OCCUPATIONAL MEDICINE REPORT

October 18, 2014

GENERAL DATA

S.T. 54 years old Right-handed female Married Iglesia ni Cristo Factory worker Dasmarinas, Cavite

CHIEF COMPLAINT

Multiple joint pains

HISTORY OF PRESENT ILLNESS

Patient initially seen at FMC 6 months ago

Last working impression:(1) skin infection, infraumbilical; and (2) rule out acute coronary syndrome

secondary to ischemic heart disease

HISTORY OF PRESENT ILLNESS

On follow up:Resolution of skin lesion (7-day course of clindamycin)

New complaint:Multiple joint pains

HISTORY OF PRESENT ILLNESS

6 months PTC(+) low back pain

○ crampy○ VAS 7-8/10○ non-radiating○ precipitated/aggravated by prolonged

standing, sitting, bending over.

HISTORY OF PRESENT ILLNESS

6 months PTC(+) bilateral knee pain

○ heaviness○ VAS 7-8/10○ also precipitated/aggravated by prolonged

standing○ (-) swelling, (-) erythema, (-) warmth, (-)

morning stiffness○ Not associated with fever or malaise

HISTORY OF PRESENT ILLNESS

6 months PTC(+) right thumb tenderness

○ (+) limitation of motion, difficulty in flexion and abduction○ (-) swelling, (-) erythema○ (-) numbness

Still ambulatory but with some limitation

No consult

Self-medicated with vitamin B complex○ No relief

HISTORY OF PRESENT ILLNESS

Persistence -> consult at FMC

REVIEW OF SYSTEMS

No fever, rashes, malaise, bleeding

No headache, seizures, change in sensorium, localized weakness

No cough, colds, dyspnea

REVIEW OF SYSTEMS

(+) chest pain (occasional, occurring with exertion); no palpitations, orthopnea, easy fatigability, paroxysmal nocturnal dyspnea

No abdominal pain, nausea, vomiting, diarrhea, constipation

REVIEW OF SYSTEMS

No dysuria, oliguria, hematuria, frequency

No polyuria, polydipsia, polyphagia, unexplained weight loss, heat or cold intolerance

REVIEW OF SYSTEMS

(+) exposure to dust and vehicle exhaust fumes; no known exposure to chemicals, loud noise, radiation

PAST MEDICAL HISTORY

(+) dyslipidemia on simvastatin 20 mg/tab, 1 tab PO OD HS x 2 months (lost to follow up)

No hypertension, diabetes, PTB, bronchial asthma

PAST MEDICAL HISTORY

(+) hospitalized x 1 week for vertigo (May 2012)

No known food or drug allergies

FAMILY HISTORY

No known hypertension, diabetes, PTB, bronchial asthma, cardiac disease, lung disease

Eldest of 10 children

Px and husband -> 4 children

FAMILY HISTORY

Eldest of 10 children

Px and husband -> 4 children

OB-GYNE HISTORY

G4P4 (4-0-0-4) menarche at 17 years oldmenopause at 52 years old

Sexually active -> 1 sexual partner

(+) BTL 28 years ago

No oral contraceptive pill use

PERSONAL SOCIAL HISTORY Non-smoker

No alcoholic beverage intake

Denies illicit drug use

PERSONAL SOCIAL HISTORY Diet: Vegetables, fruits

B.S. Elementary Education graduate

PERSONAL SOCIAL HISTORY >Lives in a bungalow with husband

made of concrete, wood, galvanized iron

urban community in Dasmarinas, Cavite

water source: tap water

drinking water source: purified drinking water station

PERSONAL SOCIAL HISTORY

(+) exposure to vehicular dust fumes

(+) nearby commercial businesses and factories

(+) uses bath, laundry, and dishwashing soap

(+) no hobbies

OCCUPATIONAL HISTORY Elementary school teacher x 5 years (1981-

1985)8 a.m. to 5 p.m.

preparing lesson plans (sitting, writing)

doing lectures for schoolchildren (standing/pacing, speaking, writing)

attending teaching seminars (sitting, listening, writing)

OCCUPATIONAL HISTORY

Full-time housewife x 20 years -> raising 4 children -> mainly doing houseworkCookingCleaning the house

○ sweeping floor○ dusting furniture

Washing dishesLaundryMending clothesBuying groceries

OCCUPATIONAL HISTORY

Entrepreneur: small catering business x 5 years (2007-2011), works 4 a.m. to 7 p.m. overall planning and management of the catering

operations, ensuring the availability of the

logistics/materials/ingredients, buying the ingredients, cooking, serving the food, reviewing the payment and expenses

OCCUPATIONAL HISTORY

Quality control Supervisor (2013-present)Fabric FactoryWorks 8a.m. to 5p.m. with a 1-hour lunch

break and 15-minute morning and afternoon breaks.

Standing and walking around the factory,Inspecting fabrics by ocular and tactile

inspection(+) use of face mask and gloves.

PHYSICAL EXAMINATION

Awake, alert, not in distress, not in acute pain

BP 120/80 both arms; PR 68 bpm; RR 20 cpm; T 36.6; Wt 55.5 kg; Ht 158.5 cm; BMI 22.11 kg/m2

Warm moist skin, good skin turgor, no lesion appreciated per infraumbilical area

PHYSICAL EXAMINATION

Pink palpebral conjunctivae, anicteric sclerae, pupils 2-3 mm ERTL, no nasoaural discharge; no palpable cervical lymph nodes, no neck vein engorgement

PHYSICAL EXAMINATION

Symmetrical chest expansion, no retractions, no wheezes, no crackles

Adynamic precordium, normal rate regular rhythm, no murmurs

Flabby abdomen, normoactive bowel sounds, soft, non-tender

PHYSICAL EXAMINATION No gross deformity of the back

Extremities: (+) bony prominence at the base of the right thumb

with limitation of range of motion at the interphalangeal and metacarpal joints;

no warmth or tenderness noted;

(+) crepitus over the bilateral knee joints on flexion;

no gross deformity

PHYSICAL EXAMINATION

Extremities: full range of motion of all other joints

○ no edema ○ pulses full and equal○ pink nailbeds

NEUROLOGICAL EXAMINATION

GCS 15 (M6 V5 E4), oriented x 3

Cranial nerves: Gross vision intact, pupils 2-3 mm ERTL, EOMs full and equal, good masseter tone, no facial asymmetry, gross hearing intact, (+) gag reflex, uvula midline, good shoulder shrug, tongue midline on protrusion

Motor 5/5 on bilateral upper and lower extremities

Sensory 100% on bilateral upper and lower extremities

NEUROLOGICAL EXAMINATION

Bilateral patellar DTRs 2+

(-) dysdiadochokinesia, (-) dysmetria

No nuchal rigidity

No Babinski, (-) clonus

LABORATORY RESULTS (10/07/2014) FBS 90.91 mg/dL Creatinine 0.61 mg/dL Cholesterol 243.24 mg/dL

(H) Triglycerides 123.01 mg/dL HDL 66.80 mg/dL (H) LDL 3.94 mmol/L (H) Serum K 3.7 mmol/L

LABORATORY RESULTS (10/07/2014) Urinalysis: Yellow, hazy, sp gr 1.025, pH

5.5, sugar/albumin neg, rbc 0-1/hpf, wbc 0-2/hpf, epithelial cells/bacteria few, mucus threads 2+

ASSESSMENT

Degenerative osteoarthritis, lumbosacral, bilateral knees, right thumb

Chronic stable angina pectoris, CCS I

Dyslipidemia

Skin infection, infraumbilical, resolved

PLAN

Diagnostics:X-rays of the lumbosacral APL, bilateral

knees APL, Right Hand APL

Serum uric acid

PLAN Therapeutics:

Ibuprofen + paracetamol 200 mg/325 mg/tab, 1 tab PO q8h with meals prn pain

Isosorbide mononitrate 30 mg/tab, 1 tab PO OD a.m.

Isosorbide dinitrate 5 mg/tab, 1 tab SL prn angina

Simvastatin 20 mg/tab, 1 tab PO OD HS

PLAN Non-pharmacologic:

Warm compress to affected areas TID x 15 mins

Advised on proper body mechanics and stretching exercises

Advised on taking short (e.g. 1-minute) but more frequent breaks (e.g. every 30 minutes) to rest joints -> suggest to advise this to management as well for implementation to other workers

PLAN

New York Committee on Occupational Health and Safety

PLAN

Non-pharmacologic:Low fat, high fiber, balanced diet

Regular aerobic exercises at least 30 minutes/day x 5 days/week

PLAN

WOF:Chest pain not relieved by rest and ISDN ->

to seek medical consult as soon as possible

Follow up once with results (ideally after 2 weeks)

THE END