Shadow Health- Danny Rivera- Focused Exam: Cough

Shadow Health- Danny Rivera- Focused Exam: Cough Established chief complaint ans: Reports cough Asked about onset of cough ans: Reports cough started 3 days ago Asked about characteristics of cough ans: Reports cough is wet Reports clear sputum with cough Asked about frequency and duration of cough ans: Reports coughing every few minutes Reports coughs last a few seconds Asked about aggravating factors for cough ans: Reports cough is worse at night Denies smoking Reports being exposed to secondhand smoke through father Reports he doesn't know what triggers the cough Asked about exposure to germs ans: Reports playing with an ill classmate Asked about hand hygiene ans: Reports infrequent hand washing Reports occasionally putting fingers in eyes, nose, or mouth Asked about cough etiquette ans: Denies covering mouth when coughing Asked about relieving factors for cough ans: Reports cough is temporarily relieved by cough medicine Followed up on cough medicine ans: Reports cough medicine was purple Reports taking one spoonful of cough medicine Reports mother gave him the medicine Reports only took the medicine this morning Denies home remedies Asked about typical medication use ans: Denies taking medication Reports taking daily vitamin Asked about activity level ans: Reports typical high activity level Reports activity level low since getting sick Reports still able to run or play Reports focusing in class is difficult Asked about nasal symptoms ans: Reports current runny nose Denies sneezing Followed up on nasal discharge ans: Reports nasal discharge is clear Reports nasal discharge is thin Asked about ear symptoms ans: Denies ear pain Reports history of frequent ear infections Denies ear discharge Denies hearing problems Asked about throat symptoms ans: Reports sore throat Reports a little pain with swallowing Asked about relevant medical history ans: Reports frequent runny noses Reports past frequent coughs Reports past pneumonia Denies asthma diagnosis Reports immunizations as current Asked about allergies ans: Denies seasonal allergies Denies food allergies Denies medication allergies Asked relevant family history ans: Reports father has history of asthma Denies family history of allergies Asked about constitutional health ans: Denies chills Denies fever Reports feeling somewhat fatigued Denies night sweats Reports cough makes it difficult to sleep Denies swelling Asked about additional review of systems for HEENT ans: Reports frequent colds Denies headaches Denies nosebleeds Denies vision difficulty Denies dizziness Denies watery eyes Denies eye redness Denies eye pain Denies sinus pain Asked about review of systems for respiratory ans: Denies chest tightness Denies chest pain Denies difficulty breathing