[Verified Answer]: DATE: 09/11/YYYY CHIEF COMPLAINT: Progressive…

DATE: 09/11/YYYY CHIEF COMPLAINT: Progressive unsteadiness of gait. HISTORY OF PRESENT ILLNESS: This is one of multiple admissions for this 65 year old female whose past medical history is significant for Parkinsonism, a bleeding disorder and cervical spondylolisthesis. She was in her usual state of fair health until the week prior to admission when she noted the onset of fever, chills, myalgias and nausea and associated with loose, brown, watery bowel movements without frank blood or melena. This abated after 2 days and she attributes this to a flu-like syndrome. Over the last 2 to 3 weeks she states that she has noted progressive unsteadiness of gait. She has fallen repeatedly at home. She also notes more increased tremor and diffuse muscular weakness. She states that she is unable to even write or make her own bed and she feels that these symptoms have been getting worse. The patient has had a history of Parkinsonism and has been treated by Dr. Beach for this disorder. Other pertinent review the patient notes the episodic occurrence of left hand numbness and tingling. She states that this does not occur in her right hand and she attributes this to her cervical disc disease. Also the patient has noted increasing sinus drainage and some sinus-type of headache associated with these symptoms. The patient denies any loss of consciousness, any orthostatic signs or symptoms. She denies any problems with speech or memory. She denies any problems with seizure-like activity. PAST MEDICAL HISTORY: Childhood – unremarkable. Adulthood – the patient has a history of Parkinsonism, as stated above in the History of Present Illness. She has a history of chronic sinusitis. She has a history of cervical disc disease secondary to motor vehicle accident. She has a history of a bleeding disorder for which she underwent splenectomy. It sounds from her description as though this might be a bleeding disorder secondary to a platelet disorder such as the immune thrombocytopenia. In 1985 the patient underwent bilateral cataract removal with intraocular lens implantation. Medications – Symmetrel 100 milligrams by mouth twice a day, Parafon Forte 250 milligrams by mouth three times a day, Decongex 3 1 capsule by mouth twice a day, and Naludar 300 milligrams by mouth every night at bedtime. Allergies – the patient states she is allergic to sulfa drugs. FAMILY HISTORY: Her mother’s sister suffered from Parkinsonism as did a distant great aunt. Her mother died at the age of 74 from a carcinoma of unknown type. Her father died in his 60’s from myocardial infarction and he had emphysema. The patient has three brothers. History is positive for Chronic Obstructive Pulmonary Disease, myocardial infarction, and carcinoma of the colon. They suffered from no Parkinsonism themselves. There is no history of anemia and no history of thyroid disease. SOCIAL HISTORY: The patient has never smoked cigarettes or used tobacco in any form. She states that at one time she was a heavy drinker but presently drinks only socially approximately once per week and not to the point of being intoxicated. REVIEW OF SYSTEMS: Head, eyes, ears, nose, throat – negative. Cardiopulmonary – negative. No shortness of breath, no cough, no hemoptysis. No sputum production. No pleuritic-type chest pain. No palpitations, edema, orthopnea, post nasal discharge, dyspnea on exercise, or shortness of breath. Abdominal – diarrhea as stated 2 days last week. The patient also gives a history of heartburn and a long standing history of chronic constipation for which she takes laxatives daily. Genitourinary – no dysuria, frequency, hesitancy or hematuria. Neurological – as per History of Present Illness. GENERAL: Reveals a well-developed, cachectic-appearing elderly white female who appeared to be visibly anxious. TEMPERATURE: 98.0 PULSE: 70 RESPIRATIONS: 20 BLOOD PRESSURE 150/90 WEIGHT: 108 pounds. No orthostatic changes were noted. HEAD: General appearance about the head and neck, although their appearance was normal in anatomically, during the examination the patient exhibited spastic-type movements with flexion of the neck. The patient seemed to be unaware that she was doing this, would be most closely described as a torticollis-type of movement which would be relaxed if you stated to the patient to relax herself. The patient was noted not to be making any lip smacking or any other abnormal head movements. EYES EARS NOSE THROAT: Eyes – Left eye noted a superior iridectomy scar. Right eye noted artificial lens noted in the anterior chamber. Funduscopic examination was unremarkable. Pupils were somewhat irregular but reactive to light and accommodation. Extra-ocular muscles were intact with some lateral gaze nystagmus noted which was felt to be within normal limits. The patient was able to elevate and depress ocular movement as directed. Visual fields were noted to be intact bilaterally. Ears – Tympanic membranes were pear