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            [0] => a:18:{i:0;a:3:{s:8:"question";s:15:"Chief Complaint";s:6:"answer";s:8:"Headache";s:13:"preload_value";s:0:"";}i:1;a:3:{s:8:"question";s:26:"History of Present Illness";s:6:"answer";s:816:"The patient is a 24-year-old male with a history of migraines who presents to the emergency department with a chief complaint of a headache. Symptoms began two hours ago when the patient woke up with “the worst headache of his life” and have been constant since onset. Head pain is currently rated as a 9/10 in severity and described as sharp with no radiation. Associated symptoms include photophobia, nausea, and chills.  Symptoms are aggravated with light and there are no alleviating factors. The patient denies blurred vision, diplopia, fever, neck pain, back pain, chest pain, shortness of breath, abdominal pain, emesis, diarrhea, hematochezia, dysuria, hematuria, or any other symptoms.  He reports taking Imitrex prior to arrival with minimal relief of symptoms. No other reported symptoms at this time.";s:13:"preload_value";s:486:"The patient is a [age] [sex] who presents to the emergency department with a chief complaint of ***. The symptoms began *** and have been *** since onset. His/her*** pain is currently rated as a ***/10 in severity and described as *** with radiation to ***. Associated symptoms include ***. Symptoms are aggravated with *** and improve with ***. The patient denies ***.  He/she*** reports taking *** prior to arrival with *** relief of symptoms. No other reported symptoms at this time.";}i:2;a:3:{s:8:"question";s:17:"Review of Systems";s:6:"answer";s:89:"All pertinent positive findings are listed in the HPI and all other systems are negative.";s:13:"preload_value";s:0:"";}i:3;a:3:{s:8:"question";s:20:"Past Medical History";s:6:"answer";s:9:"Migraines";s:13:"preload_value";s:0:"";}i:4;a:3:{s:8:"question";s:19:"Current Medications";s:6:"answer";s:7:"Imitrex";s:13:"preload_value";s:0:"";}i:5;a:3:{s:8:"question";s:14:"Social History";s:6:"answer";s:144:"Smoking Status - Yes- 1 pack/day, trying to quit
Smokeless Tobacco - No
Alcohol Use - Occasionally
Drug Use - No
Sexual Activity - Not Asked";s:13:"preload_value";s:0:"";}i:6;a:3:{s:8:"question";s:14:"Family History";s:6:"answer";s:40:"Stroke - Grandfather
Migraines - Mother";s:13:"preload_value";s:0:"";}i:7;a:3:{s:8:"question";s:19:"Initial Vital Signs";s:6:"answer";s:3:"N/A";s:13:"preload_value";s:3:"N/A";}i:8;a:3:{s:8:"question";s:13:"Physical Exam";s:6:"answer";s:2161:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: There is no midline or paraspinal tenderness to palpation, no evidence of trauma, there is no CVA tenderness.
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: The patient is alert and oriented x3. No cranial nerve deficit. Motor examination reveals +5/5 strength throughout. Sensation is normal throughout. No pronator drift. Good plantarflexion and dorsiflexion. Finger-to-nose intact. Heel-to-shin intact. Negative Romberg sign. Gait and station appear normal. Visual fields are full to confrontation.
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.";s:13:"preload_value";s:1820:"GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: There is no midline or paraspinal tenderness to palpation, no evidence of trauma, there is no CVA tenderness.
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: ***
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.";}i:9;a:3:{s:8:"question";s:18:"ED COURSE:
Orders";s:6:"answer";s:26:"CT Head W/O Contrast
Labs";s:13:"preload_value";s:0:"";}i:10;a:3:{s:8:"question";s:24:"Medications Administered";s:6:"answer";s:25:"Zofran
Toradol
Benadryl";s:13:"preload_value";s:0:"";}i:11;a:3:{s:8:"question";s:11:"Lab results";s:6:"answer";s:6:"Normal";s:13:"preload_value";s:0:"";}i:12;a:3:{s:8:"question";s:9:"Radiology";s:6:"answer";s:135:"CT Head WO Contrast: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Headache
Interpretation: Meningitis";s:13:"preload_value";s:0:"";}i:13;a:3:{s:8:"question";s:10:"Procedures";s:6:"answer";s:712:"Lumbar Puncture
A lumbar puncture was performed by Dr. ***. A lumbar puncture was deemed necessary in order to evaluate for infection. An informed consent was obtained. I used 2% lidocaine with epinephrine and a total of *** mL was injected. The patient was prepped and draped in the usual sterile fashion. I entered the L3-L4 interspace. The patient was positioned sitting. A 21 gauge three inch spinal needle was used. One attempt was needed and the fluid appeared clear. A total of four tubes, with a total volume of 10 mL each were obtained. The site was cleaned, a pressure dressing was applied, and an adhesive bandage was applied. The patient tolerated the procedure well with no immediate complications.";s:13:"preload_value";s:0:"";}i:14;a:3:{s:8:"question";s:23:"Calls/Consults/Rechecks";s:6:"answer";s:367:"***: Rechecked patient who states his symptoms have not improved and he is now complaining of neck stiffness and diplopia. Discussed a lumbar puncture for meningitis. The patient consents to the procedure. 

***: Rechecked patient. Lumbar puncture results were discussed. The plan for discharge was discussed. Patient agrees with plan. All questions were addressed.";s:13:"preload_value";s:0:"";}i:15;a:3:{s:8:"question";s:23:"Medical Decision Making";s:6:"answer";s:913:"The patient is a male who presents to the emergency department with a chief complaint of a headache.  Medical records were reviewed. Lab work was ordered and reviewed. Findings stated above.  A head CT was also ordered and reviewed. Imaging shows meningitis. The patient was provided with Zofran, Toradol, and Benadryl resulting in minimal improvement of symptoms. He later complained of neck stiffness. A lumbar puncture was performed by Dr. ***.  The patient was discharged home with a diagnosis of bacterial meningitis. It was recommended for the patient to follow up with Dr. Ted (Neurosurgery) and Dr. Miller (PCP) as soon as possible for a recheck.  The patient was provided prescriptions for azithromycin.  The patient's vital signs and condition remained stable while undergoing evaluation in the Emergency Department. The patient agreed with the plan for care.  All questions and concerns were addressed.";s:13:"preload_value";s:676:"The patient is a @AGE@ @SEX@ who presents to the emergency department with a chief complaint of ***.  Medical records were reviewed. Multiple diagnoses were considered.  Lab work was ordered and reviewed. A *** was also ordered and reviewed. Imaging shows ***.  The patient was provided with *** resulting in *** of symptoms. The patient was diagnosed with ***. The patient was advised to ***. It was recommended for the patient to follow up with ***.  The patient was prescribed ***.  The patient's vital signs and condition *** while undergoing evaluation in the Emergency Department. The patient*** agreed with the plan for care.  All questions and concerns were addressed.";}i:16;a:3:{s:8:"question";s:16:"Final Impression";s:6:"answer";s:20:"Bacterial Meningitis";s:13:"preload_value";s:0:"";}i:17;a:3:{s:8:"question";s:4:"Plan";s:6:"answer";s:103:"The patient is discharged home in stable condition and does not have any further questions or concerns.";s:13:"preload_value";s:0:"";}}
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            [0] => Mock Patient #32 REVIEW: HEADACHE - AGE 24
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Array
(
    [0] => Array
        (
            [question] => Chief Complaint
            [answer] => Headache
            [preload_value] => 
        )

    [1] => Array
        (
            [question] => History of Present Illness
            [answer] => The patient is a 24-year-old male with a history of migraines who presents to the emergency department with a chief complaint of a headache. Symptoms began two hours ago when the patient woke up with “the worst headache of his life” and have been constant since onset. Head pain is currently rated as a 9/10 in severity and described as sharp with no radiation. Associated symptoms include photophobia, nausea, and chills.  Symptoms are aggravated with light and there are no alleviating factors. The patient denies blurred vision, diplopia, fever, neck pain, back pain, chest pain, shortness of breath, abdominal pain, emesis, diarrhea, hematochezia, dysuria, hematuria, or any other symptoms.  He reports taking Imitrex prior to arrival with minimal relief of symptoms. No other reported symptoms at this time.
            [preload_value] => The patient is a [age] [sex] who presents to the emergency department with a chief complaint of ***. The symptoms began *** and have been *** since onset. His/her*** pain is currently rated as a ***/10 in severity and described as *** with radiation to ***. Associated symptoms include ***. Symptoms are aggravated with *** and improve with ***. The patient denies ***.  He/she*** reports taking *** prior to arrival with *** relief of symptoms. No other reported symptoms at this time.
        )

    [2] => Array
        (
            [question] => Review of Systems
            [answer] => All pertinent positive findings are listed in the HPI and all other systems are negative.
            [preload_value] => 
        )

    [3] => Array
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            [question] => Past Medical History
            [answer] => Migraines
            [preload_value] => 
        )

    [4] => Array
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            [question] => Current Medications
            [answer] => Imitrex
            [preload_value] => 
        )

    [5] => Array
        (
            [question] => Social History
            [answer] => Smoking Status - Yes- 1 pack/day, trying to quit
Smokeless Tobacco - No
Alcohol Use - Occasionally
Drug Use - No
Sexual Activity - Not Asked
            [preload_value] => 
        )

    [6] => Array
        (
            [question] => Family History
            [answer] => Stroke - Grandfather
Migraines - Mother
            [preload_value] => 
        )

    [7] => Array
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            [question] => Initial Vital Signs
            [answer] => N/A
            [preload_value] => N/A
        )

    [8] => Array
        (
            [question] => Physical Exam
            [answer] => GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: There is no midline or paraspinal tenderness to palpation, no evidence of trauma, there is no CVA tenderness.
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: The patient is alert and oriented x3. No cranial nerve deficit. Motor examination reveals +5/5 strength throughout. Sensation is normal throughout. No pronator drift. Good plantarflexion and dorsiflexion. Finger-to-nose intact. Heel-to-shin intact. Negative Romberg sign. Gait and station appear normal. Visual fields are full to confrontation.
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.
            [preload_value] => GENERAL: Alert and oriented x3. No significant distress noted.
HEENT: Normocephalic, atraumatic.  Pupils are 3mm equal round and reactive to light.  Nares are patent, without epistaxis.  There is no rhinorrhea.  Pharynx is moist and without erythema, exudate, or edema.  Uvula is midline.  Tympanic membranes are clear bilaterally.  There is no hemotympanum.
NECK: Supple, trachea is midline.  There is no JVD or carotid bruits.  There is no stridor.  There is no midline or paraspinal tenderness to palpation. There is no lymphadenopathy.
BACK: There is no midline or paraspinal tenderness to palpation, no evidence of trauma, there is no CVA tenderness.
CHEST: Symmetric, there is no crepitus. There is no visible evidence of trauma to the chest. 
LUNGS: Breath sounds are present and equal bilaterally, there are no rales, rhonchi or wheezes. There is no respiratory distress.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rubs, clicks, or gallops. Normal S1 and S2.
ABDOMEN: Abdomen is nondistended. There is no palpable tenderness. There is no rebound or guarding. There is no palpable mass. Bowel sounds are present and equal throughout.
PELVIS: Stable to rock. There is no visible trauma.
MUSCULOSKELETAL: There are no deformities to the extremities. Capillary refill is less than two seconds to nail beds of the bilateral hands. There is no clubbing, cyanosis or edema. Radial pulses are +2/4 bilaterally.
NEUROLOGIC: ***
SKIN: Skin is warm and dry. There is no pallor. There are no signs of acute dermatologic abnormality. There is no rash, petechiae, purpura, or ecchymosis. There is good skin turgor.
PSYCH: The patient does not have suicidal ideation or homicidal ideation.  Mood is normal. The patient does not have auditory or visual hallucinations. Judgment and cognition are normal.
        )

    [9] => Array
        (
            [question] => ED COURSE:
Orders
            [answer] => CT Head W/O Contrast
Labs
            [preload_value] => 
        )

    [10] => Array
        (
            [question] => Medications Administered
            [answer] => Zofran
Toradol
Benadryl
            [preload_value] => 
        )

    [11] => Array
        (
            [question] => Lab results
            [answer] => Normal
            [preload_value] => 
        )

    [12] => Array
        (
            [question] => Radiology
            [answer] => CT Head WO Contrast: ordered and images reviewed by Dr. ***. Interpreted by Dr. ***. 
Indication: Headache
Interpretation: Meningitis
            [preload_value] => 
        )

    [13] => Array
        (
            [question] => Procedures
            [answer] => Lumbar Puncture
A lumbar puncture was performed by Dr. ***. A lumbar puncture was deemed necessary in order to evaluate for infection. An informed consent was obtained. I used 2% lidocaine with epinephrine and a total of *** mL was injected. The patient was prepped and draped in the usual sterile fashion. I entered the L3-L4 interspace. The patient was positioned sitting. A 21 gauge three inch spinal needle was used. One attempt was needed and the fluid appeared clear. A total of four tubes, with a total volume of 10 mL each were obtained. The site was cleaned, a pressure dressing was applied, and an adhesive bandage was applied. The patient tolerated the procedure well with no immediate complications.
            [preload_value] => 
        )

    [14] => Array
        (
            [question] => Calls/Consults/Rechecks
            [answer] => ***: Rechecked patient who states his symptoms have not improved and he is now complaining of neck stiffness and diplopia. Discussed a lumbar puncture for meningitis. The patient consents to the procedure. 

***: Rechecked patient. Lumbar puncture results were discussed. The plan for discharge was discussed. Patient agrees with plan. All questions were addressed.
            [preload_value] => 
        )

    [15] => Array
        (
            [question] => Medical Decision Making
            [answer] => The patient is a male who presents to the emergency department with a chief complaint of a headache.  Medical records were reviewed. Lab work was ordered and reviewed. Findings stated above.  A head CT was also ordered and reviewed. Imaging shows meningitis. The patient was provided with Zofran, Toradol, and Benadryl resulting in minimal improvement of symptoms. He later complained of neck stiffness. A lumbar puncture was performed by Dr. ***.  The patient was discharged home with a diagnosis of bacterial meningitis. It was recommended for the patient to follow up with Dr. Ted (Neurosurgery) and Dr. Miller (PCP) as soon as possible for a recheck.  The patient was provided prescriptions for azithromycin.  The patient's vital signs and condition remained stable while undergoing evaluation in the Emergency Department. The patient agreed with the plan for care.  All questions and concerns were addressed.
            [preload_value] => The patient is a @AGE@ @SEX@ who presents to the emergency department with a chief complaint of ***.  Medical records were reviewed. Multiple diagnoses were considered.  Lab work was ordered and reviewed. A *** was also ordered and reviewed. Imaging shows ***.  The patient was provided with *** resulting in *** of symptoms. The patient was diagnosed with ***. The patient was advised to ***. It was recommended for the patient to follow up with ***.  The patient was prescribed ***.  The patient's vital signs and condition *** while undergoing evaluation in the Emergency Department. The patient*** agreed with the plan for care.  All questions and concerns were addressed.
        )

    [16] => Array
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            [question] => Final Impression
            [answer] => Bacterial Meningitis
            [preload_value] => 
        )

    [17] => Array
        (
            [question] => Plan
            [answer] => The patient is discharged home in stable condition and does not have any further questions or concerns.
            [preload_value] => 
        )

)

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