Offender Returns To Clinic Case Summary

S- 3671 dispatched to a m pt C/O of abdominal pain and black stool. Pt is a 49 y/o m whose C/C is abdominal and lower back pain. Pt also states that he is experiencing cramping around his left ribcage. Pt states that he has been experiencing N/V/D for the past four days. Pt also states that his bm's have produced black, watery stool since the monday prior to the incident date. Pt is able to provide EMS personnel with a detailed medical Hx that includes HIV, acid reflux, and recently diagnosed COPD. Pt also states that he recently stopped smoking cigarettes. Pt is also able to provide EMS personnel with a list of medications that he is currently taking that includes Duloxetine, Stribild, Ranitidine, Aripiprazole, oxycodone, and proair. Pt states that he has not taken any of his prescribed medications for the past four days prior to the incident date. Pt states that he has allergies to Kaletra and gabapentin. Pt states that his primary

Member experienced moderate pain due Dx. Osteoarthritis, have an unsteady gait, experiences dizziness (new medication Flomax 0.4 milligram) and is a risk of falling (score 11). He needs assistance of daily living. Goes to bathroom frequently due to Enlarged prostate.

Scenario: Mr. B, a 67-year-old-man, came to the ER complaining of severe pain to his left hip and leg after falling over his dog at home. Left leg appears shortened with swelling in his calf, bruised, and limited range of motion.Mr. B has a history of impaired glucose tolerance and prostate cancer. Home medications include atorvastatin and oxycodone for chronic back pain. Mr. B’s labs, taken during a previous visit with his primary care doctor, revealed elevated cholesterol and lipids.

Mr. ___ [NAME] is a 49-year-old white male, a patient of Dr. ___ [NAME], with a history of right knee replacement x 4, secondary to a gunshot wound in ___ [DATE]. Left knee, he has had multiple surgeries, primarily on the ligaments and I understand the meniscus. Also has right hip pain. The hip is probably related to his difficulty with the right knee. He has chronic pain in the knees. He has a need for testosterone as his labs are very low. PTSD, (___) anxiety. Really here today to follow up on the testosterone. Lab was drawn; other results are not yet available. His non-fasting glucose today was 106 and the hemoglobin A1c that was done was 5.9. He does have some history of hyperglycemia, but I think there were primarily non-fasting, he may just have some glucose intolerance. Complains primarily of knee pain and right hip pain. He is having erectile dysfunction, was given Viagra, and when he saw the urologist he was told that he needed testosterone, as it was quite low at 1.8.

The medical evidence shows a chest CT taken on 9/2015 indicated the claimant was positive for mild atelectasis and mild fatty liver. The physical exam on 8/15 was normal. 5/15 he was positive for chronic heart failure with an ejection fraction of 565 and he

The patient is a 44-year-old gentleman who no longer sees an endocrinologist as that office closed. He was last seen here in October of 2014. He had an appointment in April, but showed up late and decided not to stay for this. He did have lab work that he was supposed to do from December, but he never did get this done. He does tell me he continues to work two jobs and finds it very difficult to take good care of himself, he does not eat well. He continues to smoke greater than a half a pack of cigarettes per day.

This is 51 year old AAM. Patient has a history of HTN and DM, his current medications are glipizide 5 mg QD and lisinopirl 5 mg QD, but hasn't been taking them for more than one week. Patient reports neuralgia, tingling and prickling sensation at his bottom of his feet. Patient is a current resident at a Group Home and unable to afford any of the medications and needs community resources. Patient also report blurred vision, denies chest pain, SOB, N/V/ D,or fever. Patient is a current tobacco user, denies use of alcohol or illicit drugs.

In the ER, I have an African American female patient, age 32, who presents with sickle cell anemia. She has come into the emergency room with 2-day history of heart palpitations, headache, dyspnea, fatigue, and back pain. She states her appetite has decreased. She states that she is voiding well and having regular bowel movements. The backache extends from above the lower T-spine to the lumbosacral spine. The patient is allergic to codeine, but states she is able to take morphine. She is currently taking folic acid and Tylenol. She has had no previous surgeries and denies any smoking or drug use. Upon examination, her vitals were the following; a temp of 38 degrees tympanic, pulse was 105 BPM indicating tachycardia, and blood pressure is 115/50

The patient was not seeking medical help for many years. She started to follow the physicians for the last few years. She had some CKD that is progressing to stage 5 recently. Her kidney disease is attributed to longstanding insulin dependent diabetes mellitus. She has never had a kidney biopsy done. Her last creatinine is 3.8 with an estimated GFR of 13. She had 4.5 proteinuria in July 2015. She is still not on dialysis yet. She will be starting peritoneal dialysis when it is medically indicated. She has not been evaluated for kidney or pancreas transplant in the past.

The patient is a licensed carpenter and is the sole provider for his household. He lives with his wife in a small apartment in an inner city. He admits that he does not get involved in physical activities due to unsafe neighborhood with high crime rate. He has no hobbies and prefer to read at home. He eats one large meal a day after work, misses breakfast majority of the times. He admits eating unhealthy meals for lunch, few serving of fruits and vegetables, and high- calorie food mostly pasta and meat at home. He does not engage in any street drugs or alcohol intake, however he admits smoking cigarette one pack per day for the past thirty years.

Lab Values and Diagnostics On September 2nd patients hemoglobin A1c level was 5.4 and within normal limits. Blood glucose was elevated at 112 mg/dl, normal values for this lab is 65-105 mg/dl. Patient’s cholesterol was 153, triglycerides 72, LDL cholesterol 89, HDL cholesterol 50, and Cholesterol/ HDL ratio was 3.1. All lipid values were within normal limits. T4 was 6.0 ug/dl and TSH was 1.11 ul/ml. Both thyroid test were within normal limits. Patients AST was 14u/l, and ALT was 13 u/l both of these liver function values were within normal limits. Patient’s chart did not state any prolactin levels.

The patient is a 78-year-old female who was transferred from a local nursing home because of altered mental status transfer from care one of Wayne. On presentation initial blood pressure was 126/86 with pulse of 80, respirations of 16, and a low-grade temp of 99. Her history is significant in that she has known to have metastatic cervical carcinoma, she has a diversion colostomy, urostomy and she had chemotherapy and radiation in May of 2015. She was hospitalized previously with urinary tract infection which grew an enterococcus. She comes in now presenting again with altered mental status. She herself is complaining of weakness. Initial lab work on admission reveals her to be tachycardic. She has no white count. Her hemoglobin was

This is 41 year old white male. Patient is here complaining of back pain that is radiating down to his legs, sharp pain. Patient reported that he was attacted and was severely bitten and also was stumped on his lower back was hospitalized for several weeks , about one month ago from that he is also experiencing post dramatic distress syndrome. anxiety and panic attach and nightmares. Patien denies chest pain, SOB, N/V/ D,or fever. Current pain 6/10. Patien is a current tobacco user with a 30 pack year history, histroy of alcohol abuse, and substance abuse, currently in a group home.

Assessment: Appears to be hypotonic hypovolemic hyponatremia secondary to several days of vomiting and diarrhea.

The patient appears his stated age of 19. He is fully conscious, alert and oriented. His skin color is White/Caucasian and he appears to have a healthy nutritional status. He weighs 215 pounds, has a height of 5’10”, and a BMI of 31. The patients BMI of 31 indicates the patient is obese based on his height and weight even though the patient appears to be in a healthy state. The patient is sitting upright with correct posture and position and has no noticeable deformities. He has full mobility: a normal gait of heel to toe, he doesn’t require any use of assistive devices, and has a full range of motion (ROM) of all joints. Facial expression is relaxed and alert and his mood and affect are appropriate for the environment