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Chest Pain: Musculoskeletal in Origin

Identification

  • Name: Nora Smith

  • Age: 73 years old

  • Race: Caucasian

Chief Complaint

“I’d like to ask for your recommendation for something for my chest pain.”

History of Present Illness: Students should ask the following questions

  1. “What brought on the pain?”

    • I have been working in the garden for the last 2 days.

    • The pain started 2 nights ago but felt worse last night after a long day in the garden.

  2. “What makes it worse?”

    • Lifting things like boxes of my small garden tools.

    • It bothers me when I sleep on my side.

  3. “What makes it better?” (for example: rest, medications)

    • I started using a heating pad on my left shoulder this afternoon.

    • I took two Tylenol 325mg last night and felt better but just for a few hours.

  4. “Describe the pain (sharp/dull, burning/aching, constant/intermittent).”

    • Dull and aching most of the time and a little worse when I lift.

    • I feel stiffness in my shoulders.

  5. “Where is the pain located?”

    • In both of my shoulders

  6. “Does it spread out to other body areas?”

    • No

  7. “Do you have pain in other body areas?”

    • No

    • No other symptoms such as shortness of breath, sweating, rapid heart rate

  8. “How severe is the pain (1–10 scale)?”

    • I would say 2, probably.

  9. “Does it occur or get worse at certain times of day?”

    • It aches more in the morning when I get up, then it gradually feels better with movement.

  10. “How long have you had the pain?”

    • For about 2 days, ever since I started working in the garden.

    • It started to feel worse last night.

Past Medical History

  • Urinary incontinence

  • Osteoporosis

Past Surgical History

  • None

Family History

  • Father died at 92 from Alzheimer’s disease complications.

  • Mother died at 79 from cancer.

  • I have one daughter who is alive and well.

Social History

  • Occupation: Retired

  • Marital Status: Divorced

  • Children: 1

  • Alcohol: None

  • Tobacco: None

  • Recreational Drug Use: None

  • Caffeine Use: None

  • Education: High School Degree

  • Exercise: Walks daily

Medication History (NOTE: Just give drug name unless students ask for strength and frequency.)

  • Tolterodine 4mg extended-release by mouth once daily for urinary incontinence

  • Alendronate 70mg by mouth once weekly for osteoporosis

  • Herbals and vitamins

    • Calcium carbonate plus vitamin D 600mg/200 international units by mouth twice daily

RECOMMENDATION

  • After the student-pharmacists have fully assessed the pain, they should make a clear recommendation.

  • If no recommendation is made, the standardized patient should ask: “What do you recommend that I take for my pain?”

  • The student-pharmacist should conclude that the description of the pain sounds like muscle ...

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