Request for Consultation Gloria Ramos

REQUEST FOR CONSULTATION Patient Name: Gloria Ramos Hospital No.: 13246 advisor: Sachi Kato, M.D., Dermatology Requesting Physician: Leon Medina., M.D. Internal Medicine Date: 06/23/2010 Reason for computer address: Please evaluate stomatitis possibly methotrexate sodium related. HISTORY OF express ILLINESS: The patient is a very pleasant 57 grade old white female, a native of Cuba, being seen for an military rank and treatment of sores in her mouth that she has had for the last 10-12 daytimes. The patient has a long history of severe and debilitating rheumatoid arthritis for which she has had legion(predicate) treatments, but over the past ten years she has been tough with methotrexate quit successfully. Her venereal disease has varied somewhere surrounded by 20 and 25 mg per week. About the beginning of this year, her dosage was decreased from 25 mg to 20 mg, but because of a flare of the rheumatoid arthritis, it was increased to 22.5 mg per week. She has had no problems with the methotrexate as far as she knows. She also took an NSAID most a month ago that was recently discontinued because of the ulcerations in her mouth. About two weeks ago, just about the time the stomatitis began she was hardened on an antibiotic for suspected upper respiratory infection. She does non remember the name of the antibiotic.

Although she claims she remembers taking this type of medication in the past without any problems. She was on that medication, three pills a day for three to four days. She notes no other problems with her skin. She remembers no supersensitised reactions to medications. She has no previous history of fever blisters. PHYSICIAL EXAMINATION: Reveals outward erosions along the lips, particularly the abase lip. The posterior buccal mucosia, along the sides of the tongue, and also some superficial erosions along the upper and lower gingival. Her posterior pharynx was difficult to visualize, but I precept no erosions on the areas today. There did however, appear to be sensation small erosion on the soft... If you want to get a full essay, order it on our website: Ordercustompaper.com

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