C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure. Allergic

C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure. Allergic Rhinitis Depression Hypothyroidism Father died at age 49 from AMI: had HTN Mother has DM and HTN Brother died at age 20 from complications of CF Two younger sisters are A&W The patient has been married for 25 years and lives with his wife and two children. The patient is an air traffic controller at the local airport. He has smoked a pack of cigarettes a day for the past 15 years. He drinks several beers every evening after work to relax. He does not pay particular attention to sodium, fat, or carbohydrates in the foods he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted or exercised. Zyrtec 10 mg daily Penicillin States that his overall health has been fair to good during the past year. Weight has increased by approximately 30 pounds in the last 12 months. States he has been having some occasional chest pressure and headaches for the past 2 days. Shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis. Reports some shortness of breath with activity, especially when climbing stairs and that breathing difficulties are getting worse. Denies any nausea, vomiting, diarrhea, or blood in stool. Self treats for occasional right knee pain with OTC Ibuprofen. Denies any genitourinary symptoms. B/P 190/120, HR 73, RR 18, T. 98.8 F., Ht 6’1”, Wt 240 lbs. TMs intact and clear throughout No nasal drainage No exudates or erythema in oropharynx PERRLA Funduscopy reveals mild arteriolar narrowing without nicking, hemorrhages, exudates, or papilledema Supple without masses or bruits Thyroid normal No lymphadenopathy Mild basilar crackles bilaterally No wheezes RRR No murmurs or rubs Soft and non-distended No masses, bruits, or organomegaly Normal bowel sounds Moves all extremities well No sensory or motor abnormalities CN’s II-XII intact DTR’s = 2+ Muscle tone=5/5 throughout

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