Author: Joseph Andrie, MD
Co Author #1: Niladri Das, MD
28 year old female mounted shooting athlete with no past medical history presenting for evaluation of 30 lb weight gain over 4 weeks, hoarse voice, acne and swelling of her upper and lower extremities.
Patient reports that in addition to her weight gain, she has had increasing dyspnea on exertion, particularly after a flight of stairs. She has also had 2 weeks of a hoarse voice without other respiratory symptoms. Her fingers are also swollen in the morning and they also feel stiff. Additionally, she has noticed some swelling of her bilateral lower extremities. She has been trying to go to the gym more often because of her weight gain, but no longer has the stamina. On top of all of this, she did not really have a period for her last cycle. She is not on birth control. She has a national mounted shooting competition with her horse upcoming.
BP 132/74, HR 100, BMI 28.8
Gen: NAD, sitting upright, appears bloated generally
HEENT: normal conjunctiva, thyroid normal, no cervical lymphadenopathy
Cards: 2/6 systolic murmur at left sternal border, no rub or gallop
Lungs: CTA b/l, no wheezes or rhonchi
Abdomen: soft, non-distended, non-tender
Extremities: mild edema bilateral hands, no appreciable edema bilateral lower extremities
MSK: normal inspection of all joints, normal ROM of all upper and lower joints, gait normal
Neuro: PERRL, EOMI, neurovascularly intact bilateral upper and lower extremities, alert and oriented.
Skin: mild papular acne on face, primarily peri-orally
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