RS呼吸系统
Trachea central 气管居中。
Respiratory rate15/ min, no respiratory distress呼吸频率15次/分，无呼吸窘迫。
Expansion symmetrical and normal胸廓扩张对称正常。
Vocal fremitus normal 语音震颤正常。
Percussion note normal叩击音正常。
Breath sounds vesicular throughout, no added sounds全肺闻及水泡音，无额外音。 

Abdomen腹部
No scars/ veins distension无疤痕、静脉怒张。
Palpation: soft, but tender LIF(left iliac fossa)扪诊：腹部柔软，但有触痛（左髂前窝）。
Percussion note normal叩击音正常。
Auscultation: bowel sounds normal听诊：肠鸣音正常。
Genitalia not examined生殖器未检查。
Rectal examination: not performed肛门检查：未检查。

NS神经系统
Higher function normal高级神经功能正常。
Cranial nerves颅神经
ⅰ: normal第一对颅神经：正常。
ⅱ:PERRLA(pupils equal in reaction to light and accomodation)/ normal fundi and visual fields 第二对颅神经：瞳孔对光调节反应等大，正常眼底与视野。
ⅲ,ⅳ,Ⅵ: no diplopia / nystagmus第三、四、九颅神经：无复视和眼球震颤。
ⅴ-Ⅻ: normal第五至十二对颅神经正常。
upper and lower limbs: power, tone, coordination, sensation all normal
上下肢：肌力、肌张力、协调、感觉正常。

Joints and skin： Normal关节与皮肤：正常。

Summary
47-year-old male smoker with a family history and previous history of ischaemic heart disease, presents with s 4-month history of increasing exertional chest pain and a 4-hour history of persistent, severe pain at rest, which is unrelieved by GTN and associated with nausea, vomiting, and sweating. On examination, he has a resting tachycardia and evidence of left ventricular dilatation with a displaced apex beat and possible secondary mitral regurgitation. The most likely diagnosis is acute myocardial infarction.
47岁男性，有吸烟史与缺血性心脏病的家族史与过去病史，近4个月胸骨后压痛渐重，今静息时出现持续严重疼痛4小时，硝酸甘油未能缓解，并伴有恶心、呕吐与大汗。体检发现有静息时心动过速与左心室扩大依据，心尖搏动偏移，可能有二尖瓣返流。可能性最大的诊断是急性心肌梗死。

Problem list问题总结
1. chest pain-myocardial infarction?胸痛是否由心肌梗死引起？
2.  known ischaemic heart disease- myocardial infarction, post-infarct angina已知缺血性心脏病是否引起心肌梗死、梗死后心绞痛？
3. Clinical left ventricular enlargement with secondary mitral regurgitation?
临床上有否左心室扩大伴二尖瓣返流？
4. Previous duodenal ulcer but quiescent for years-no contraindications to thrombolysis?
十二指肠溃疡但静息多年，对溶栓疗法是否有禁忌症？
5. Gout – can be precipitated by diuretics prescribed for cardiac failure
痛风――治疗心衰的速尿可促发痛风
6. HGV driver – should he still be driving?
是否适合继续从事重型货车司机驾驶职业？

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