Discussion

Case 1
Case 2
Case 3

Chief Complaint(CC) 
I have a tumor on my left breast
I have pain during intercourse and urination
My back hurts so bad I can barely walk

History of Present Illness (HPI)
A 55-year-old African American social worker presents to your clinic with a finding of a lump in her left breast while in the shower this past week.
A 19-year-old female reports to you that she has sores on and in her vagina for the last three months.
A 35-year-old male painter presents to your clinic with the complaint of low back pain. He recalls lifting a 5-gallon paint can and felt an immediate pull in the lower right side of his back. This happened 2 days ago and he had the weekend to rest, but after taking Motrin and using heat, he has not seen any improvement. His pain is sharp, stabbing, and he scored it as a 9 on a scale of 0 to 10.

Drug Hx
I took birth control pills for 10 years, starting when I was 20 I am not on hormone replacement
She tries to practice safe sex but has a steady boyfriend and figures she doesnt need to be so careful since she is on the birth control pill
 Motrin for pain.

Family Hx
My grandmother had breast cancer when she was 76 years old
 
Father hypertensionMother DM

Subjective
Denies any fever or chills. No changes in vision or hearing, no difficulty chewing or swallowing. Supple neck, states that she does self-breast-exams on occasion. Menopause at 52No skin changes or nipple discharge from the left breast
states I have sores and bumps on the inner creases of my thighs and pelvic area. There is yellowish discharge from the sores that comes and goes
He is having some right leg pain but no bowel or bladder changes. No numbness or tingling

Objective Data

 VS
temperature 98.6F; respiratory rate (RR) 16; heart rate (HR) 80, regular; blood pressure (BP) 130/84; height: 58; weight 160 lbs; body mass index (BMI) 24
temperature: 100.2F; pulse 92; respirations 18; BP 122/78; weight 156 lbs, 25 lbs overweight; height 53
temperature: 98.2F, respiratory rate 16, heart rate 90, blood pressure 120/60O2 saturation 98%

 General
well developed, nourished, healthy-appearing female
patient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight); no obvious distress noted
well-developed healthy 35-year-old male; no gross deformities

 HEENT
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition multiple carries.

Lungs
clear to auscultation
within normal limits, appropriate lung sounds auscultated, clear and equal bilaterally
CTA AP&L

Card
regular rate and rhythm (RRR)
S1S2 without rub or gallop
S1S2 without rub or gallop

Breast
Examined in sitting and supine positions. In sitting position, no evidence of skin changes, right breast is slightly larger than the left, symmetrical movement with the arms above the head and at the side and with flexion of the pectoral muscles; 5-mm nonmobile, non-tender, firm mass felt at 10 oclock position, 5 cm from the areola. Right breast without dominant masses or tenderness. Nipples without inversion or evidence of nipple discharge. Breast mass is palpated in the supine position in the same manner as in the sitting position

INSPECTION: no dimpling or abnormalities noted upon inspectionPALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.

INSPECTION: no dimpling or abnormalities noted upon inspection
PALPATION: Left breast – no abnormalities noted. Right breast – denies tenderness, pain, no abnormalities noted.

Lymph
negative axillary, infraclavicular, and supraclavicular lymphadenopathy
Inguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in size
no bruising, fever, or swelling noted, no acute bleeding or trauma to skin.

Abd
normoactive bowel sounds x 4;
tender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomiting
benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.

GU
Bladder is non-distended.
labia major and minor: numerous ulcerations, too many to count; some ulcerations enter the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobility
Bladder is non-distended.

Integument
good skin turgor noted, moist mucous membranes

intact without lesions masses or rashes.

MS
Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.
Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.
No obvious deformities, masses, or discoloration. Palpable pain noted at the right lower lumbar region. No palpable spasms. ROM limited to forward bending 10 inches from floor; able to bend side to side but had difficulty twisting and going into extension. 

Neuro
No obvious deformities, CN grossly intact II-XII
No obvious deficits and CN grossly intact II-XII
DTRs 2+ lower sensory neurology intact to light touch and patient able to toe and heel walk. Gait was stable and no limping noted.

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