Subjective Data:. Chief Complaint: Headaches On And Off

of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

Heart: has regular rhythm and rate, with no clubbing, cyanosis, or edema of the extremities.

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

The patient denies having any history of CNS infection or already significant systemic infections. He has never had any thunderclap headaches, or any left-sided neurological symptoms. He does recall having a marked headache during the flight in the 1980s and one recent exertion-induced headache last fall, lasting 15 minutes. Otherwise, he gets mild headaches and aches and pains for which he does occasionally take aspirin. There is no family history of aneurysms. His father did die of a brain tumor, which the patient called the primary "Astro something". It was not metastatic. The patient says his ENT is aware of the nasopharyngeal mass and has called it polyps. The patient also has history of bradycardia and occasionally when he takes his pulse and he finds that it is irregular. He has an evaluation with a cardiologist coming up to rule out atrial fibrillation. He also has a family history of what may be a benign essential tremor. His father a couple of paternal uncles had this tremor. He has had it for years. It has slowly increased over the years, but it still is intermittent to high frequency, low amplitude, mostly action

Heart: Rhythm regular, no murmurs. Normal S1 and S2. No S3, S4 or murmurs. No peripheral edema, cyanosis or pallor. Extremities are warm and well perfused. No carotid bruits.

Ht: 62”, Weight: 134 pounds, BMI: 24.5 Temp 98.4 BP 128/90 P 76 R18, even. The Oxygen saturation 98%.

His gait is normal. No obvious discrepancies in the eye and mouth movement of his face during our discussions here in the office.

Vital signs: Blood pressure 128/79, pulse 77 regular, temp 98.2 Fahrenheit, O2 saturation 100% on room air. General: Well-developed, well-nourished,

Cardiovascular Assessment: No visible pulsations, no heaves or lifts. Apical pulse present in the fifth intercostal space at the left midclavicular line. Auscultation of apical rate 62 beats per minute, normal rhythm regular S1 - S2 heart sounds present. Pulsations present when supine and disappear at a 45 degree angle position. Extremities are brown color without redness, cyanosis, lesions or varicosities bilaterally. Temperature warm bilaterally, Allen test was negative. Homan’s sign negative. Carotids: +2 and present bilaterally. Right Radial +2, left radial +1 , Right Brachial: +2

Patient is a 25-year old right-handed white female who started having around age 11 or 12. Menarche was around age 13. After menarche, she did notice some correlation with her milder headaches and her menses. That has been persistent throughout. She also was having headaches at other times. She gets two kinds of headaches. Her mild headaches are up to twice a week. She had been taking Excedrin, Aleve, Tylenol, or Advil for these. She has a more severe headache that may be preceded or associated with a scintillating scotoma. She is unclear about the quality of the blurred vision, although she notes that when she closes her eyes during one of these episodes, she does still see spots suggesting, a positive visual phenomenon, but she states in this visual blurring last the whole two hours that the headaches lasts. The headache is throbbing with photophobia, phonophobia, osmophobia, nausea. These headaches with

A 79-year-old female present with her daughter for ongoing fatigue also noted to have lost 5 pounds over past 6 months. No night sweats or fevers. Pertinent past medical history includes severe, generalized osteoarthritis, hypertension, type 2 diabetes mellitus and depression. She is taking the following medications: acetaminophen 650mg every eight hours, Lyrica 75 mg twice daily; alendronate 70 mg once weekly, valsartan 320 mg once daily, fluoxetine 40mg once daily and insulin glargine 20 units once daily. Your exam reveals slight pale conjunctivae, a 2/6 systolic ejection murmur and generalized arthritic joints in her extremities. A point of care test results in a hemoglobin of 10.2 g/dL. Complete blood cell count is done; results

Objective Data Provided: Objective Needed: In Italics 5’8”, 105lbs, Temp, BP looking for hypotension, Pulse looking for bradycardia, RR, mental status exam- appearance, attitude toward