2. Patient History

3.  TO  14 year old male  Lives in Palau  Right-handed  Informant: Patient, good reliability Chief Complaint: Wrist Injury

4. Fall 2 nd floor of house ~ 20ft hitting R hand, fully extended - on sandy surface (+) loss of consciousness for a few seconds (+) deformity on R wrist 8 days PTA

5. Consult at local hospital X-ray revealed fracture of the distal radius Given Tramadol Discharged (no ortho) (-) Change in sensorium (-) Nausea, vomiting, seizure (-) numbing of R hand 8 days PTA Admission

6. General: no weight loss, Cutaneous: no lesion, no pruritus HEENT: with occasional headaches no redness no aural/nasal discharge no neck masses no sore throat Cardiovascular: no easy fatigability, fainting spells, no palpitation Respiratory:no cough, colds Abdominal:no change in bowel movement Genitourinary:no change in urination Endocrine: no polyuria, polydypsia, no heat/cold intolerance Hematopoietic: no easy bruisability, or bleeding

7.  No asthma, hypertension, diabetes, allergies, heart disease, bone diseases  No maintenance medications  No previous surgeries  Does not recall previous immunizations  Hospitalized > 5 years ago 2 o AGE

8.  Diabetes Mellitus, Heart Disease  No hypertension, asthma, cancer, stroke, or allergies

9.  1 st year high school student  Lives with his family in a 2 story house in Palau  Denies smoking, alcohol drinking, and drug abuse

10. Physical Exam

11.  General Survey  Awake, active, and not in cardiorespiratory distress  Vital Signs  Febrile at 37.5 o C  RR 20 bpm  HR 71 bpm  Height:168cm weight:59kgBMI: 20.9

12.  Skin  Dirty skin  No rashes, hemorrhages, scars  Moist  CRT 1-2 seconds

13. Head no lesions Eyes anicteric sclerae, slightly pale palpebral conjunctiva pupils 2-3mm Ears no discharge, tenderness Nose septum midline, moist mucosa Throat mouth and tongue moist no TPC

14. Neck no cervical lymphadonapathy supple Chest adynamic precordium no heaves, thrills, or lifts, PMI at 5 th ICS MCL regular rate, normal rhythm no murmurs Lungs symmetrical chest expansion, no retractions clear breath sounds

15. Abdomen flat, no scars, no lesions normoactive bowel sounds tympanitic on all quadrants Soft nontender no masses, no organomegally

16. Right upper extremity Shoulder and Elbow no deformity, no asymmetrical no discoloration, no lesions no tenderness, no swelling no limitation of movement full ROM

17. Right upper extremity posteriorly deformed distal forearm bluish discoloration on the anterior wrist no lesions tenderness around the wrist Soft tissue swelling of the anterior wrist wrist ROM limitation due to pain intact radial, median, and ulnar nerves (motor and sensory) allen’s sign? ROM limitation due to pain

18. History  14 year old male  LLQ  RLQ pain  Nausea, vomiting, fever, anorexia Physical Exam  RLQ direct and rebound tenderness  Rovsing’s sign  Psoas sign