MEDICATIONS:
1. Atenolol 50 mg daily.
2. Ibuprofen 800 mg once or twice a day.
3. Dyazide.
4. Tylenol No. 3 (prescribed, but not taking).
REFERRING
PHYSICIAN:
SSSSSSSS
REASON FOR
CONSULTATION:
Evaluate patient’s
complaints of wrist pain and swelling to establish rheumatologic diagnosis.
PATIENT’S CHIEF
COMPLAINT: Generalized aches and pains
and swelling of the legs.
HISTORY OF
PRESENT ILLNESS: The patient is a
69-year-old African‑American female seen by Dr. Nwapa in April of this year,
where swelling of both wrists was noted for which prednisone in decreasing
doses over a period of 10 days was prescribed.
Patient reports that her wrist pain and swelling subsided completely
only to return when that medication was stopped. Now, patient has wrist pain and swelling from
time to time. She also has generalized
aches and pains. She is concerned about
swelling in her feet, which she began to notice when she began taking ibuprofen
800 mg once a day. Ibuprofen also <___>
to moderate patient’s symptoms. Patient
is also complaining of numbness and tingling in the fingers of both hands,
digits 1 through 3 bilaterally, more on the left then on the right. She complains of being stiff all over in the
morning.
REVIEW OF
SYSTEMS: No abdominal pain associated
with the use of ibuprofen. No
headaches. Back pain from time to time.
PAST MEDICAL
HISTORY: Hypertension. Patient is currently being worked up for
hypercalcemia.
FAMILY
HISTORY: Diabetes and heart disease.
SOCIAL
HISTORY: Patient smoked a pack of
cigarettes for about 50 years. She
drinks from time to time.
PHYSICAL
EXAMINATION:
VITAL
SIGNS: Weight 149 pounds Temp. 98.4 BP 98/62
Pulse 75
MUSC/SK: A complete peripheral joint evaluation for
swelling, tenderness on palpation, limitation of motion, and deformity was
performed today. I found what appeared
to be hint of swelling of the dorsal aspect of both wrists, although there was
no clear-cut fullness, nor fluctuance.
Wrist extension was about 45 degrees bilaterally. Tenderness on palpation over the dorsal
aspect of both wrists was intermittent.
Traction maneuvers were sometimes painful and sometimes not. Patient is able to make a fist
bilaterally. No swelling in the DIPs,
PIPs nor MCPs. No swelling of the
elbows. In the lower extremities, no
pain with range of motion of hips. The
knees were cool to touch. No anterior
effusions. No lateral instability. No pretibial edema. No swelling of the ankles of the feet.
IMAGING
STUDIES: Radiographs of the hands and
wrists were reviewed. No evidence of chondrocalcinosis
articularis. Weightbearing radiographs
of the knees revealed chondrocalcinosis articularis. No radiographic evidence of arthropathy
involving the feet, nor the ankles.
There have been hint of joint space narrowing in both hips, perhaps
right more than left in the axial direction.
LABORATORY
STUDIES: Rheumatoid factor screen
negative. Antinuclear antibody screen
weakly positive. Corrected serum calcium
level 11 mg/dL.
IMPRESSION: This patient may have had an episode of inflammatory
joint disease; the nature of which is unclear to me.
MEDICAL DECISION
MAKING: I gave the patient a
prescription for Medrol Dosepak to use should her knee pain and swelling become
more of a problem. I believe she is
experiencing water retention associated with the use of ibuprofen, so I
suggested that she take the Tylenol No. 3 that was prescribed and consider the
use of naproxen sodium 220 mg, which is available over-the-counter. She is strongly undergoing of her hypercalcemic
condition.
