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Office of Education
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Dan Yang: InterviewDr. Grey: What's the matter Dan? Dan: I have this awful pain in my chest. It began yesterday and kept me up all night. Dr. Grey: Where's the pain? Dan: It seems to be right in the middle of my chest. Dr. Grey: What does it feel like? Dan: It's sharp, like a knife. Dr. Grey: Does it travel anywhere? Dan: I can feel it in the muscle, from my neck to my shoulder. Dr. Grey: Anything make it better? Dan: Last night I couldn't lie down in bed so I sat up in a chair. That seemed to help. I stayed there all night. Dr. Grey: Does it hurt to breathe? Dan: Yes. Dr. Grey: How were you feeling before this pain started? Dan: I got sick at school last Wednesday. All of a sudden I began throwing up and having diarrhea. I went to Student Health and the Nurse Practitioner told me there was a virus going around. She gave me some pills and told me to drink lots of soda. By the next day I was better, but I felt awfully weak and I missed American History and Chemistry. Dr. Grey: Did you have a fever? Dan: The nurse said I had a temperature of 102 degrees on the first day when I felt warm and cold. After that my temperature was normal. I've checked twice each day. Dr. Grey: Have you been coughing? Dan: No. Dr. Grey: Dizzy? Dan: A little bit, when I stand up. Dr. Grey: (turning to Dan's father, who was also Dr. Grey's patient). Anything else Paul? Mr. Green: You know my history. I had a heart attack when I was 45 years old. I'm just worried about my son.  The correct answer is d. An infectious disorder is suggested by fever prior to the onset of pain. Given his college age, Dan is at extremely low risk for myocardial infarction, even with his father having had an MI at age 45. Also, the pain of myocardial infarction tends to last for less than an hour and is not effected by position. The cardinal symptom of pulmonary embolism is shortness of breath. Fever and chest pain can occur later as a result of pulmonary infarction. Pneumothorax can occur spontaneously in young adults and be quite painful, but does not in and of itself cause fever. |
