Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoparathyroidism, Muscle twitching, Musculoskeletal chest pain, Nausea, Pain
Clinical narrative: Office Visit  10/19/2021 Cough  Dx Rib Pain ? Cough Number of Diagnoses or Management Options Cough: new, needed workup Rib pain: new, needed workup Diagnosis management comments: Patient is a 40-year-old ambulatory female presenting to the urgent care for evaluation of right-sided rib pain that started today.  Patient reports she woke up and was having right-sided rib pain.  Pain has been constant and sharp in nature.  She has not taken any over-the-counter medications for her pain today.  Patient reports that she has had a cough for several months.  Patient reports she has shortness of breath with activity.  Denies shortness of breath at rest.  Patient reports having a headache and nausea intermittently. She denies vomiting, diarrhea, abdominal pain.  She has had 3 doses of the COVID-19 vaccine.  Patient is a healthcare worker. Patient reports that she has a history of hypertension. She states she just took her antihypertensive medications prior to arrival to urgent care.   Patient is well-appearing. Patient is AAOx4. Tympanic membranes appear normal bilaterally. No oropharynx exudate, swelling, or erythema. Respirations are equal and non labored. Lungs are clear to auscultation anteriorly and posteriorly. Patient is speaking in full sentences without difficulty. Regular cardiac rate and rhythm. Abdomen is soft and non tender. Skin is warm and dry. She is not diaphoretic. Patient has a low-grade fever of 100.2F.  She is hypertensive with a blood pressure of 150/94.  Patient reports that she just took her inside hypertensive medication prior to arrival.  She denies feeling lightheaded, headache currently, or having vision changes.   Well's Score for PE 0, therefore, PE is unlikely. EKG in office shows normal sinus rhythm with a rate of 73 bpm.  No ectopy noted.  No ST elevation or depression noted.  Nonspecific T-wave abnormality noted.  EKG compared with previous EKGs which shows no significant changes.  Covid-19 PCR positive.  Patient advised of results..  Patient can use tylenol or ibuprofen for pain or fever as needed per instructions on the label. Patient is agreeable to plan of care. Quarantine procedures discussed with patient. Return precautions discussed. Patient should be evaluated by PCP, return to urgent care, or emergency department for new or worsening symptoms. Patient verbalizes understanding. Patient is stable and ambulatory from the exam room.  Chief Complaint Patient presents with ? Rib Pain ? Cough     HPI Patient is a 40 y.o. female Presents with cough that has been ongoing for months. Today patient woke up with right sided rib pain. She reports shortness of breath with activity. She has headache and nausea. She denies vomiting, diarrhea, or abdominal pain. She has had three COVID19 vaccines. She is a healthcare worker. She has not taken OTC pain medications. Patient reports that she has a history of hypertension. She states she just took her antihypertensive medications prior to arrival to urgent care.   ED Discharged   10/23/2021 (2 hours)  Last attending ? Treatment team Hypocalcemia +1 more  Clinical impression Hand Problem    Medical Decision Making     40-year-old female with past medical history of papillary thyroid cancer status post thyroidectomy in 2015 and postprocedural hypoparathyroidism presenting to the ED today with signs of hypocalcemia including carpopedal spasm, muscle twitches, circumoral paresthesia.  Exam was remarkable for hypertension with blood pressure of 165/102.  Patient had coarse of breath sounds bilaterally with some crackles at the bases.  Heart S1-S2 without murmurs gallops or rubs.  Patient had positive Chovstek Sign was facial twitches upon sides of her face.  Does have some circumoral paresthesia.  Patient symptoms are classic for hypocalcemia.  Hypocalcemia secondary to hypoparathyroidism which we know of.  The recent COVID-19 infection could have worsened her hormonal level with her blood.  We have been to obtain some blood work including CBC, CMP, ionized calcium, PTH and mag.  We are going to admit the patient to hospital medicine given the symptomatic hypocalcemia.  CBC came back unremarkable.  CMP came back significant for low calcium of 7.0.  Ionized calcium was also low at 0.82.  Magnesium was normal at 2.2.  Patient got her Covid.  Shot recently as well.