1-1 PATIENT NOTE: DIARRHEA HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patient s problem(s ). HPI: 25 yo male c/o diarrhea and bloody stool for 3 days. Blood in stool with ea ch bowel movement, patient notes drops of blood prior to defacation, and burning during defacation. One bowel movement or less a day for 10 years. Diarrhea bega n one month ago and has loose watery stool at least one time a day, with rectal spasms. Abdominal pain, 8/10, began 2 days ago, sharp, constant, atleast two ti mes a day. Diet consists most of junk food, no appetite changes, lost 10 lbs in a week. Exercise each day walks one mile. ROS: negative except as noted above Allergies: none Medications: prior use of OTC laxatives Pmh: pneumonia 2 years ago, hospitalized for 1 week. Psh: hemorrhoids removed 2 years ago Fh: parents alive and well, sister died of breast cancer 5 years ago Sh: denies tobacco, etoh, or drug use, lives alone, works as a librarian PHYSICAL EXAM: Describe any positive and negative findings relevant to this pat ient s problem(s). Be careful to include only those parts of examination you perform ed in this encounter. PHYSICAL EXAM: GA: patient is in no acute distress Vs: wnl Chest: clear breath sounds bilaterally Heart: RRR, normal S1/S2, no rubs, gallops or murmers Abdomen: periumbilical tenderness, non-distended, +bs DATA INTERPRETATION: Based on what you have learned from the history and physica l examination, list up to 3 diagnoses that might explain this patient s complaint(s) . List your diagnoses from most to least likely. For some cases. Fewer than 3 di agnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. L astly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, E CG, etc. Diagnosis #1: Hemorroids HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - Bloody stool - periumbilical ten derness present - Blood in stool with each bowel movemen - bowel sounds present - Drops of blood prior to defecation Diagnosis #2: Colon Cancer HISTORY FINDING(S) - Bloody stool - lost 10 lbs in a week nt - Diarrhea with rectal spasms Diagnosis #3: Diverticulitis HISTORY FINDING(S) - Bloody stool PHYSICAL EXAM FINDING(S) - periumbilical tendernes PHYSICAL EXAM FINDING(S) - patient is in no distress - periumbilical tenderness prese - bowel sounds present

s - Diarrhea t DIAGNOSTIC STUDIES: Rectal exam, stool for occult blood Stool for C.difficile toxin Fecal leukocytes Colonoscopy CBC

- bowel sounds presen