General Information: GY is a 70 years old White American male at the emergency department of NYP Medical
Center with multiple complications.
CC: “I feel weakness and difficulty of breathing”.
HPI: GY is a 70 years old male presents to the emergency department with multiple complications. He has not
felt well last couple of weeks and lost appetite and lost weight 15 lb in the last month. GY has diabetic
nephropathy which has progressed to ESRD for 10 years. He has renal failure and has been on hemodialysis
for 5 years (2 times/week). He has history of coronary heart disease for last 10 years, COPD for last 15 years
and abnormality in secretion of corticosteroid hormone from birth. He occasionally feels pain in his chest which
disappears after taking nitroglycerine sublingual tablet or rest. He complains shortness of breath and becomes
weak after walking several blocks.
PMH: Ischemic Heart Disease X 10 years and controlled by medication
Chronic Obstructive Pulmonary Disease X 15 years and uncontrolled
Adrenal insufficiency X from birth
FH: Mother died at the age of 90 from diabetes.
Father died of heart attach at the age of 75.
He has no siblings.
SH: Ethanol drinking with 2 beers x daily, he smokes 1 pack of cigarettes daily, he is single and live in
Meds: Nitroglycerine SL 0.4 mg prn for chest pain
Atenolol 50 mg po qd
Levalbuterol neb 0.63 mg tid every 6 hours
Ipratropium neb 500 mcg every 6 hours
Lipitor 10 mg po daily
Prednisone 5 mg po daily
Glyburide 10 mg po daily
Furosemide 40 mg po daily
PE: VS: BP 130/74 P 79 RR 18, T 98ºF, Wt 62 kg, Ht 5’8”
CHEST: RRR, no murmur, rales bilaterally chest wall NT.
CV: S1 S2 normal, no chest pain, no palpitation, no shortness of breath
Abd: No bruits tenderness, no masses.
Skin: Rash at lower extremities
HEENT: No history of headaches, dysphasia or odonyphasia
Mental status: Normal.
Labs: Na 135; K 4.3; Cl 102; CO2 24; BUN 27 (H); Scr 2.1 (H); Glu 170 (H); ALT 26; AST 21; total Chol 175;
LDL 120; HDL 39; TG 115; Albumin 4.8; Hgb 18; Hct 43% RBC 5.6; WBC 9; Plt 250, A1C 9.0, DST 450.
Problem List: 01. Coronary Heart Disease (CHD)
- Chronic Kidney Disease (CKD)
- Chronic Obstructive Pulmonary Disease (COPD)
- Adrenal Insufficiency
- Coronary Heart Disease (CHD)
S: GY is a 70 year old male who is suffering from coronary heart disease from last 10 years. He complains
weakness and difficulty of breathing. He occasionally feels pain in his chest which disappears after taking
nitroglycerine sublingual tablet or rest. He drinks beer and smokes regularly.
O: Age 70; BP 130/74 P 79 RR 18; ALT 26; AST 21; total Chol 175; LDL 120; HDL 39; TG 115; Hgb 18; Hct
43% RBC 5.6
K. Rowling is the author of the Harry Potter series of fantasy novels. Rowling was born in London in 1965. She lived with her parents and her sister. Her family was not rich. She was a quiet child and she did not get her education in a special school. When she was on the train in 1990 traveling to London she got the great idea of a boy who was studying in a school for wizards. In December the same year her mother died of suffering from multiple sclerosis. At the same time she was writing the first novel of Harry Potter. She didn’t tell her mother about it. Her death affected Rowling’s writing because she wrote a lot of details about Harry’s own loss in the first book because she knew the feeling of loss so deeply. She married for the first time in 1992, and in 1993 she had her first child Jessica. But on 17 November she and her husband divorced. Rowling finished her manuscript in 1995 with an old manual typewriter. She submitted this book to many publishing houses and they rejected it. Then after one year the editor Barry Cunningham who works at Bloomsbury publishing house in London accepted the book and published 1000 copies in 1997. The book won the first award and then won the second award of the Children’s Book of the Year. After that, six more Harry Potter books were published. In 2004 Rowling became the richest person in the world. The Story of the novel Harry Potter is a ten year old boy. He is an orphan who lives with the Dursley family: his aunt Petunia, loathsome uncle Vernon, and his cousin Dudley. The Dursley family doesn’t like Harry. One day Harry finds a letter sent to him. Before he opens the letter, uncle Vernon takes it. Then the letters come again later in huge numbers. But Vernon tears them all up. Finally he tries to escape from this letters to a miserable shack on a small island. On Harry’s birthday, a giant man named Hagrid tells Harry that he is a wizard and that he has been accepted at Hogwarts School of Witchcraft and Wizardry. He also tells him that his parents have been killed by Voldemort. He has a scar in his forehead during the battle. When he goes to the school, the students are assigned to four houses: Gryffindor, Ravenclaw, Slytherin and Hufflepuff. Harry is in Gryffindor. He becomes friends with Ron and Hermione. His enemy is Draco Malfoy (Slytherin). Then Harry becomes a member of the Quidditch team because he is skillful in flying on a bro>GET ANSWER