PA and lateral chest x-ray revealed a decrease in the width of the perihilar region, which is consistent with sarcoidosis. Upon examination, Family Practitioner A noted shotty anterior and posterior cervical and supraclavicular lymphadenopathy. On, the patient again presented to Family Practitioner A with a history of an energy level which had somewhat improved, but air exchange seemed somewhat limited when running. Family Practitioner A advised him to follow up with the chest x-ray on as previously scheduled. On, the patient contacted Family Practitioner A by telephone and advised him that the lymph nodes were swollen and he had intermittent neck pain, which reduced with the Ibuprofen. In early April, the patient contacted Family Practitioner A’s office for refills of Ibuprofen 800 mg TID, which had been prescribed by Family Practitioner A. He recommended a follow-up x-ray in one month. Upon examination, he noted shoddy posterior and supraclavicular adenopathy with mild anterior adenopathy consistent with sarcoidosis. On, the patient again presented to Family Practitioner A, who noted the decision by the patient to delay the biopsy and the surgeon’s notation that there was a clinical likelihood of sarcoidosis. The patient was advised that if the lymph nodes remained enlarged, a biopsy would be mandatory. After reading the CT and chest x-ray reports, the surgeon concluded that it would suggest sarcoidosis although lymphoma was also a possibility.Īfter a lengthy discussion with the patient regarding treatment options including observation or biopsy, the biopsy was declined by the patient who indicated he wished to consult with his primary physician, Family Practitioner A. They were not noted to be firm or matted and were mobile. ![]() The surgeon noted three palpable lymph nodes varying from 1 cm to 3 cm. On, the patient presented to the surgeon for a possible biopsy. The findings were discussed with Family Practitioner B. Lymphoma and sarcoidosis represented the primary considerations. Family Practitioner B referred the patient to a surgeon to rule out lymphoma.Ī CT scan taken on was read as noting the presence of adenopathy. A chest x-ray taken on that date revealed a somewhat widened mediastinum. Examination revealed a marked cervical and posterior cervical adenopathy and also supraclavicular adenopathy. On, the patient presented to Family Practitioner A’s associate, Family Practitioner B, with swollen lymph nodes, lethargy, weakness, and dizziness. The thyroid panel was within normal limits and the family practitioner prescribed erythromycin for pharyngitis. After an assessment, Family Practitioner A diagnosed a goiter and acute viral syndrome and ordered a CBC, WBC, and thyroid panel. ![]() On, a 29-year-old male presented to Family Practitioner A with complaints of fever, achiness, diarrhea, mild sore throat, and a swelling in the neck.
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