Case 4 History and Physical Essay

Peripheral pulses posterior tibial and dorsalis pedis 2+ bilaterally. No edema on legs. Apical pulse regular rate and rhythm; s1, s2 noted. No murmurs, rubs or gallop rhythms. Denies dizziness, and fainting. Resp RR between 36-40 SpO2 85% per oximetry on 2 liters oxygen by n/c. Difficulty breathing and complaints of chest tightness. Patient unable to lay flat. Lung sound bilateral wheezes and crackles in right lower lobe. All other lobes clear A&P. Cough with yellow sputum. Tachypnea. Head of bed 45 degree. GI Last bowel movement 2 days ago, hard, long brown stool. Complains of constipation related to medication. Bowel sound are WNL in all 4 quadrants. Abdomen is soft, with no palpable masses. Poor appetite. Like sweet foods. Does not like vegetable or fruits. Like sodas, beer, scotch. Little water intake. GU Urinates every 2-3 hours. Yellow. No odor of urine. No history of UTI. One vaginal infection 2 years ago. No abnormal periods, last menstrual period 3 weeks ago. No pain or discharge. Skin Hair poorly groomed, dirty and oily. Nail are dirty and appear to be bitten. Skin clammy and moist with flushed color. IV IV of D5W at 125 mL in left forearm with 18

BACKGROUND: Ms. Copeland is a 58-year-old left handed white female who was referred to the Hillcrest memory Diagnostic Center by the emergency room physician for evaluation of memory problems and difficulties in functioning including suicidal ideations.

Question #1: How would Sheryl Sandberg’s leadership style be described based on the four behavioral leadership styles?

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

She has been given a prescription of Amoxicillin for her tonsillitis and she will commence Denosumab for bone metastases and she is aware that she will need to see a dentist prior to starting this treatment. She seemed

The patient is a sixty-seven-year-old male; he is a retired CPA and he is in for his twenty-fifth visit. The patient’s main complaint is chronic sinusitis that he has been dealing with for the last thirty years; his secondary complaint is chronic phlegm in his throat. The OPQRST was not listed, but the patient reported that he did not have spontaneous sweating, he had no thirst but could drink, and that his complaints had no effect on his sleep. The patient uses nasaclear as a preventative for the sinusitis.

At today's visit, she is awake, alert and oriented. She is accompanied by her private help. She complains of chronic, constant shortness of breath that is worse with minimal exertion, has not worsened or improved, is on continuous oxygen. She continues to sleep in her recliner due to increased dyspnea when she lies in a regular bed. She has to seep in an upright position that she cannot achieve in a regular bed. She complains of chronic, dull, intermittent right hip, knee and back pain, her hip pain radiates down her legs, severity 2/10. She states that today her pain feel good because she takes her pain medication. She denies chest pain and reports a great appetite and having regular bowel movements.

A review of the medical records indicates that she suffers from multiple medication illness which include, end stage liver disease with associated abdominal ascites-Her live disease is related to her history of alcohol abuse, anemia related to her liver disease, chronic edema, and chronic hypothyroid and chronic pain. She was hospitalized twice in the last month for her end stage liver disease.

Her childhood was marked by recurrent diarrhea that was thought to be caused by lactose intolerance but that was never confirmed. Since the age of 26 years she suffered multiple episodes of stroke, resulting in persistent right hemiparesis. She also complained of intermittent tinnitus, asthma, headache and recurrent depressive symptoms. At the age of 34 years, she underwent bilateral cataract surgery. Extensive diagnosis including cerebral MR revealing vasculitis-like changes was undertaken and finally neurosarcoidosis was suspected. She was put on several treatments

The patient s a 70-year-old female who presents to the ED complaining of bilateral lower extremity pain. She sais thatt the pain has been present and she has been complaining about the right leg more than the left for a while but the pain became sharp, intermittent with pins and needles pain in the back of her calves and thighs. It became so severe a 10/10 in intensity that it caused her to come to the ED. The patient's medical history is extensive, she had aortic stenosis, had a TAVAAR in February 2017, history syncope, orthostatic hypertension, lung carcinoma, mild MR, TR, diastolic heart failure, complete occlusion of the right coronary artery, COPD on home O2, AND rheumatoid arthritis. The patient ambulates ordinarily with a walker.

It can be useful as a second line of defense when corticosteroids or Cyclosporine is ineffective. With routine monitoring, serious side effects are uncommon. However, common disadvantages and side effects are azotemia, which is when there is an excess of other nitrogen-containing compounds in blood, gastrointestinal bleeding, canker sores, gastrointestinal perforations, dizziness and loss of appetite are common side effects. Patients who used this prescribed medicine also had decreased thrombocytes and leukocytes. However, methotrexate is not expensive as these other treatments in fact it can be relatively cheap with a coupon and/or

Chief Complaint: painful ulcers in oral mucosa and swelling/redness in his right hallux (“big toe”), weight loss, abdominal pain, initially was constipated but now passing stools regularly with no observable blood, elevated temperature, poor appetite, fatigue, skin lesions on right shin, painful sensations in jaw

The clinical manifestations include arthritis, rash, oral ulcers, and commonly patients experience anemia (McCance and Huether, 2014, pg 278). This disease is a consideration for this patient based on the fact that a review of her history and physical reveals anemia, oral ulcers, rash, she reports daily joint

F. T. is a 56-year-old woman who comes into the clinic to establish care. She has not seen a primary care provider in the last eleven months and needs refills on all of her medications. She is somewhat agitated and argumentative about getting her labs drawn and cannot understand why the provider just won’t refill her prescriptions. She denies any acute changes in health, chest pain, unilateral weakness, numbness/tingling, vision changes, bowel or urinary problems, and has not been to the GYN in fourteen years because she states that she has already gone through the change. She denies bilateral lower extremity edema, however, she does have shortness of breath when she walks in the park, but she rarely exercises and states that she

Based on above finding a diagnosis of methotrexate poisoning was given. She was treated with Inj.folinic acid 1@ iv OD, Inj. NS 500ml iv BD, Inj.ceftriaxone (1g) iv TDS, Inj. Metronidazole (500 mg) iv TDS, Inj. Paracetamol (2cc) iv diluted if temp >100, T. BC/FA 1 OD and T.Dicyclomine 1