NR667 iHuman Performance Study Guide & Complete EHR Record
Larry Orlander - Abdominal Pain Case
Patient: Larry Orlander (50 y/o M) iHuman Score: 100% Verified Primary Dx: Large Bowel Obstruction Etiology: Sigmoid/Transverse Mass
01 EXECUTIVE CASE SUMMARY
Clinical Scenario: Mr. Larry Orlander is a 50-year-old African American male presenting with a 3-day history of
severe, progressive, intermittent crampy periumbilical and diffuse abdominal pain (5/10 to severe), accompanied by
persistent nausea, vomiting, progressive abdominal distention, and complete obstipation (inability to pass gas or stool
for 2 days). PMH is significant for diverticulitis. Surgical history includes appendectomy (age 10) and right inguinal
hernia repair (age 20).
Primary Diagnosis Large Bowel Obstruction (LBO) secondary to Colonic Mass (Sigmoid/Transverse)
Key Differential Diagnoses Small Bowel Obstruction (SBO), Sigmoid Volvulus, Diverticulitis, Ischemic Colitis, Perforated
Viscus
Critical Lab Findings Leukocytosis (WBC 15,000/mm³), Hemoconcentration (Hgb 17 g/dL, Hct 51%), Hypokalemia
(K+ 3.1 mmol/L), Prerenal Azotemia (BUN 32 mg/dL, Cr 1.3 mg/dL)
Immediate Management ED Admission, NPO, IV Fluid Rehydration + KCl replacement, NG Tube Decompression,
Zofran 4mg IV, Urgent General Surgery & GI Consultation
02 IHUMAN HISTORY QUESTIONS & SCORING KEY (33/33 COMPLETE)
Below is the full 33-question history sequence yielding 89%+ (100% credit per rubric) in the iHuman clinical assessment module:
PATIENT RESPONSE / DIAGNOSTIC
# IHUMAN CLINICAL HISTORY QUESTION
RELEVANCE
1 How can I help you today? "I've been having terrible stomach pain for the
past 3 days and I keep throwing up."
2 Are there any other symptoms or concerns we should discuss? Reports severe nausea, vomiting, feeling
bloated, and inability to pass gas or stool.
3 When did your abdominal pain start? Pain began 3 days ago and has progressively
worsened in severity and frequency.
4 Does anything make the pain in your abdomen better or worse? Eating worsens the pain and triggers vomiting;
nothing brings significant relief.
5 Where more precisely is your abdominal pain? Initially periumbilical, now feels diffuse across
the entire abdomen.
6 How severe (1-10) is your abdominal pain?
NR667 iHuman Case Study: Larry Orlander | Comprehensive Clinical Guide Page 1 of 8
, PATIENT RESPONSE / DIAGNOSTIC
# IHUMAN CLINICAL HISTORY QUESTION
RELEVANCE
Rates pain as 5/10 baseline, escalating to
8-9/10 during intense cramping waves.
7 Do you have nausea and/or vomiting? Yes, frequent bilious non-bloody vomiting
following food or fluid intake.
8 Do you have any allergies? No Known Drug Allergies (NKDA).
9 Are you taking any prescription medications? Not currently taking any regular prescription
medications.
10 Are you taking any over the counter or herbal medications? No regular OTC or herbal supplements.
11 What does the pain in your abdomen feel like? Cramping, sharp, colicky intermittent waves of
severe pain.
12 Does the pain in your abdomen radiate someplace else? No radiation to back, chest, or groin.
13 Is the pain in your abdomen affected by what, when, or how much Yes, any food or liquid intake immediately
you eat? aggravates cramping and causes emesis.
14 Any change in the frequency of your bowel movements? Severe obstipation — no bowel movement or
gas passed for the past 2 days.
15 Any previous medical, surgical, or dental procedures? Appendectomy at age 10; right inguinal hernia
repair at age 20.
16 Are you unable to pass gas? Yes, completely unable to pass flatus for 2 days
(hallmark of complete obstruction).
17 Can you tell me about any current or past medical problems History of diverticulitis diagnosed several years
you've had? ago.
18 Do you have a history of bowel obstruction? Denies prior documented episodes of bowel
obstruction.
19 Have you or any family member had a history of inflammatory No personal or family history of Crohn's disease
bowel disease? or ulcerative colitis.
20 Have you had the pain in your abdomen before? Had mild diverticulitis pain in past, but never
this severe or with vomiting/distention.
21 Do you have heart disease and/or have you ever had a heart Denies CAD, MI, or heart failure history.
attack?
22 Have you lost weight? Unintentional mild weight loss noted over past
few months.
23 Have you been vomiting anything that looks like blood or coffee Denies hematemesis or coffee-ground emesis.
grounds?
24 Do you have any black tar or foul-smelling stools? Denies melena or black stools.
25 Have you ever been hospitalized?
NR667 iHuman Case Study: Larry Orlander | Comprehensive Clinical Guide Page 2 of 8
Larry Orlander - Abdominal Pain Case
Patient: Larry Orlander (50 y/o M) iHuman Score: 100% Verified Primary Dx: Large Bowel Obstruction Etiology: Sigmoid/Transverse Mass
01 EXECUTIVE CASE SUMMARY
Clinical Scenario: Mr. Larry Orlander is a 50-year-old African American male presenting with a 3-day history of
severe, progressive, intermittent crampy periumbilical and diffuse abdominal pain (5/10 to severe), accompanied by
persistent nausea, vomiting, progressive abdominal distention, and complete obstipation (inability to pass gas or stool
for 2 days). PMH is significant for diverticulitis. Surgical history includes appendectomy (age 10) and right inguinal
hernia repair (age 20).
Primary Diagnosis Large Bowel Obstruction (LBO) secondary to Colonic Mass (Sigmoid/Transverse)
Key Differential Diagnoses Small Bowel Obstruction (SBO), Sigmoid Volvulus, Diverticulitis, Ischemic Colitis, Perforated
Viscus
Critical Lab Findings Leukocytosis (WBC 15,000/mm³), Hemoconcentration (Hgb 17 g/dL, Hct 51%), Hypokalemia
(K+ 3.1 mmol/L), Prerenal Azotemia (BUN 32 mg/dL, Cr 1.3 mg/dL)
Immediate Management ED Admission, NPO, IV Fluid Rehydration + KCl replacement, NG Tube Decompression,
Zofran 4mg IV, Urgent General Surgery & GI Consultation
02 IHUMAN HISTORY QUESTIONS & SCORING KEY (33/33 COMPLETE)
Below is the full 33-question history sequence yielding 89%+ (100% credit per rubric) in the iHuman clinical assessment module:
PATIENT RESPONSE / DIAGNOSTIC
# IHUMAN CLINICAL HISTORY QUESTION
RELEVANCE
1 How can I help you today? "I've been having terrible stomach pain for the
past 3 days and I keep throwing up."
2 Are there any other symptoms or concerns we should discuss? Reports severe nausea, vomiting, feeling
bloated, and inability to pass gas or stool.
3 When did your abdominal pain start? Pain began 3 days ago and has progressively
worsened in severity and frequency.
4 Does anything make the pain in your abdomen better or worse? Eating worsens the pain and triggers vomiting;
nothing brings significant relief.
5 Where more precisely is your abdominal pain? Initially periumbilical, now feels diffuse across
the entire abdomen.
6 How severe (1-10) is your abdominal pain?
NR667 iHuman Case Study: Larry Orlander | Comprehensive Clinical Guide Page 1 of 8
, PATIENT RESPONSE / DIAGNOSTIC
# IHUMAN CLINICAL HISTORY QUESTION
RELEVANCE
Rates pain as 5/10 baseline, escalating to
8-9/10 during intense cramping waves.
7 Do you have nausea and/or vomiting? Yes, frequent bilious non-bloody vomiting
following food or fluid intake.
8 Do you have any allergies? No Known Drug Allergies (NKDA).
9 Are you taking any prescription medications? Not currently taking any regular prescription
medications.
10 Are you taking any over the counter or herbal medications? No regular OTC or herbal supplements.
11 What does the pain in your abdomen feel like? Cramping, sharp, colicky intermittent waves of
severe pain.
12 Does the pain in your abdomen radiate someplace else? No radiation to back, chest, or groin.
13 Is the pain in your abdomen affected by what, when, or how much Yes, any food or liquid intake immediately
you eat? aggravates cramping and causes emesis.
14 Any change in the frequency of your bowel movements? Severe obstipation — no bowel movement or
gas passed for the past 2 days.
15 Any previous medical, surgical, or dental procedures? Appendectomy at age 10; right inguinal hernia
repair at age 20.
16 Are you unable to pass gas? Yes, completely unable to pass flatus for 2 days
(hallmark of complete obstruction).
17 Can you tell me about any current or past medical problems History of diverticulitis diagnosed several years
you've had? ago.
18 Do you have a history of bowel obstruction? Denies prior documented episodes of bowel
obstruction.
19 Have you or any family member had a history of inflammatory No personal or family history of Crohn's disease
bowel disease? or ulcerative colitis.
20 Have you had the pain in your abdomen before? Had mild diverticulitis pain in past, but never
this severe or with vomiting/distention.
21 Do you have heart disease and/or have you ever had a heart Denies CAD, MI, or heart failure history.
attack?
22 Have you lost weight? Unintentional mild weight loss noted over past
few months.
23 Have you been vomiting anything that looks like blood or coffee Denies hematemesis or coffee-ground emesis.
grounds?
24 Do you have any black tar or foul-smelling stools? Denies melena or black stools.
25 Have you ever been hospitalized?
NR667 iHuman Case Study: Larry Orlander | Comprehensive Clinical Guide Page 2 of 8
