Case 5: Introduction

History of Present Illness (HPI)

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A 52 year old African American woman with a past medical history of pre-diabetes, hypertension, and asthma presents with worsening lower extremity edema and diffuse pruritis (itching) over the past several months.

She has had several visits to the Emergency Department for the edema and lower extremity pain, and doppler ultrasounds were negative for deep vein thrombosis. She endorses worsening exercise tolerance due to this lower extremity pain but denies significant shortness of breath. She reports noticing several episodes of “frothy” urine, but denies fevers, chills, vomiting, chest pain, headache, abdominal pain, joint pain, rash, or change in bowel habits.

The patient currently takes lisinopril, as needed albuterol inhaler, and has been intermittently taking ibuprofen for pain. She was previously prescribed amlodipine, which had been stopped due to the lower extremity edema, though there was no improvement in her edema. She denies any tobacco, alcohol, or illicit drug use. Born and raised in New York City, she has no significant travel history. She reports only that high blood pressure runs in her family.

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