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Spandrio Biochimica Clinica Pdf - 3rd Floor Tuesday, September 25, 2007 Patient First Name: Tony Patient Last Name: Brunner Date of Birth: 3/12/2008 Reason for Visit: Chest Pain Review of Systems: Tony is new to the practice and just had his first visit on 9/25/07. He was here with his sister who had some abdominal pain. We did a review of systems which was negative. We did an EKG which showed normal sinus rhythms at all intervals and no abnormalities of the QT interval or T wave form. We decided to order an MRI of his abdomen, chest and head. Tony came back for a second visit on 9/26/07. He had a sudden onset of low grade fever and sore throat. He felt a lot more tired than he usually does on his days off from work. His sister had just finished taking him to an urgent care center where they gave him antibiotics. The sister also explained that Tony had been coughing more often recently and that he was starting to develop a harsh cough after every deep breath along with some mucous expectoration. His sister ended up taking him back to the urgent care center but was unable to get any further information from them because the center was closed at the time of her arrival. The part that interested me most in this case was his symptom of getting a harsh cough after deep breaths. I decided to order a Sputum Culture and Gram stain because I suspected that it would be positive for something along with a chest X-ray to make sure he wasn't developing pneumonia. His chest X-ray was negative for pneumonia or bronchitis, but his sputum culture and Gram stain were positive for Staphylococcus aureus. He was started on Levaquin 750mg twice daily to help with the infection. I asked him about the new symptoms and he said that over the past few days he has been having a new discomfort in his abdomen and chest. He said that there was no sharp pain but more of ache after eating which made him think it may be gastritis or colitis. I ordered a Hepatitis panel which came back negative, and an upper GI with small bowel follow through. These tests did not show any abnormalities of his liver function or small intestine. I also asked Tony to bring back any medications he is currently taking. He told me that he takes four medications, antibiotics for penicillin allergy, an antihistamine (Diphenhydramine) for hives, Benadryl (a cold and allergies medication) which he started at the Urgent Care Center for his sore throat because he was having trouble breathing, and Advil (an anti-inflammatory capsule) to treat the pain in his stomach. He also told me that he takes two supplements daily. Tony came back to the office on 9/27/07. His sister came with him again to help with the X-rays. We got his chest X-ray done this time which showed no abnormalities of his lungs or heart chambers. cfa1e77820