Questions: 1. What are the abnormal finding in Ms Mavis? 2. Discuss yours analyze for each one? 3. What are the normal f

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Questions: 1. What are the abnormal finding in Ms Mavis? 2.
Discuss yours analyze for each one? 3. What are the normal finding
for each one? The Case for health assessment: Chief Complaint:
Mavis is a 55-year-old female was seen by her GP due to a chest
infection, she was given a course of antibiotic and she was advised
to return to the surgery for a follow up. Although she completed
her prescribed treatment, she was still complaining of shortness of
breath and chest tightness. History of Present Illness: Mavis has
been having symptoms of shortness of breath and chest tightening
for over five years with little or no variations in her symptoms,
but she tends to feel worse in the morning and in cold, damp or
windy conditions. However, the timing of her breathlessness
symptoms can be indicative of several possible causes. Information
of past medical history and family may aid in strengthen a suspect
diagnosis, such as coronary artery disease or respiratory disease
in the same family may indicate prevalence. However, Mavis did not
have any previous medical history, there were no drug allergy
history although her father was a heavy smoker and suffered from
emphysema and he died of lung cancer 10 years ago. Retrospectively,
this event may have impacted Mavis avoidance of seeking medical
advice, despite 5 years’ history of experiencing shortness of
breath. Physical Examinations: When the physical assessment phase
of the assessment began, it was noted that Mavis became slightly
breathless and this was possible may be due to the time she spent
walking up the stairs before coming into the consultation room.
There were no signs of cyanosis, or oedema of her extremities.
Although Mavis was breathlessness, she seemed comfortable and not
appeared to be in distress.  General: Alert and oriented, in no
apparent distress.  On examination Mavis was apyrexial, raised of
body temperature, she did not show any signs of shock her pulse
rate of 80/min, blood pressure of 125/80 mmHg, and respiratory rate
of 17/min, her oxygen saturations on air were 98%. Her height 165cm
and weight 59kg. Her peak flow was 280L/min which is 75% predicted
value. She has no evidence of weight loss as it can be caused by
malignancy, chronic infection such as tuberculosis or HIV. There
was no evidence of peripheral oedema.  HEENT: Normocephalic,
atraumatic, sclera anicteric. Mucus membranes are moist.  On
inspection of Mavis neck and chest area, there was tracheal
deviation and asymmetry of chest shape. There no complaint of
tenderness on palpation of the ribs and sternum. Chest expansion
symmetrical, however, there was slight bilateral decreased in chest
expansion.  Though, Mavis’ finger nails have signs of clubbing,
her nails are yellow stained which indicative of her being a heavy
smoker. Evaluation of cigarette stains as a marker of tobacco
related diseases, the development of stains independent of the
cumulative exposure to smoking.  Mavis’s conjunctiva and mucosa
areas are pink, as pallor of conjunctivae, nail beds, palmer
creases and face are pallor.  There was slight diffuse
hyper-resonant. On auscultation it revealed there was reduced
breath sound on both sides of Mavis chest. No adventious sounds
heard. No chest pain, no haemoptysis, no night sweat, no fever, no
chest pain, no increased respiratory rate and pulse rate. 
Abdomen: moderate tenderness to palpation in the right lower
quadrant without rebound, guarding, or rigidity. Bowel sounds are
present throughout. Negative psoas and obturator signs. 
Genitourinary (GU): genitalia examined in standing position with a
normal external exam, no masses felt with a cough, intact
cremasteric reflex  Back: No cerebrovascular (CVA) tenderness 
Neurological: No focal deficits  Skin: Warm and dry, no rashes