Caleb Metz Performance Report

PerformanceOverviewforMelissaDensononcaseCalebMetz Thefollowingtablesummarizesyourperformanceoneachsectionofthecase,whetheryoucompleted thatsectionornot. Status:Submitted CaseSection Status TotalScore Your Score Timespent PerformanceDetails 92% History Done 88% 1hr39min 9sec 32questionsasked,29correct,4missedrelativetothecase'slist Physicalexams Done 93% 18min 21sec 24examsperformed,10correct,1partiallycorrect,0missedrelative tothecase'slist Keyfindings organization Done 4min26sec 9findingslisted;9listedbythecase Problem statement Done 20min6sec 92wordslong;thecase'swas81words Differentials Done 100% 19min5sec 7itemsintheDDx,6correct,0missedrelativetothecase'slist Differentials ranking Done 100% (lead/alt score) 100% (must notmiss score) 1min5sec Tests Done 100% 3min22sec Diagnosis Done 100% 1min16sec Management plan Done Exercises Done 80% (of scored items only) 4testsordered,4correct,0missedrelativetothecase'slist 1hr12min 44sec 204wordslong;thecase'swas193words 22min 39sec 8of10correct(ofscoreditemsonly) HistoryNotecardbyMelissaDensononcaseCalebMetz Usethisworksheettoorganizeyourthoughtsbeforedevelopingadifferentialdiagnosislist. 1. Indicatekeysymptoms(Sx)youhaveidentifiedfromthehistory.Startwiththepatient'sreason(s)fortheencounter andaddadditionalsymptomsobtainedfromfurtherquestioning. 2. Characterizetheattributesofeachsymptomusing"OLDCARTS".Capturethedetailsintheappropriatecolumnand row. 3. Reviewyourfindingsandconsiderpossiblediagnosesthatmaycorrelatewiththesesymptoms.(Remembertoconsider thepatient'sageandriskfactors.)Useyourideastohelpguideyourphysicalexaminationinthenextsectionofthe case. HPI Sx= Sx= Sx= Sx= Sx= Sx= Onset       Location       Duration       Characteristics       Aggravating       Relieving       Timing/ Treatments       Severity       ProblemStatementbyMelissaDensononcaseCalebMetz C.M.isa13y/omalewhopresentswithsuddenonsetofpaintohisleftscrotumwhileplayingbasketball.Thepainstarted2 hourspriortohisarrivaltodayandhedescribesthepainasfeelinglikehegot'punched.'Healsoc/onauseaandvomitedonce duringthecarridetotheclinic.Hereportsnothingmakesthepainbetteranditbecomesworsewithmovement.Onphysical examheisrestless,diaphoretic,andtachycardic.Hisgenitalexamrevealsleftscrotaltendernessandswelling,erythema,andan absentcremastericreflex. ManagementPlanbyMelissaDensononcaseCalebMetz TesticularTorsion DiagnosticTests: CBC-MildlyincreasedWBC ScrotalUS,doppler-absenceofbloodflowtolefttesticle CTabd/pelvisw/ocontrast-Normal Urinalysis(UA)-Normal Medications/treatments: Onceadiagnosisoftesticulartorsionismade,thispatientshouldbedirectedtothenearestemergencyroom.Furthertreatment includespainmedicationfortesticularpainrelief,resolutionofthehorizontallieofthetestes,andrestoredbloodflowtothe testes(Vasconcelos-Castroetal.,2020).ThepatientshouldbekeptNPOassurgicalexplorationfollowsmanualreduction. Consults/Referrals: Urologyshouldbeconsultedastesticulartorsionisconsideredamedicalemergency. ClientEducation: Lackofbloodflowforanextendedperiodoftimetothetesticlescanberesultinnecrosisandatrophyofthetestes(VasconcelosCastroetal.,2020). Patientsshouldbeinstructedtoseekimmediateattentionfortesticularpainbecausetheabilitytosavethetestesisdirectly relatedtothedurationofthetwistedspermaticcord.Evenifthepaingoesaway,thepatientshouldstillseekmedicalcare. References: Vasconcelos-Castro,S.,Flor-de-Lima,B.,Campos,J.,&Soares-Oliveira,M.(2020).Manualdetorsionintesticulartorsion: 5/yearsofexperienceatasinglecenter.JournalofPediatricSurgery,55(12),272832731. https://doi.org/10.1016/j.jpedsurg.2020.02.026 ElectronicHealthRecordbyMelissaDensononcaseCalebMetz HistoryofPresentIllness Category DataenteredbyMelissaDenson ReasonforEncounter testicular/groinpain Historyofpresentillness C.M.isa13y/omalewhostatesthat2hrsagohestartedexperiencingsudden,sharp paintohislefttesticlewhileplayingbasketball.Ptreportsconstantpainat9/10and stateshefeelslikehe'gotpunched.'Ptalsoexperiencingnauseaandreportshevomited inthecaronthewaytotheclinic.Ptreportspainisworsewithmovement,andhehas nottakenanythingforrelief. PastMedicalHistory Category DataenteredbyMelissaDenson PastMedicalHistory none. Hospitalizations/Surgeries tympanostomyasachild. Medications Category DataenteredbyMelissaDenson Medications none. Allergies Category DataenteredbyMelissaDenson Allergies none. PreventiveHealth Category DataenteredbyMelissaDenson Preventivehealth regularvisitswithpediatrician.Covidvaccinated. FamilyHistory Category DataenteredbyMelissaDenson FamilyHistory Father:49,HTNMother:48,nomedicalhistorySibling:9,healthy SocialHistory Category DataenteredbyMelissaDenson SocialHistory Dependentadolescentwholivesinasingle-familyhomewithbothparentsandsister.Pt isamiddleschoolstudent.Nohistoryofalcohol,tobacco,orothersubstanceuse.Pt notsexuallyactive. ReviewofSystems Category DataenteredbyMelissaDenson General Deniesfeverorchills.Nausea.Vomitingx1duringcarridetoclinic.Skindiaphoretic. Integumentary/Breast Acnetofaceandback.Deniesrashorlesions. HEENT/Neck Head:Deniesheadacheorheadtrauma.Eyes:Deniesdrainage.Ears:Deniesearpainor drainage.Nose:Deniesrunnynoseorstuffiness.Throat:Deniessorethroatorinfection. Neck:Deniesswollenlymphglands. Cardiovascular Denieschestpain,dizziness,andpalpitations. Respiratory Deniesshortness,dyspnea,orcough. Gastrointestinal Deniesabdominalpainorchangeinbowelpatterns. Genitourinary Sudden,sharppaintogroinandLtesticulararea.Deniesfrequency,urgency,orpainful urination.Denieshematuria. Musculoskeletal Lgroinpain. Allergic/Immunologic Denieslymphdisorders.Deniesallergiestofood,medications,orallergies. Endocrine Deniesinguinaladenopathy.Deniesintolerancetocoldorheat. Hematologic/Lymphatic Deniesbleedingorbruising. Neurologic Deniesweakness,dizziness,orseizures. Psychiatric Inacutepain,butotherwisehappychild. PhysicalExams Category DataenteredbyMelissaDenson General Skinwarm,mildlydiaphoretic. Skin Norashes.Acnenotedonback. HEENT/Neck Negative. Cardiovascular BP130/70,HR120(tachycardic).Nomurmurs. Chest/Respiratory Respirations18,SP02100%onroomair.Breathingunlabored.Lungsclearto auscultationbilaterally. Abdomen Leanabdomen.Nondistended.Novisibleorpalpatedhernias,tenderness,ormasses. Genitourinary/Rectal Lscrotalswellingwithmilderythema.LtesticlehigherthanR.Ltesticletenderto touch.Nomassesappreciated.AbsentLcremastericreflex;RWNL.NegativePrehn's sign.Tannerstage3.Circumcised,nopeniledischarge,rashes,orlesions. Musculoskeletal/Osteopathic StructuralExamination Nodeformitiesorswelling. Neurologic A/Ox4.Normalgaitandposture. Psychiatric Appropriatemoodandaffect. Lymphatic Nolymphadenopathy.