. do you work
I work at a civil engineering firm here in town.
what do you do I'm an engineer.
what is the name of the firm you work for Brian Robert Foster.
are you up to date on your immunizations Yeah, I am.
when did you last take the flu shot
Well, I usually get the flu shot. I've had one in the past year. [AUDIO COMING SOON]
it is important for you to take your flu shot early Good to know. Thank you.
when was the last time you took a pneumonia vaccine I can't remember . . . I don't think so.
have you had a tetanus shot
I'm up to date on my tetanus shot. [AUDIO COMING SOON] when did you take your tetanus shot
I'm up to date on my tetanus shot. [AUDIO COMING SOON] have you ever had surgery
I've never had any surgeries. have you ever been hospitalized
I've never had to go to the hospital, no. do you have a doctor
Dr. Melinda Smith.
when was the last time you saw dr smith (Clarified to When was your last doctor's visit?.)
I had a physical about 3 months ago. (Clarified to when my last doctor's visit was.)
do you have a cardiologist
No, but I guess I might need one.
you might need to have a cardiologist follow you since you have an extensive family history of cardiac problems and you
are now experiencing chest pain Good to know. Thank you.
when did you last go to the dentist Um . . . probably about a year ago. do you have a sexual preference
I've only ever been attracted to women. Well, women and Paul Newman.
does your chest pain radiate
The pain doesn't radiate anywhere. It's mostly just right in the middle of my chest.
do you have arm pain
No, when I am having the chest pain, it's mostly just in middle of my chest.
do you have shoulder pain
No, the pain hasn't been in my shoulder. do you have back pain
I haven't had back pain, no. do you have neck pain
My neck's been fine.
how often does your chest pain happen (Clarified to How often do you have chest pain?.)
Well, it has happened three times the past month. It usually goes away after about a couple of minutes. (Clarified to how often have pain in your chest.)
does your pain seem to be related to anything
It seems like moving around makes it worse, or at least more noticeable. I felt a little better when I sat down to rest for a few minutes.
do you have crushing pain (Clarified to Is the pain crushing?.)
No, it's more tight and uncomfortable. (Clarified to if the pain is crushing.)
is the pain gnawing
No, it's not like that. [AUDIO COMING SOON]
is the pain burning Not really.
does your pain get worse when you eat (Clarified to Does eating anything make your pain worse?.)
I don't think that has anything to do with it, but I guess I don't know. (Clarified to if eating makes the pain worse.)
does the pain get worse with spicy foods
I don't think spicy foods have anything to do with it.
does the pain get worse with fatty foods (Clarified to Do certain foods make the pain worse?.)
I don't think that has anything to do with it, but I guess I don't know. (Clarified to if certain foods make the pain worse.)
do you eat a healthy diet Yeah, I think so.
what do you eat daily
Um, let's see . . . For breakfast I usually eat a granola bar and drink an instant breakfast shake. I've been doing that a while since it saves time in the morning. Most days for lunch I get a sandwich from the sub shop near work. That's usually a turkey sub, but sometimes I get a spicy Italian sub. My wife and I grill a lot, and usually have some grilled meat with veggies for dinner.
do you take aspirin
I usually just take Tylenol or ibuprofen. do you take fish oil
That's right.
what is the dose of your fish oil
I take it daily. I think it's 1200 milligrams.
how long have you taken fish oil (Clarified to Did you take fish oil today?.)
Took it this morning. [AUDIO COMING SOON] (Clarified to if I took fish oil today.)
when were you prescribed fish oil (No matching questions found.)
why do you take fish oil (Clarified to How do you take fish oil?.)
I take it daily. I think it's 1200 milligrams. (Clarified to how I take fish oil.)
do you have any allergies
No, well . . . I've had a bad reaction to codeine before, but that is all I know of.
what happened when you took codeine
When I took codeine a few years ago for my back, it made me pretty nauseous. I started throwing up and felt pretty terrible. [AUDIO COMING SOON]
do you have any food allergies
No, well . . . I've had a bad reaction to codeine before, but that is all I know of.
do you have any environmental allergies
No, well . . . I've had a bad reaction to codeine before, but that is all I know of.
do you have diabetes
No, I've avoided it but my mother and sister both have it. do you have heart disease
Besides moderate hypertension and slightly elevated cholesterol, none that I know of.
do you have coronary artery disease Not that I'm aware of.
have you had any treatment for chest pain (Clarified to Have you ever had treatments for heart problems?.)
Nothing other than blood pressure and cholesterol screenings. (Clarified to if I have been treated for heart problems.)
how often do you check your blood pressure
I usually only get it checked when I visit the doctor.
do you remember having any abnormal blood pressure readings
Yes, I supposedly have moderately high blood pressure. do you ever check your blood pressure at home
Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.
have you ever seen a cardiologist
I haven't seen a cardiologist -- this is the first time I'm telling anyone about this chest pain. [AUDIO COMING SOON]
have you ever had an ekg
I had one about three months ago. They usually put one on me at my annual physical.
have you ever had a stress test Yes, I usually do one every year. was your ekg normal
I don't remember the actual results, but as far as I know, it was normal.
was your stress test normal
I'm not sure, all the doctor ever tells me is, "everything looks good."
how often do you see a doctor
I see the doctor every 6 months unless there's something wrong in between.
do you exercise
Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven't had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I've been having.
do you eat a lot of salt
I'm not sure, I don't really pay attention to it. do you drink a lot of water
I usually drink water all day at work. At least four glasses, probably more. [AUDIO COMING SOON]
do you drink caffeine
I drink a cup or two of coffee almost every day. Not much else. do you drink soda
Once in a blue moon maybe. I avoid it 99% of the time.
do you feel fatigued
I'm not more tired than normal. do you feel stressed
Not usually, but I'm feeling pretty anxious not knowing what's going on with my chest.
do you have anxiety
Not usually, but I'm feeling pretty anxious not knowing what's going on with my chest.
do you have fever
I haven't had a fever, no. do you have chills
I haven't had chills, no.
have you gained weight recently
I've gained maybe 20 pounds over the last couple years. I guess I'm getting older . . . my wife doesn't seem to mind though!
have you lost weight recently
Not exactly . . . I've gained about fifteen to twenty pounds in the last couple years.
do you have night sweats Nope, no night sweats.
do you live in a clean home My wife and I own our house. do you have palpitations
I don't think so. I haven't noticed any. do you have headache
No, my head feels okay. do you have dizziness No, I haven't felt dizzy.
what triggers your headaches (Clarified to What do your headaches feel like?.)
Uh, well, I guess they feel like a dull ache. They're annoying,
but not debilitating. (Clarified to what my headache pain feels like.)
what relieves your headaches
I usually just take Tylenol or ibuprofen. what makes your headaches worse
I usually just take Tylenol or ibuprofen. what causes your headache
Uh, well, I guess they feel like a dull ache. They're annoying, but not debilitating.
do you have swelling
I haven't noticed any swelling. do you have angina
I've never been diagnosed with angina. [AUDIO COMING SOON]
have you had a heart murmur No, none that I know of.
have you had blood clots Not that I know of.
have you had bleeding Not that I know of.
do you have a cough I don't have a cough.
any difficulty breathing My breathing's fine.
Inspected face
Inspected for jugular venous distension: No jugular venous distention; JVP 3 cm above sternal angle
Inspected anterior chest wall Inspected left side chest wall Inspected anterior chest wall Inspected right side chest wall
Inspected left side of abdomen Inspected front of abdomen Inspected right side of abdomen
Inspected right hand: no visible abnormal findings Inspected left hand: no visible abnormal findings Inspected fingernails of left hand
Inspected right hand: no visible abnormal findings Inspected left hand: no visible abnormal findings Inspected fingernails of right hand
Inspected left leg Inspected right leg
Inspected toenails on left foot Inspected toenails on right foot Inspected left leg
Inspected right leg
Inspected right leg for edema: No edema Inspected left leg for edema: No edema Checked capillary refill in fingernails Checked capillary refill in fingernails Checked capillary refill in fingernails Checked capillary refill in fingernails Checked capillary refill in fingernails Checked capillary refill in fingernails Checked capillary refill in fingernails Auscultated right carotid pulse: Bruit present Auscultated left carotid pulse
Auscultated aortic area with the bell Auscultated aortic area with the diaphragm Auscultated pulmonic area with the diaphragm
Auscultated Erb's point with the diaphragm Auscultated Erb's point with the bell Auscultated Erb's point with the diaphragm Auscultated tricuspid area with the diaphragm Auscultated mitral area with the diaphragm Auscultated aortic area with the bell Auscultated aortic area with the diaphragm Auscultated pulmonic area with the diaphragm Auscultated Erb's point with the diaphragm Auscultated tricuspid area with the diaphragm Auscultated mitral area with the diaphragm Auscultated mitral area with the bell Auscultated tricuspid area with the bell Auscultated Erb's point with the bell Auscultated pulmonic area with the bell Auscultated aortic area with the bell
Auscultated breath sounds in anterior right upper lobe Auscultated breath sounds in anterior left upper lobe Auscultated breath sounds in anterior right middle lobe
Auscultated breath sounds in anterior left mid-chest (upper lobe)
Auscultated breath sounds in anterior right lower lobe Auscultated breath sounds in anterior left lower lobe Auscultated breath sounds in posterior left upper lobe Auscultated breath sounds in posterior right upper lobe
Auscultated breath sounds in posterior left mid-back (lower lobe)
Auscultated breath sounds in posterior right mid-back (lower lobe)
Auscultated breath sounds in posterior left lower lobe Auscultated breath sounds in posterior right lower lobe
Auscultated breath sounds in posterior left lower lobe on side
Auscultated breath sounds in posterior right lower lobe on side
Auscultated aorta in abdomen Auscultated aorta in abdomen Auscultated right renal pulse Auscultated left renal pulse Auscultated right iliac pulse Auscultated left iliac pulse Auscultated right femoral pulse Auscultated left femoral pulse Auscultated right upper quadrant Auscultated left upper quadrant Auscultated right lower quadrant Auscultated left lower quadrant Auscultated over liver Auscultated over spleen
Palpated right carotid pulse: Thrill, 3+ Palpated left carotid pulse: No thrill, 2+
Palpated PMI: Displaced laterally; brisk and tapping; less than 3 cm
Palpated right brachial pulse: No thrill, 2+ Palpated left brachial pulse: No thrill, 2+ Palpated right radial pulse: No thrill, 2+ Palpated left radial pulse: No thrill, 2+ Palpated right femoral pulse: No thrill, 2+ Palpated left femoral pulse: No thrill, 2+ Palpated right popliteal pulse: No thrill, 1+ Palpated left popliteal pulse: No thrill, 1+ Palpated right tibial pulse: No thrill, 1+
Palpated left tibial pulse: No thrill, 1+
Palpated right dorsalis pedis pulse: No thrill, 1+ Palpated left dorsalis pedis pulse: No thrill, 1+
Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension
Tested skin turgor
Palpated for right kidney: Not palpable Palpated for left kidney: Not palpable Palpated for spleen: Not palpable
Palpated liver: Palpable 1 cm below right costal margin Palpated right upper quadrant with deep pressure: No masses Palpated left upper quadrant with deep pressure: No masses Palpated right lower quadrant: with deep pressure: No masses Palpated left lower quadrant with deep pressure: No masses Percussed right upper quadrant
Percussed left upper quadrant Percussed right lower quadrant Percussed left lower quadrant Percussed spleen
Percussed for liver span: 7 cm in the mid-clavicular line Performed EKG
how many medications do you take daily
I'm taking cholesterol and blood pressure meds, yeah. do you take any other medications
Just the atorvastatin and metaprolol. . . and sometimes
ibuprofen when I need it. [AUDIO COMING SOON] do you take herbal medications
I take fish oil, that's it. do you feel fatigue
I'm not more tired than normal. do you feel weak
I wouldn't say I feel weak.
do you have trouble sleeping
I usually sleep about 6 or 7 hours a night. do you have itching
I haven't noticed anything weird with my skin, no. do you have redness
I haven't had problems with my eyes like that. do you have nail discharge
Not that I've noticed. any skin color changes
My skin hasn't changed color on me. double vision
I get my eyes checked every few years. So far, no glasses! eye pain
I haven't had problems with my eyes like that. eye redness
I haven't had problems with my eyes like that. vision changes
I get my eyes checked every few years. So far, no glasses! vision changes
I get my eyes checked every few years. So far, no glasses! photo phobia (No matching questions found.)
do you have photo phobia (No matching questions found.)
do you have photo-phobia (No matching questions found.) di your eyes hurt when exposed to light
I haven't had problems with my eyes like that. eye discharge
I haven't had problems with my eyes like that. earache
No, my ears are fine. Tinnitus
No, my ears are fine. Bleeding nose
No, I sure don't think so.
Vertigo (No matching questions found.) do you have Vertigo
Thankfully, no.
Have you had any hearing things has My hearing's fine.
Have you had any hoarseness Nope.
Have you had any oral ulcers (Clarified to Have you ever had oral lesions?.)
Um . . . no. No problems with that. (Clarified to if I have had oral lesions.)
Have you had a sore throat
I haven't had a sore throat in a long time. Have you had congestion
I haven't felt congested. All clear. [AUDIO COMING SOON] Have you had no discharge (No matching questions found.) Have you had post nasal drip (No matching questions found.)
Have you had post nasal discharge (No matching questions found.)
Have you had rhinorrhea (No matching questions found.)
Have you had call (No matching questions found.) Have you had cough
I don't have a cough.
Hemoptysis (No matching questions found.) have you been coughing up blood
No, definitely not.
Can we have dyspnea (No matching questions found.)
Can we have shortness of breath (Clarified to Do you currently have shortness of breath?.)
My breathing's fine. (Clarified to if I have shortness of breath right now.)
Any pain on inspiration
No, not right now, but when I do it's tight and uncomfortable. I've experienced it three times this month.
Are you producing sputum I don't have a cough.
Do you have phlegm I don't have a cough. Any numbness
Nope, I haven't noticed anything.
Anything Lane (No matching questions found.) any tingling
Nope, I haven't noticed anything. Have you passed out
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