[doctor] okay hi andrea well i
[patient] hello
[doctor] i understand you're you've come in with some right knee pain can you tell me about it what's going on
[patient] it it's not the right knee it's the left knee
[doctor] okay the left knee
[patient] and it just happens occasionally less than once a day when i'm walking all of a sudden it is kind of like gives out and i think here i'm going to fall but i usually catch myself so lot of times i have to hold a grocery cart and that helps a lot so it comes and goes and it it passes just about as quickly as it comes i do n't know what it is whether i stepped wrong or i just do n't know
[doctor] okay well so where does it hurt like in on the inside or the outside or
[patient] internally and it it just the whole kneecap fades
[doctor] okay well did you hear or feel a pop at any point
[patient] no
[doctor] okay
[patient] like that
[doctor] have you ever had any type of injury to that knee i mean did you fall or bump it against something or
[patient] no not that i can recall
[doctor] okay and have is it painful have you taken anything for for pain
[patient] no because it does n't last that long
[doctor] okay
[patient] it just like i said it just it goes about as fast as i came in
[doctor] so is it interfering with your just things you like to do and
[patient] hmmm no not really
[doctor] so i know you said that you like to do a lot of travel
[patient] yeah i've got a trip planned here in the next month or so and we are going down to columbus georgia to a a lion's club function and probably be doing a lot of walking there and they got some line dances planned and i do n't think i will be able to participate in that because of the knee
[doctor] is that where you would be kicking your leg out or something
[patient] no it's do n't you know what line dancing is like dancing in theories of fairly fast moves but it's mostly sideways motion
[doctor] and is and that you think that's when your knee might give out then or just not gon na take the chance
[patient] not gon na take the chance
[doctor] okay yeah that sounds like a good idea have you thought about even having a a cane just in case or do you think that's does that happen often enough
[patient] wrap it i would n't be able to keep track of it so no no pain
[doctor] okay okay well so since you're in how about your blood pressure how how is it doing and have you been taking your blood pressures at home like we talked about
[patient] yes they are doing fine still about the same
[doctor] so
[patient] correct that whatever
[doctor] so what has it been running
[patient] i ca n't really remember it's been several days since i took it but i think it runs around one twenty over seventy somewhere along in there
[doctor] okay alright and so what about your medication we have you on some medication for your blood pressure right
[patient] yes i take take them regularly at eight thirty in the morning and eight thirty at night
[doctor] and what is the medication and the dosage that you are taking
[patient] i'm taking a farxiga and amlodipine
[doctor] okay
[patient] and lisinopril and the hydrochlorothiazide so i i ca n't pronounce that one so but those are all small dosage pills
[doctor] that but yeah go ahead
[patient] no that was it i just take them regularly eight thirty in the morning eight thirty at night
[doctor] yeah well that's good i i know you said you set an alarm on your phone to make sure that you get them taken at the right time so that's really good and how are your blood sugars doing how is your diet doing
[patient] my blood sugar has been running a little higher at about one thirty
[doctor] is that in the morning when you're fasting
[patient] yes
[doctor] okay
[patient] and i have been told that sometimes the morning blood sugars are higher for some reason but i do n't know i i do n't really worry about it as long as it does n't get up too extremely high so
[doctor] and are you taking your metformin
[patient] yes yes that's along with the blood pressure medicine morning and night
[doctor] okay alright so are you are you eating like late at night or anything like that
[patient] no we usually eat by six
[doctor] okay okay alright well hopefully we can get you to feeling better okay so i want to do a quick physical exam really check that knee out so your vital signs look good they they look alright your temperature is ninety eight . two your pulse is seventy two respirations are sixteen blood pressure is one twenty two over seventy so that looks fine i'm gon na go ahead and take a listen to your heart and lungs so on your heart exam it's a nice regular rate and rhythm but i appreciate a slight two over six systolic ejection murmur at the left base here on your lung exam your lungs are clear to auscultation bilaterally okay now let's take a quick look at that knee so does it hurt when i press on it
[patient] no
[doctor] okay can you bend your knee and straighten it out
[patient] yes
[doctor] okay i'm gon na do some maneuvers and i'm gon na just gon na call out my findings on this okay on your right knee exam no ecchymosis or edema no effusion no pain to palpation of the of the left medial knee is there any decreased range of motion do you feel you feel like you're you're able to fully move that as you should the same as the other knee
[patient] yeah
[doctor] okay so no decreased range of motion negative varus and valgus test okay and so with your x-rays i reviewed the result of your left knee x-ray which showed no evidence of fracture or bony abnormality so lem me tell you a little bit about my plan so your left knee pain i think you just have some arthritis in that i want to prescribe some meloxicam fifteen milligrams a day we might do some physical therapy for that just to strengthen the muscles around that area and prevent any further problems with that okay and so for your second problem the hypertension so i wan na continue the lisinopril at twenty milligrams a day and order an echocardiogram just to evaluate that heart murmur alright and
[patient] okay
[doctor] for the diabetes mellitus i wan na order a hemoglobin a1c to see if we need to make any adjustments to your metformin and i'm also gon na order a lipid panel okay do you have any questions
[patient] no i do n't think so when will all this take place
[doctor] we will get you scheduled for the echocardiogram i will have my nurse come in and we will get that set up okay
CHIEF COMPLAINT

Left knee pain.

HISTORY OF PRESENT ILLNESS

Andrea Barnes is a 34-year-old female who presents today for evaluation of left knee pain.

The patient has been experiencing intermittent episodes of pain and sudden instability with ambulation. Her pain is localized deep in her patella and occurs less than once daily. Due to the fleeting nature of these episodes, she has not taken medication and simply braces herself until it passes. She denies any trauma or injury, or ever hearing or feeling a pop in the knee. Her symptoms do not interfere with her daily activities and she does not use a cane.

Regarding her hypertension, it has been several days since she last checked her blood pressure at home, but it was approximately 120/70 mmHg at that time. Her current medications include amlodipine, lisinopril, and hydrochlorothiazide, all of which she takes on a regular basis.

In terms of her diabetes, her fasting morning blood glucose levels have been approximately 130 based on home monitoring. This is slightly higher than usual, even though she has been compliant with metformin and Farxiga. She does try to avoid eating late at night.

MEDICAL HISTORY

Patient reports a personal history of hypertension and type 2 diabetes.

SOCIAL HISTORY

Patient likes to travel and is planning a trip to Columbus, Georgia in the next month or so. She is part of the Lion's Club.

MEDICATIONS

Patient reports that she is taking amlodipine, lisinopril 20 mg once daily, hydrochlorothiazide, Metformin, and Farxiga.

REVIEW OF SYSTEMS

Musculoskeletal: Reports left knee pain and instability,

VITALS

Temperature: 98.2 degrees F
Heart rate: 72 bpm
Respirations: 16
Blood pressure: 122/70 mmHg

PHYSICAL EXAM

MSK: Examination of the right knee: No ecchymosis or edema. No effusion. No pain with palpation.
Examination of the left knee: Full range of motion. Negative varus and valgus stress test.

RESULTS

X-rays were obtained and reviewed today. These reveal no evidence of fracture or bony abnormality.

ASSESSMENT

1. Left knee pain.
2. Hypertension.
3. Diabetes mellitus type 2.

PLAN

After reviewing the patients x-rays, I believe there is some arthritis in the knee. I'm going to prescribe meloxicam 15 mg once daily. We can consider physical therapy to strengthen the muscles around the area to prevent any further issues.

Her hypertension is well controlled with her current medication regimen. She can continue with lisinopril 20 mg once daily. I'm also going to order an echocardiogram for further evaluation of the murmur heard on exam.

She has been compliant with metformin as prescribed, but her blood glucose levels have been slightly elevated recently. I'm going to order a lipid panel, as well as a hemoglobin A1c to determine if any adjustments need to be made to her dose of metformin.