Heather is a 26yo, G3 P1011, who is currently 24 weeks 2 days as dated by ultrasound. She is relatively healthy. She has one prior full-term delivery without complications. She was referred today to evaluate her lower extremities. Her issue started on Black Friday, when she came home from shopping, she noticed red areas all over her legs. It started as 4-5 but quickly developed into several on her bilateral shins. After a day or two they became nodules and then turned to discolorations such as bruises. During this time, she was evaluated in your office and there was concern for varicosities and possible phlebitis. She was started on Lovenox and an aspirin. She was seen by vascular surgery and there was no evidence of DVT’s. She was …show more content…
I did explain EIF to her. She did have a quad screen that was screen negative and in the setting of a normal anatomy, otherwise, the finding of a single EIF is of little significance. We spent the majority of the time discussing what I think is erythema nodosum given the history and description. Erythema nodosum is typically somewhat of an autoimmune/hypersensitivity reaction. Typically with immune complex it does deposit in the bilateral lower extremities. Pregnancy itself can be a precipitating factor for erythema nodosum. It is a self-limiting disorder but is occasionally treated with NSAIDs. Ideally we avoid NSAIDs in pregnancy. Currently, I think she is getting better from her prior flare, although she may have another flare in pregnancy and if so, you may consider treatment with prednisone 20 mg q a.m. for 10 days. I do think we can stop her Lovenox and I would change the full dose aspirin to a baby aspirin. I also noted in her thrombophilia work-up that while it appears that the full-work was ordered perhaps some of the test did not result due to the absence of a frozen sample. Because I think her risk for thrombophilia is low, I do not think you have to repeat these, but I informed Heather that in the future if anyone asks about her thromboph9ilai panel they may need to double-check with your office to know whether or not it was complete. For now, I do not think she needs to follow-up through
She was having pain in her neck and soreness in her thigh and back. she claimed that she felt continuous pain because of this
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
Pemphigus vulgaris is a serious but rare autoimmune disorder of the epithelial cells and mucosal lining of the skin. The first cases were recorded by McBride in 1771 and by Whichman in 1979. McBride was to describe the first to casualties as being caused by “bloody ichor” and “putrid ulcers”. (Jordon, 2013) However, Whichman was the one who would originally name the disease as pemphigus. The word “pemphigus” is of Greek origin which means blister or bubble. (Jordon, 2013) As the name suggests, this disease causes painful blisters or bullous erosions of the squamous epithelia and mucous membranes. It can be sub-classified based on the location of the lesions in the epidermis. Pemphigus vulgaris is considered to be one of the deep forms of the disease. The lesions appear deep into the epidermis of the skin right above the basal lamina. (Zeina, 2013)
The first time she was at the clinic two nurses were present when Dr. Younger examined her and nothing unusual happened. At the March 17, 2017 office visit there was no nurse present. Dr. Younger asked her to sit on the exam table and then he began to feel her legs starting at her ankles slowly moving up to her mid thighs before he stopped. Ms. Lawson stated he did this in a manner where he squeezed her legs inappropriately and it made her feel uncomfortable. She didn’t understand why he had to feel her legs in that manner when her problem was with her knees.
This article is going to explain the future risk of how recurrent DVT going to impact on her health by use literature and relevant pathophysiology knowledge. At the same time, a patient education plan will be established for supporting care needs. This care plan including the symptoms of recurrent DVT and when to seek for medical advice after Dorothy after her discharge from hospital. Deep venous thrombosis(DVT) is the formation of a blood clot or thrombus in the large vein of the legs(Narani, 2010).
Hoarseness, breathiness, scratchy/rough voice, the "lump in your throat" sensation, shooting pains from ear to ear, the need to breathe in deeper than usual ... these are all symptoms that a nodule can cause. A nodule is basically a small growth and looks like a bump on your vocal folds. This growth occurs from vocal abuse, misuse, and overuse. A healthy, normal vocal chord often has smooth, white mucosal surfaces and has no irregular objects on your vibrating borders. But when you abuse your vocal chords by putting force and tension upon them, the vibrations go into an "overload" and can cause too much friction on them. Eventually a type of bruise forms called a hematoma and a layer of fibrous tissues form into a soft or hard bump, AKA a nodule. Usually two nodules would form on each side of a vocal fold where the friction was extensive.
The emergency room visit of E.F. is almost two times a week with mostly complaints of shortness of breath, swelling and hyperkalemia and at times, positive ETOH.
During my morning rounds I began my assessment of Mrs. M., and I noted that she had shortness of breath and she was making gurgling sounds. I immediately auscultated her lungs and noted bilateral wheezing throughout all fields, her heart was irregular and rapid and she had 2plus pitting pedal edema. I noticed she had an IV running at 125ml/hr, which I quickly stopped. The patient did not have orders for IV fluid there was only an order to KVO. I raised the head of the bed and paged respiratory to the floor.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
There is no secret that we have struggled with Ava having Eczema for a while now and while we have found several body products to help keep it at bay. However after returning from spring break in Saskatchewan, her eczema reared its ugly head with a vengeance but this time on her face around her mouth and nose!
Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., Edwards, F. D. (2008). Diagnosis
A salon is not always a pretty and peaceful sight for those working there. At times, a
Its 7:30pm. It’s a Wednesday evening. A little 4 year old boy Chad and his mother Kelsey are at home. “It’s time for a bath” Kelsey calls. Chad walks down the hallway and into the bathroom. She already had the water filled up. As he steps into the bubbly water, a bump on chads stomach catches her eye. At the time she wasn’t thinking it was anything that could harm her son so she let it rest for a few days. She started realizing chad was having shortness of breath, he was losing weight, his lymph nodes were swelling, he would sweat badly during night time night, started seeing purple spots, and he would bruise really easy. She watched it on and off and it hasn’t changed. Its Monday now and she’s worried. She went ahead and took him to the doctor.
Patients may present with symptoms and signs limited to the foot or with systemic problems.
If a pregnant female came into the ER and had a CBC ran showing a low platelets count,