Mrs. Hunter comes to Dr. A.B. Domen

1
Mrs. Hunter comes to Dr. A.B. Domens office for
advice at the request of her family practitioner,
Dr. Landry. Mrs. Hunter is complaining of
stomach pain. Dr. Domen records Mrs. Hunters
chief complaint, completes an extended system
review and a pertinent past family and social
history. He also performs a complete single
system specialty exam of her stomach and makes a
decision of moderate complexity. Dr. Domen
prepares a report with his recommendations for
Dr. Landry.
2
Dr. Norman visits Jane Pulmones in the hospital a
second time to re-evaluate her lung condition.
He performs an extensive review of her past
medical management, considering at least four
possible diagnoses and checks on her progress
with an examination of her lungs. During the
exam, Dr. Norman looks at the affected body area
as well as other symptomatic or related systems
and recommends modifications to the attending
physician on Ms. Pulmones treatment.
3
Ms. Barb Wire, a new patient of yours, falls of
her exercise bike and injures her wrist. Upon
presentation in your office, your doctor
completes a brief history of the incident with a
problem pertinent system review and examines the
wrist in an expanded problem focused exam. He
orders some x-rays and makes a straightforward
decision. He prescribes some Motrin and explains
to Ms. Wire his findings.
4
Ms. Sandy Beach has been a patient of yours for
the past two weeks. She has been complaining of
headaches that have persisted for 6 months.
During this particular visit to your office, your
doctor, Dr. U. Ken Too, questions Ms. Beach
extensively about the history of the headaches,
completes an extensive re-examination of her
neurological findings and obtains all pertinent
past family information concerning headaches,
completes a detailed examination of her medical
records and tests performed during the visit.
After considering all the information he has
obtained from the tests, records and Ms. Beach,
Dr. Too determines that the diagnoses options are
limited, the amount of data reviewed in moderate
and the risk of mortality is low.
5
Mr. T. Bone comes to your office to get his
sutures removed. He is a regular patient of
yours. The sutures were placed by another doctor
when Mr. Bone was on vacation. Because the
sutures are superficially located on the skin of
Mr. Bones arm and the healing looks good, the
nurse removes the stitches and sends Mr. Bone
home.
6
Ms. West is on vacation in your town and was
involved in a serious automobile accident.
Unconscious, she is rushed by ambulance to the
nearest hospital where the emergency department
is open. Dr. Quick, noticing the extensive
bleeding of the head, asks that Dr. Crane, a
neurologist, be summoned and begins the
examination. X-rays and tests are ordered. By
this time, Ms. Wests male friend has arrived and
he is thoroughly questioned concerning the
patients medical history and a phone call is
placed to her family physician for more detailed
information. Drs. Quick and Crane review all the
medical information, x-rays and test data. Ms.
West is till unconscious and in critical
condition, tests show possible brain damage, a
skull fracture and internal bleeding. One and
one-half hours later Ms. West is moved to the
intensive care unit for continued observation.
Code for Dr. Quick.
7
Ms. Chip A. Dee presents her son (a new patient)
to your office one afternoon after school. The
12-year-old boy is complaining of feeling dizzy
and having a sore throat. As your doctor begins
her exam, she notices some sever bruising on
young Chips body. Your physician does an
extended history on Chips illness, with a
complete system review and asks some serious
questions of Chips mom. Upon completing this
comprehensive history your physician performs a
complete multi-system examination checking for
any broken bones as well as a thorough exam of
Chips throat. Your physician reviews a multiple
number of diagnoses, and decides that the risk of
complications or even death to young Chip is
high. She leaves the room and reports Mr. and
Mrs. Dee to Childrens Protective Services.
8
Ms. I Keri Nuff, a 95 year old patient, presents
herself in your office for the first time
complaining of general malaise. Upon completion
of a comprehensive history and a comprehensive
exam, you decide that there are several diagnoses
that may apply to Ms. Nuffs case, and because of
her age, her risk of complications is moderate.
You decide that Ms. Nuff should be admitted to
the hospital for further tests. You admit Ms.
Nuff on that same day.
9
Mr. U. Never Doalot, an established patient of
yours for years, comes into your office
complaining of back pain. Mr. Doalot is a
32-year-old unemployed patient. You examine Mr.
Doalots back briefly and find out how long he
has had this pain. Mr. Doalot says that he
helped his brother-in-law move yester and it was
last night that his pain began. You explain to
Mr. Doalot that he should take some aspirin and
begin to show him some exercises that should help
alleviate his pain. Mr. Doalot has difficulty
understanding you diagnosis and treatment plan
and you spend the next 40 minutes explaining his
therapy.
10
An 85 year old patient of yours in admitted to
the hospital by an orthopedist to test for
possible bone cancer. As the internist for the
patient you are asked to treat her for diabetes.
During your initial visit to see the patient, you
complete a problem focused history and exam,
making a straight forward decision to continue
the patients treatment as it is.