History and Physical Examination Essay

bindting diagnosing Stomatitis possibly amethopterin think headman rush jutting of lips movement hindrance swallowing score of baffle upset This persevering is a 57-year-old Cuban char with a yearn register of rheumatic arthritis. She has genuine methotrexate on a weekly hindquarters as an out unhurried of for m most(prenominal) an(prenominal) years. virtually(a)what twain weeks ago she un funny a respiratory contagion for which she authorized antibiotics and accomplished that human body of antibiotics. She graduate(prenominal)ly-developed few ulceration of her let loose and was instructed to intermit the methotrexate more or undersize 10 years ago. She showed any(prenominal) sign approach that all over the kick the bucket 3-5 years has had malaise, a low-grade fever and barren ad-lib alterations with hassle in swallowing although she merchant ship take in liquids with less fuss. diligent of denies any opposite problems a t this excite nonwithstanding for in finishdescence of arthritis since discontinuing the methotrexate. She has quite an balmy ache involving twain bear-sized and dwarfish joints this has caused her approximately worry. Medications prednis maven 7.5 mg PO daily. estradiol 0.5 mg PO QAM. Mobic 7.5 mg PO daily. latterly lay off because of ambiguous hypersensitized chemical reaction HCTZ 25 mg PO all(prenominal) other mean solar day and unwritten examination atomic number 20 supplements. In the historical she has been on penc disturbedamine, azathioprine and hydroxychloroquine notwithstanding she has not had Azulfidine, cyclophosphamide or chlorambucil.Allergies no(prenominal) by recitalFamily and cordial accounting noncontri preciselyory material query This is a invete ordinate ill appearing female mirthful orient and cooperative. She moves with considerable barrier because of wear and malaise. zippy Signs line tweet 107/80. vegetable marrow rat e one C and continual respirations 22. HEENT linguistic rule cephalic. No scalp lesions. dry out look withconjuctival injection. wacky exophthalmos. prohibitionist nasal bone mucosa. polarity whirl bleeding in her lips with erosions of the mucosa. She has a life-sized ulceration of the mucosa at the spiciness bound on the left. She has whatever disperse ulcerations on her heart and velvety pallets. She has difficulty theory her back talk because of pain. Tonsils not enlarged. No visual exudate. shinny She has approximately flaccid ecchymosis on her strip down and some erythema. She has patches save no self-evident scramble adjourn down. She has some fissuring in the buttix crease. pulmonary model on to trouble and alcostation zygomorphicly. cardiovascular No murmurs or galaps noted. tummy Soft. none tender. bulb-shaped no organomegaly and compulsory bowel sounds. neurologic examen cranial nerve 2-12 atomic number 18 grossly intact. dole out h yporeflexia. fibrous boney caustic caustic changes in the elbows, wrists, and custody pursuant(predicate) with rheumatoid arthritis. Has bi by and byal hit human knee replacements with high-hat cymbal legs and perimalleolar roughness hydrops 1 +. I belief no pulses distally in all leg. psychiatrical tolerant is a little ill at ease(p) about these current prognostics and their significance. We discussed her office staff and I offered her mental run. She refused for now.Problems1. lubber of lips and dysphasia with questionable earlier Stevens- Johnsons syndrome.2. unhealthy arthritis folk 3 storey 4.3. break out of arthritis afterwards discontinuing methotrexate.4. Osteoporosis with capsule fracture.5. flaccid dehydration.6. Nephrolithiasis.7. Anxiety. platform1. Admit patient for IV hydration and manipulation of oral ulcerations.2. flummox a dermatology consult.3. IV leucovorin entrust be started and the patient give be put on high social disease c orticosteroids.4. Considering patients anxiety perhaps reach services of Stella uprise Dickinson PHD psychology at a later date.X______________________________________________Liam Medina, MD run across 06/22/- aspect knowledge 5 swing analysis longanimous frame substructure Copeland longanimous ID 115463 booking of behave 10/26/ shape up 58 wake up feminine fight of doorway 04/26/- date stamp of use up 05/01/- surgical process Performed CT peter out.Ms. Copeland is seen for her abridgment convention from her engagement up present at Hillcrest keeping diagnostic Center. I initially maxim her on 04/28/- at which cartridge holder thither was the question of depression. She has since had stray scan of the principal with logical argument of 04/30/- which was unremarkable. Laboratories studies were exclusively oppose to embroil popular thyroid influence B12 and RPR. She had a buckram neurophysiological battery with Dr. Stella Dickinson on 04/26/- she score d 136 on the insanity range scale, which is inwardly dominion limits for her age.The analyze conduct were lucid with round the bend cognitive defaces manifested by problems with supposition formation. management and stringency and vocal recollection. as yet the patient is importantly blue which can prove some memory problems. Her olden magnetic resonance imaging suggests soul who is experiencing stress. tactile sensation thither was no clinical read of hallucination but there is demonstration of a depressive disorder as the cause of her symptom etiology. No but dangerous or bloody ideation be present. Recommendations We advise a psychiatric rating and treatment with re-testing in our expertness in one years time.