ER Note NL

Subjective:
Chief Complaint:
Polyarthropathy, severe right hand pain and functional impairment

History of Present Illness:
This very pleasant patient presents with a several week history of polyarthropathy, with severe right hand pain and functional impairment. The patient describes persistent pain involving multiple joints, with the right hand being most severely affected, particularly the fourth digit metacarpophalangeal joint. The patient reports swelling and tenderness in the right hand, as well as similar symptoms in the left hand, toe, knee, and back. The pain has been progressive, spreading to additional joints daily, and has resulted in significant difficulty performing occupational tasks in construction. The patient notes that over-the-counter acetaminophen and anti-inflammatory medications have not provided relief. The patient reports the presence of plaques on the chest. The patient is awaiting a specialist appointment on April 2nd but does not know who the specialist is.

The Review of Systems:
Musculoskeletal: The patient reports persistent pain involving multiple joints, with the right hand being most severely affected, particularly the fourth digit metacarpophalangeal joint. The patient also reports swelling and tenderness in the right hand, as well as similar symptoms in the left hand, toe, knee, and back. The pain has been progressive, spreading to additional joints daily, and has resulted in significant difficulty performing occupational tasks.

Integumentary: The patient reports the presence of plaques on the chest.

Past Medical History:
- No significant findings.

Current Medications:
1. Acetaminophen
2. Non-steroidal anti-inflammatory drugs

Allergies:
No significant findings.

Social History:
- Alcohol: The patient is staying off alcohol
- Occupation: Construction worker

Objective:
Physical Examination:
Physical Examination:
The patient appears well and is in no distress.
Vitals as above are noted

Cardiovascular:  Normal S1, S2.  No S3 or S4.  No murmurs.  Extremities warm and pink.  No peripheral edema. 
Respiratory:  Good air entry bilaterally.  Equal.  No adventitious sounds. 
Abdomen: Soft and non-tender without rebound or percussion tenderness, no costovertebral angle tenderness to percussion
Neuro: moves all four extremities, face symmetrical

Test Results:
Blood work did not show anything alarming.

Assessment:
Summary Statement:
Assessment/plan: Polyarthropathy with severe right hand pain and functional impairment, possible psoriatic arthritis or rheumatoid arthritis flare.

The patient presents with several weeks of progressive polyarthropathy, most severe in the right hand, with associated swelling and functional impairment. There is a history of plaques on the chest. Blood work is unremarkable. The patient is awaiting a rheumatology appointment. A short course of corticosteroids is initiated to manage the current flare. The patient is provided with a work note and advised regarding the potential impact of steroids on specialist assessment. The patient is commended for abstaining from alcohol and for weight loss efforts. Discharge instructions include follow-up with the specialist on April 2nd and to return if symptoms worsen or new symptoms develop.

Cheers,

David Chen
[Clinic Name]