Patient was seen at urgent care c/o difficulty in opening her mouth. She also stated she was having problems swallowing. When asked if she had any pain, she pointed to the submandibular area. The physician palpated the area and could feel what seemed to be a small salivary stone, which was confirmed on x-ray. The physician massaged the area and had hoped to express the stone. Unfortunately, he could not. Patient was referred to an oral surgeon for further examination and removal of the stone.
Dx: Sialolithiasis
What will be an ideal response?
Question 2
Thomas is a 58-year-old male with ASHD, DM type 2, HTN, and GERD who presents with c/o rectal bleeding. He states, There was blood in the toilet after I had a bowel movement. He admits he was straining a lot to pass the stool.
PMH: As noted, the patient has ASHD, DM type 2, which is well controlled with metformin and Byetta, HTNcontrolled by Norvasc. He also takes omeprazole, Simvistatin, and Neurontin for diabetic neuropathy. He reports the ASHD is stable at this time, according to my cardiologist.
Temp: 99 Pulse: 76 BP: 130/74 Blood sugar: 110
Physical Exam:
ENTPERRLA, no PND
Neck: WNLno lymphadenopathy
CardiovascularRRR, no JVD, no carotid bruits
Lungsnormal breath sounds; no rales or crackles
Abdomen normal bowel sounds
Digital Rectal Examstool on glove was brown. No evidence of blood. Hemorrhoids were noted.
Fecal occult blood test was negative.
EKGWNL
CBCboth H&H are within normal limits
I discussed my findings with the patient. Since the fecal occult blood test was negative, and the EKG and H&H are normal, I do not think he is bleeding internally. He has both internal and external hemorrhoids. What I believe happened is that one of the hemorrhoids popped as he was straining to defecate. I am discharging him home with instructions to return to the ED should he experience any additional rectal bleeding, or if he notes any blood in his stool. Otherwise, I would like him to follow up with Dr. Jason Kittridge at our GI clinic within the next week.
Impression: ASHD, Hemorrhoids, DM with neuropathy, GERD
What will be an ideal response?
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