Aortic Potenosis Case Study

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

Physical therapy saw the patient, and the result of the examination are as follows; 6/10 left knee pain at rest and during activity (0 no pain, 10 worst pain), manual muscle testing for both upper and lower extremities were 4/5 except left knee flexion/extension 3+/5 due to pain, sensation on both UE/LE were intact to light touch, Stephen requires a moderate assistance of one person for both functional mobility and gait activity. He uses a front wheeled walker up to 35 feet due to decreased balance and antalgic gait from the left knee

Per medical report dated 11/24/15 by Dr. Cano, the patient is complaining of severe numbness in the right hand, tightness around the right worse than left hand. She also associates this with dropping items. She is unable to button her shirts or raise her arms up to her elbows. This is continuous all day long. Also, associated is severe low back pain with numbness, radiation, and muscle spasm in the thoracic area, and numbness and radiation down the right sciatic nerve with severe low back pain. She continued to work, sixteen-hour shifts, seven days a week. At this time, she is unable to function. She states that she has had 24 sessions of physical therapy that has definitely helped her.

The patient is an 86-year-old female who was brought to the emergency room because of bilateral leg swelling. She was recently discharged from the Arbor Glen Reha and she's developed increasing bilateral leg edema. Her medical history is significant for hypothyroidism, chronic kidney disease stage II, anemia which is a chronic, ulcer in the sacral ulcer stage III and she denies any other symptoms. Review of the lab work does show a bump in her creatinine from 1.27 baseline in February of 18 to 1.54 on this admission with an increase in her BUN. She also demonstrates a mild anemia of 10 with a MCV of 90. Her edema is described as massive by the attending physician. PT examination reveals she needs significant assistance to moneuver her

The patient is an 88-year-old gentleman who is brought to St. Joe's ER complaining of inability to walk. The patient 6 days ago began to having trouble walking with his walker. He reported left arm pain which radiated up his left arm. The patient had pain in the left foot. The patient was taken to St. Joseph's Hospital in Wayne. In the ER he was diagnosed with gout and begun on Colchicine. Since that time he has shown no improvement. He has become essentially chair-bound and unable to walk so he is brought to St. Joe's ER. His medical history is significant for atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease and the patient also has a colostomy bag he had a procedure done and they were unable to connect is

Mr. Garcia has been having bilateral lower leg pain for about a week that started after cleaning out his garage. States that the discomfort has been constant the last few days. The patient states that he has less pain when he is walking. Sitting with his legs propped up also helps with the pain. The patient’s pain is a five to six out of ten. The patient has a history of hyperlipidemia, high blood pressure, and diet controlled type two diabetes. He takes Lipitor, Bystolic, and a daily aspirin.

Based on the progress report dated 03/01/16 by Dr. Ahmed, the patient continues to complain of constant lower back pain radiating to her left leg which she describes as sharp with pins, and needles and intermittent numbness and weakness.

The patient is a 70-year-old gentleman who presented with left hip pain of 3 weeks duration which has been worsening over the past 5 days 10/10 nonradiating pressure-like pain is worse on exertion and improved with rest is persistent. The patient's medical history is significant for gout, hypertension, diabetes, coronary disease, hypercholesterolemia, arthritis and nephrolithiasis. The patient had a right total knee replacement, 3 caths (the last one in 2003), a right rotator cuff repair, a right thumb injury and has had 6 previous hospital admissions for the right total knee replacement. Initial blood pressure is 169/70 with pulse 64 respirations of 20. The patient is afebrile and has a weight of 112 kg. The patient's physical exam is

12/18/15 Progress Report indicated that the patient presents with back pain radiating down his right leg; lower backache and right hip pain. The pain is 10/10-scale level without medications and 9/10-scale level with medications. His quality of sleep is poor. His activity level has remained the same. Current medications include Lidocaine 5 % patch, Cymbalta 30 mg and Vimovo Dr 500-20 mg.

O: mild grimace on her face; sitting strait up on the exam able without the support; tender over the left side of the lumbar spine, Full lower lumbar ROM with some pain; able to perform heel and toe walks; negative straight leg raise; no impairment of NVS; DTR 2+to bilateral lower extremities

This is a 49-year-old male who required inpatient hospitalization due to acute CHF exacerbation. He went to the ED due to complaints of lower extremity swelling accompanied by shortness of breath and productive cough. He also stated that he was having difficulty when lying, due to fluid collection in his lungs. His past medical history is significant for hypertension, CHF, DM type 2, and status post right toe amputation. On physical examination, he exhibited 4-plus bilateral edema which was red in appearance and tender to touch. He also had a left diabetic ulcer on the left foot. His vital signs included of a blood pressure of 148/88 mmHg, a temperature of 36.1 degrees Celsius, and a pain score of 10/10. Chest x-ray showed right pleural effusion

The patient is a 68-year-old Caucasian female who presents with a swelling of her left lower extremity with acute pain. The patient's history is significant for end-stage kidney disease on peritoneal dialysis, insulin-dependent diabetes mellitus, and neurogenic bladder. She was recently in the hospital for C. difficile colitis. This is a recurrent DVTs. The first episode was 4 years ago. She was on Coumadin for 6 months at the time. The left leg is described as being warm to touch, 1+ edema and tender. The ultrasound describes a chronic occlusive thrombus of the popliteal vein with developed collateral circulation but the physical findings would suggest there is some acuity going and the patient will be placed on anticoagulation and