CHIEF COMPLAINT: History and physical.

HISTORY OF PRESENT ILLNESS: This 59-year-old Caucasian female presents to the office for physical exam and Pap smear, new patient back to the Troy Facility. Patient was last seen February 2018.

CURRENT MEDICATIONS: Glucovance 2.5 mg 1 tablet three times a day, Pravachol 40 mg daily, Effexor 75 mg daily, Zestril 10 mg a day, Synthroid 0.05 mg daily, vitamin E 400 a day, vitamin B12 daily, calcium, aspirin 1 a day, Toprol 50 mg 1 a day, and a natural estrogen and progesterone cream.

ALLERGIES: NONE.

PAST MEDICAL HISTORY: Significant for diabetes, heart disease, hyperlipidemia, hypertension, hypothyroidism, chickenpox, degenerative disease of the knees.

SURGERIES: Back surgery in 1987 and bunionectomy in 1995.

FAMILY HISTORY: Significant for diabetes, hyperlipidemia, hypertension, melanoma, and stroke.

SOCIAL HISTORY: Patient does not smoke, does not exercise, does not use drugs, does not drink. There are no weapons in the home. Patient's occupation is a secretary, one person living at home. Patient is single. Not sexually active.

REVIEW OF SYSTEMS: Significant for pain that she has noticed occuring in her left shoulder starting from her neck going down her shoulder and arms to her fingers especially to the second and third finger. Also pain with urination. Review of systems otherwise noncontributory.

O: Height is 5'1-3/4", weight is 193, blood pressure 112/72, pulse is 80, vision 20/20. Pupils equal, round, reactive to light accomodation. Extraocular movements intact. Ear canals patent, TMs normal. Nares patent. Pharnyx is clear. No buccogingival or posteropharyngeal lesions. Heart: Regular rate and rhythm without murmur, click, or gallop. Lungs: Clear to auscultation without wheezing, rales, or rhonchi. Abdomen: Soft and nontender. No organomegaly, no hepatosplenomegaly. Bowel sounds are normal. Skin: Positive varicose veins and spider veins noted on lower extremities and on legs, varicose veins noted in upper thigh. Musculoskeletal: On palpation of the left cervical spine and left shoulder, positive tenderness with again sensation of numbness to the second and third finger. No joint tenderness. Gait is normal. Leg lengths are equal. Neurologic: Cranial nerves II through XII grossly intact. Extremities: No cyanosis, clubbing, or edema. Breasts: No masses, dimpling, tenderness, or discharge. On pelvic exam, no external genitalia lesions, no inguinal adenopathy. Vaginal mucosa is moist, no discharge. No cervical motion tenderness. No masses over the ovaries, over the uterus. Right ovary is palpable, left ovary not palpable. No rectovaginal fistula. Pap smear obtained. Guaiac negative. On review of patient's chart, labs done February 2018, cholesterol of 149, LDL of 71, creatinine of 0.6, glucose of 116, TSH of 4.24, hemoglobin of 13.5.

ASSESSMENT AND PLAN:

1. Diabetes. Patient's diabetes is new-onset being seen in 2015. She is using Glucovance 2.5 mg three times a day. Wew ill check a hemoglobin A1c, fasting blood sugar, kidney and renal studies along with a UA/albumin-creatinine ratio to assess her kidney function from the diabetes. Patient is also going to be seeing an endocrinologist.

2. Hypertension. Blood pressure is 112/72, under excellent control. Patient is using Zestril 10 mg a day.

3. Hypothyroidism. Patient is using Synthroid 0.05 mg daily. We will check a TSH level.

4. Hyperlipidemia. Patient is using Pravachol 40 mg a day. We will check a fasting lipid profile and her liver function studies because of the use of the Pravachol.

5. Possible cervical nerve impingement. Patient's symptoms going down the left arm could involve the median nerve. We will do an EMG study of the neck and arm for further evaluation. EMG recommendation given.

6. Preventive medicine. Pap smear obtained. Mammogram ordered. She will also receive her TdaP here in the office today for tetanus booster. Labs will include CBC, lipid profile, biochem profile, TSH, hemoglobin A1c, stool cards x3, UA, and UA/albumin-creatinine ratio.