Reference no: EM133394393

Darryl McFadden's history is such that he complains of nasal blockage, postnasal drip, and cough, especially at night. His symptoms are perennial but occur mainly from March through October. He says he has been getting allergy injections sporadically over the past 5 years but is not doing well.

His history sheet reveals that he is exposed to a cat and to dust and other factors in his household, and that seems to make him worse. He has been on Entex medication, the only treatment he has had other than his injections.

The physical examination revealed the lungs were clear. There were no rales. There were decreased breath sounds on expiration. The nasal turbinate's [the bones that divide the large nasal cavity] were boggy and dusky (gray) bilaterally. There were no obvious pus pockets. There was premaxillary edema bilaterally, especially on the right. There was mild postnasal drip, and there was mild cervical lymphadenopathy. There was slight tenderness in the epigastric region, but no evidence of any masses or liver or spleen enlargement.

Skin scratch testing was performed, revealing a definite allergy to trees, grasses, weeds, ragweed, mold, feathers, house dust and mite dust, and dogs and cats.

The patient also had a pulmonary function that was unremarkable. There is still engorgement on clinical examination.

Assessment/Plan: The patient is a 16 old male w/ a PMH [previous medical history] significant for allergies, who presents with chronic upper respiratory symptoms consistent with allergic rhinitis.

The patient was started on beclomethasone and instructed to use two sprays in each nostril every 12 hours. He is to continue the guaifenesin/phenylephrine, the same dose you have prescribed, as needed, and he is to receive regular allergy injections.

We will begin with injections twice a week as long as he can tolerate this, namely without his arms getting sore or developing any other clinical symptoms of congestion from the shots. If he can't continue, we will have to drop him back to once a week. These injections should be given for a year and then tapered down slowly to reach once a month for 3 years, if possible.

Thank you for referring this patient. Vaccines will be sent to your office as well as the copies of other records on this patient.

Jerry Perlmutter, M.D.

Question

1. What does bilaterally mean?

2. Mild cervical lymphadenopathy was noted. Look up whether cervical can refer to more than one body system. What is it referring to in this context?

3. Use your knowledge of word parts to figure out what lymphadenopathy means.

4. The report states that there was some slight tenderness in the epigastric region. Where is this located?