1-9 PATIENT NOTE: NOSE BLEED HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 31 YO M C/O NOSEBLEED FOR A WEEK. LEFT NOSTRIL ONLY. SUDDEN BRIGHT RED BLOOD APPROXIMATELY A TISSUE FULL. PATIENT REPORTS RECENT TRAUMA AT FOOTBALL PRACTICE. NO OTHER DISCHARGE, NO BRUISING, NO ODOUR. AGGRAVATED BY SNEEZING, NOSE BLOWING AND DRY TEMPERATURES. NO POST NASAL DRIP, NO RECENT INFECTIONS, OR SURGERIES. EXCESSIVE BLEEDING POST DENTAL PROCEDURES. ALLEVIATED WITH PRESSURE FROM A TISSUE. PATIENT DENIES HEADACHE, DIZZINESS, SINUS INFECTIONS, BOWEL AND BLADDER CHANGES. ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES: CATS AND DOGS MEDICATIONS: NONE PMH: NONE PSH: NONE FH: PARENTS ALIVE AND WELL SH: SMOKES 1 PPD FOR 5 YEARS, DRINKS BEER EVERYDAY CAGE 2/4, OCCASIONALLY USES COCAINE AND MARIJUANA. LIVES IN THE COLLEGE DORMS WITH ROOMMATES. SOPHOMORE PRE LAW MAJOR. ONE GIRLFRIEND FOR 3 YEARS USES CONDOMS. PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter. PHYSICAL EXAM: GA: PATIENT HOLDING TISSUE IN LEFT NOSTRIL WITH BLOOD ON IT VS: WNL HEENT: NORMOCEPHALIC, ATRAUMATIC, NO BRUISING, PERRLA NOSE: LEFT NOSTRIL AND RIGHT NOSTRIL WNL CHEST: CTAB HEART: RRR, NORMAL S1/S2 NEURO: ALERT TO PERSON PLACE AND TIME, CN: 2-12 INTACT, MOTOR: STRENGTH 5/5 THROUGHOUT, GAIT: NORMAL EXTREMITIES: NO BRUISES, NO EDEMA, NO CYANOSIS DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc.

DIAGNOSIS #1: DRUG ABUSE HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - h/o use of cocaine and marijuana - bleeding from left nostril - nose bleed from left nostril only since a week - sudden bright red blood from nose DIAGNOSIS #2: TRAUMA HISTORY FINDING(S) - recent trauma at football practice - sudden bright red blood from nose - aggravated by sneezing, nose blowing PHYSICAL EXAM FINDING(S) - bleeding from left nostril -

DIAGNOSIS #3: HEPATIC ENCEPHALOPATHY HISTORY FINDING(S) - sudden bright red blood from nose DIAGNOSTIC STUDIES: - CBC - INR - AST/ALT/T.BILI - U/S RUQ - CT-HEAD PHYSICAL EXAM FINDING(S) - bleeding from left nostril