Internal Medical Case

It is my privilege to take this opportunity to recommend Dr. Juan Pablo Ortega for a residency position in Internal Medicine. I have known Dr. Ortega for approximately 2 months during his observership in the Lymphoma/Myeloma Department at MD Anderson Cancer Center. During this time, I have seen firsthand the dedication that Dr. Ortega has. He is on the right track to be an outstanding internist who values the input of his peers. He has a clear vision for where he wants to be and dedicates much of his time and energy to his success. He was very open to discuss his goals of becoming an Internist and later pursuing a fellow either in nephrology or endocrinology.

1. What does the company listen to, why do they listen to, and who listens?

This reporting period, Mrs. Hare continues to have good and bad days regarding her lower extremity pain. She rated her discomfort ranging from a “7-10”. Mrs. Hare did have to take a pain pill once a week which reduced her pain to a “2”. Ms. Hare has not returned to therapy or obtained her orthotics but she is returning to acupuncture. Mrs. Hare has obtained her dental records and is in the process of locating the Dentist that was referred by a family member. I once again reminded her of the social security

Clinical manifestations include pain, heaviness, inability to bear weight on the affected leg, with redness, swelling. Patient is also above normal body temperature and early signs of fever, positive for Staphylococcus aureus at the site of the wound with clear signs of progressive infection (high neutrophils and WBC count).

Our patient was a 55-year-old female who came for laparoscopic omega gastric bypass surgery to lose weight because of excessive obesity (with a BMI of 46.6). In her past medical history she had hyperlipidemia and depression and in her past surgery history, she underwent mastoidectomy surgery in her right ear and hysterectomy due to menorrhagia 12 years ago. In that time she was on OCPs because of menorrhagia and after she didn't respond to the treatment they had to do hysterectomy surgery after which she developed DVT in her right leg so she was treated with warfarin for six months and after that warfarin was discontinued. Currently, she is taking propranolol 20mg, nortriptyline 25mg, atorvastatin 40mg and fluoxetine 20mg daily. In pre-operation

Based on progress report dated 08/28/15, the patient complains of severe low back pain rated as 5-6/10, radiating to the left leg to ankle. He reports that he feels the same as the last visit.

Upon creating our differential diagnosis, we were given the information about a forty-eight year old male who was admitted to the hospital for a serious accident involving his leg while using a chain saw to remove a dead tree. He had a spiked fever and was complaining of pain. The picture of the wound given showed a red warm wound on the knee that was larger than the initial wound. Information given indicated that he had swollen and tender inguinal lymph nodes. Based on all of this information given we concluded that the patient could possibly have: mononucleosis, pneumonia,cellulitis, an insect bite, bursitis, UTI, tinea, lyme disease and some type of infectious abscess. We ruled out most of these suspected diagnosis by taking all of the

Per medical report dated 04/13/2016, patient continues to have left knee greater than left shoulder pain. Her left knee pain is increasing. Lower extremity examination

Examination on admission to the hospital showed marked tenderness over the right femoril vein and the long safenous vein from the groin to approximately midthigh. There was no redness or edema; homan sign was negative, and there were no obvious significant varicosities and no calf-tenderness.

This is 49 year old WM. Patient has a history of HTN and currently taking lisinopril 25 mg QD and HCTZ 25 mg 2 tabs QD. Patient's current BP 152/85. Patient denies chest pain,SOB, N/V/D, or fever. Patient also has wound to his right leg, chronic issue for the past 16 years. Patient had a gun shot would to the leg and had rod placed. It's got broken 16 years ago, ever since than he had chronic infectin at the site, at times he hasa to lenxit and drain the infection. Current pain

Office notes dated 06/21/2016 revealed that the patient complained of right foot pain with a pain rating of 6/10. Physical examination revealed tenderness

According to the progress report on 10/15/15, the patient is still having neck and left-sided upper extremity complaints. She has some complaints on the right side, as well. The patient’s hip seems to be causing her mild complaints only. She has not been able to get back to work. On examination, the patient has negative Spurling’s and foraminal compression tests on her right side; she only had neck pain with that. Her foraminal compression test on the left side

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.

This is a 52-year-old male status post-cardiac cauterization with initial complaints of angina symptoms: crushing chest pain, shortness of breath, and diaphoresis. He has a history of hypertension, hypercholesterolemia with medication non-compliance, and a cholecystectomy 10 years ago. He has no known drug allergies, and his current discharge medications include Tenormin XL 50 mg daily, Lipitor 10mg daily, Glucophage 500mg daily, and Baby Aspirin 81mg daily.

The patient reports she has had left hip and knee pain for the past 6 months.