Subjective: Pаtient presents tо clinic tоdаy fоr multiple complаints. First, he is here for follow-up of his hypertension. He has been doing well on his labetalol, is not having any difficulties. However, over the last week he has had an upper respiratory infection and has been taking Sudafed-based cold products without noting what is on these. He has not taken his blood pressure at home since he has been sick. Next issue is that he is having some trouble with his knees. Anytime he gets up to move, his knees are stiff in particular when he starts walking or going down stairs his knees ache. The more steps he does, the better this becomes. It is more of an ache and stiffness than actual pain. A while ago, his right knee was bothering him quite significantly in regards to pain. This was injected with 80 mg of Depo-Medrol here in the office and this has helped with the pain but still has stiffness and achy. This is particular in morning -when he gets up. He was requesting a referral for a possible surgical intervention at this time. Other complaints today include a rash or possible fungus of the feet. He has been having troubles with this for a while, just thickening and callusing of his feet and some discoloration and would like this looked at. Next issue is since he had been taking blood pressure medicines he has been having some problem with erectile dysfunction mainly with getting and maintaining an erection. He was wondering if he has the option of trying a Viagra or other similar medication. 2. He was given a letter stating that his blood sugar was elevated. He should come in to discuss diabetes. 3. Next issue is he has a rash on his scalp that he has been doing shampoo in the past for. This has helped somewhat but has never resolved completely. He would like this looked at also today. Objective: Today, respirations 18. Pulse is 92. Blood pressure is 150/88. This is on Sudafed. Temp is 99. Weight is 164. Height 568-1/2 inches. In general, this is a 60-year-old obese male, very pleasant here with his wife who has slight nasal congestion in the office today. Skin is warm and moist. General: Sclerae are white. Examination of the feet noted to have some thickening and scaling with some calluses noted. Sensation is intact with good vascular supply. There is no discoloration noted. This is mainly between the toes and the dorsum of the foot distally. Heart was regular rate and rhythm. Lungs are clear to auscultation. No wheezes, rhonchi or rales. Knees noted to have x-rays that were done in the beginning of the year that shows possible arthritis in both knees. Examination of the scalp revealed multiple patches, scaliness and flaky skin that are in circular areas more prominent on the edge of the circle with some central clearing. A Wood's lamp was used and noted that these areas fluoresced. Assessment/Plan: Hypertension slightly elevated today but patient has been taking Sudafed. Patient was instructed to avoid all pseudoephedrine and we will recheck this in a month. Diabetes mellitus. This is a new diagnosis for him. We will send him to diabetic management and we will start him on Glucophage 500 mg twice a day. We will also get a hemoglobin A1c and microalbumin to creatinine ratio, basic metabolic and CBC today. Eczema of the feet. Were given some Lac-Hydrin to be used. He is instructed on good diabetic foot care. Bilateral knee pain consistent with osteoarthritis of his knees. Tinea capitis. We will give him some Diflucan for 4 weeks to see if this clears it up. If this continues to be a problem, may need to do scraping or a biopsy. Erectile dysfunction. Patient will be given some samples of Viagra to see if this helps. Patient is to return to the clinic in a month for continued care. The diagnoses reported include: I10, E11.9, L25.9, M17.9, B35.0, N52.9 What diagnosis code would NOT be reported?
Whаt аre the 2 dоminаnt sоurces оf atmospheric gases in the atmosphere that have a substantial influence on all remote sensing applications?