[doctor] hey philip good to see you today so take a look here at my notes i see you're coming in for some right knee pain and you have a past medical history of hypertension and we will take a look at that so can you tell me what happened to your knee [patient] yeah i was you know i was just doing some work on my property and i i accidentally slipped and fell down and i just still having some knee issues [doctor] okay well that that's not good do you [patient] no [doctor] what part of your knee would you say hurts [patient] i would just say you know the it it you know it basically when i when i'm flexing my knee when i'm moving it up and down and i put pressure on it [doctor] alright did you hear a pop or anything like that [patient] i did feel something pop yes [doctor] okay and did it was it swollen afterwards or is it looks a little bit swollen right now [patient] yeah little bit swollen yeah [doctor] okay so so far have you taken anything for the pain [patient] just taking some ibuprofen just for some swelling [doctor] okay that's it what would you say your pain score is a out of ten with ten being the worst pain you ever felt [patient] i would say that when i'm stationary i do n't really feel a lot of pain but if i start doing some mobility i would say probably a four five [doctor] about a four okay and how long ago did you say this was is this happened this injury [patient] it's been a week now [doctor] a week okay alright alright so we will take a look i'll do a physical exam of your knee in a second but i do want to check up you do have a past medical history of hypertension i'm seeing here you're on twenty milligrams of lisinopril when you came in today your blood pressure was a little bit high it was one fifty over seventy so have you been taking your medications regularly [patient] yes i have [doctor] okay so you might have a little white coat syndrome i know some of my patients definitely do have that so what about your diet i know we talked a little bit before about you reducing your sodium intake to about twenty three hundred milligrams per per day i know you were during the pandemic your diet got out of little bit out of control so how have you been doing how have you been doing with that [patient] i definitely need some help there i have not have not made some some changes [doctor] okay yeah we definitely need to get you to lower that salt intake get your diet a little bit better because the hope is to get you off that medication and get your blood pressure to a manageable level okay so we yeah we definitely can talk about that alright so lem me take a look at your knee i'll do a quick physical exam on you and before i do just want to make sure you're not having any chest pain today [patient] no [doctor] are you any belly pain [patient] no [doctor] no shortness of breath just wan na make sure [patient] no [doctor] okay so i'm just gon na listen to your lungs here your lungs are clear bilaterally i do n't hear any wheezes or crackles listen to your heart so on your heart exam i do still hear that grade two out of six systolic ejection murmur and you already had that and so we we knew about that already so lem me look at your knee here so when i press here on the inside of your knee does that hurt [patient] a little bit [doctor] little bit how about when i press on the outs the outside gon na press on the outside is that painful [patient] no [doctor] no alright so i'm gon na have you flex your knee is that painful [patient] yeah that's uncomfortable [doctor] that's uncomfortable and extend it so that's painful [patient] yeah yes [doctor] okay so on your knee exam i i see that you do have pain to palpation of the medial aspect of your right knee you have some pain with flexion extension i also identify some edema around the knee and some effusion you have a little bit of fluid in there as well so prior to coming in we did do an x-ray of that right knee and luckily you did n't break anything so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you have what we call a mcl strain so a medial collateral ligament strain so when you fell i think you twisted a little bit and so it irritated you strained that that ligament there so for that what we can do for you first i'm gon na prescribe you some ibuprofen eight hundred milligrams and you can take that twice a day and that's gon na help you with that swelling and that pain that you currently do have i'm also gon na put you in a a knee brace just to try and support those muscles to allow it to heal and then i want you to ice the knee you can do that for twenty minutes at a time for three to four times a day that should also help with the the swelling of your knee for your hypertension now i'm gon na keep you on that twenty of lisinopril okay because you are taking it and you you're doing pretty good with it i also want to get you a referral to nutrition just to try to help you with that diet you know because right now you are your diet is little bit out of control so we just need to rain you in a little bit and hopefully you know with their help we can eventually get you off that lisinopril alright so do you have any questions for me [patient] do i need to elevate my leg or stay off my leg or [doctor] yeah i would yeah you can elevate your leg stay off your stay off your leg you know if you have any kids have them work out in the yard instead of you just to to for a couple of weeks it's a good thing if you want to do that [patient] tell him this doctor's order [doctor] tell definitely tell him his doctor tell him i said it [patient] alright do you have any other questions no that's it i appreciate you seeing me [doctor] alright so my nurse will be in with the those orders and we will see you next time
ASSESSMENT AND PLAN

1. Right knee MCL strain.
 - Medical Reasoning: Based on the physical examination findings, the patient has a MCL strain of the right knee. - Medical Treatment: I have prescribed ibuprofen 800 mg twice a day. I will also place him in a knee brace. I advised him to ice the knee for 20 minutes at a time for 3 to 4 times a day. The patient was instructed to elevate his leg as needed and avoid strenuous activities for 2-3 weeks.
 
 2. Hypertension.
 - Medical Treatment: The patient will continue lisinopril 20 mg daily. I have also provided a referral to see a nutritionist for dietary changes.
 
 