Chief Complaint: Left knee pain This 83-year-old patient presented to my office this…

Chief Complaint: Left knee pain This 83-year-old patient presented to my office this morning complaining of knee pain sal and wanting to see an orthopedic surgeon for a knee replacement. My first impression of the patient was that he appeared lethargic and extremely tired-looking. Upon questioning, he stated that he was far more tired than normal and “ust didn’t feel good,” attributing this to the chronic pain in the knee. I reviewed his meds and completed a 10-point review of systems, which revealed increasing bouts of periodic diarrhea with dark stool. He has overall poor health with multiple previous surgeries and hypertension that has been difficult to control. Other systems are negative for new complaints today At the completion of our office visit, I arranged for a direct admission to the hospital. I saw him again at the hospital and continued the diagnostic workup. No known allergies. Takes Lisinopril 40 mg daily, Corea half of a 25 mg pill twice per day, and Protonix daily. He is married and lives with his second wife. The first wife died in 1996. His mother lived to 93 and father lived to 96. . He reports that they died of “old age.” Vital Signs: Blood pressure is 96/62. RR 18, P 54. T 97.3, Wt 197, down six pounds from last month with BMI of 28.67. General: Elderly male in no acute distress. Skin: Laminectomy scar on his lower back. No clubbing or cyanosis of his fingers and no suspicious lesions. Neurologic: He is alert and oriented but his timeline is unclear, especially relating to the diarrhea. Is far more concerned about his knee than anything else. Cranial nerves grossly intact and motor strength is 5/5. HEENT: Atraumatic, normocephalic. Anicteric sclera. No sinus tenderness. Posterior oropharynx is very irritated. Lips without cyanosis. NECK: Supple without adenopathy. No thyromegaly nodules, or carotid bruits. CHEST: Normal symmetry. CARDIOVASCULAR: Rate is somewhat bradycardiac and very dificult tones to auscultate. Regular rhythm. LUNGS: Clear. ABDOMEN: Soft, nontender, nondistended, decreased bowel sounds. no hepatosplenomegaly, rebound, or rigidity. No inguinal adenopathy, 2+ inguinal pulses bilaterally. MUSCULOSKELETAL: Left leg shows some atrophy in the muscles and left knee looks larger than the right knee. No real swelling appreciated. Not warm GU: Normal scrotal exam. No hernia. RECTAL: Perianal area is somewhat irritated. There is a large external hemorrhoid. Prostate is slightly enlarged. Stool is dark brown but heme negative right tive Labs are pending. EKG shows a significant sinus bradycardia around 50-55 beats per minute. This does not appear to be atrial fibrillation. He has a somewhat widened QRS complex or intraventricular conduction delay. He does not peak T waves or have any other significant issues regarding arrhythmia. nph ned. DOSEE ,07-89050 .Q1,@SH ON.TAI E Assessment: 1. Hypotension, potentially due to antihypertensive medication or based on decreased