[patient] hi kenneth how are you the medical assistant told me that you had some knee pain yeah i was getting ready for the holiday weekend and i was out on my boat skiing and i i did a jump and kinda twisted when i landed and my knee has been hurting me ever since [doctor] okay so that was about five days ago then [patient] yeah yeah that was last weekend [doctor] last weekend okay now which knee is it [patient] it's my right knee [doctor] your right knee okay and i know that it sounds like you were on a motor boat as you were you know water skiing but did you hear anything pop or feel anything pop when it happened [patient] no it just felt like something stretched and then it swelled up some afterwards [doctor] okay and were you i assume that you were were you able to get out of the water by yourself or did you need some assistance [patient] i was able to get out but it was very sore to climb up and you know any kind of squatting or bending is really pretty sore [doctor] yeah okay and have you ever injured this knee before [patient] no that was the first time [doctor] that was the first time okay where do you have a boat what lake do you have it on lake [patient] lake martin [doctor] okay nice and so you're a frequent water skier [patient] yeah i try to go every weekend when we can [doctor] that's nice very very good are you looking forward to spring are you a baseball fan are you excited by opening day [patient] no i'm not a baseball fan but i love spring and chicken time of year launds of outdoor activities nice nice i'm i'm not really a baseball fan either but my husband makes me watch the the meds all the time and they lose all the time so he is always upset so so anyway [doctor] yeah right so how about your high blood pressure how are you doing with that are you taking your blood pressure medication like i asked [patient] i'm taking it everyday and i check my blood pressure at home and it's been about one twenty five over eighty most of the days [doctor] nice okay so i believe we have you on lisinopril about twenty milligrams a day any side effects from that that you're noticing [patient] not that i know of it's been a good medicine for me and i do n't have any trouble with it [doctor] okay great alright and since you had this knee pain any numbing or tingling in your foot at all [patient] no just the swelling and the pain [doctor] okay and what have you taken for the pain [patient] i i took some aleve twice a day some over the counter aleve twice a day [doctor] okay and [patient] putting a cold pack on it [doctor] okay and has that helped at all [patient] yeah that's helped a fair amount it's still pretty sore though [doctor] okay alright well let's see have you ever had any surgeries before let me just think any surgeries i do n't see any in your in your record here [patient] i had my tonsils out [doctor] okay you had your tonsils out okay alright well let me go ahead i wan na do a just a quick physical exam i'm gon na go ahead and be calling out some of my clinical exam findings and i'll let you know what that means when i'm done okay so looking at your vital signs here in the office it does look like you're doing a really good job managing your blood pressure your blood pressure is up is about one twenty over seventy seven today here in the office and that's with you probably in a little bit of pain so that's good and on your neck exam i do n't appreciate any lymphadenopathy on your heart exam your heart is a nice regular rate and rhythm i do n't appreciate any murmur on your lung exam your lungs are clear to auscultation bilaterally on your musculoskeletal exam on your right knee i do appreciate some ecchymosis some edema there is an effusion present does it hurt when i press [patient] yeah that's sore [doctor] okay there is pain to palpation of the right medial knee there is i'm just gon na bend your knee in all sorts of directions here does that hurt [patient] yeah do n't do that anymore [doctor] alright the patient has decreased range of motion there is a negative varus and valgus test there is a negative lachman sign there is a palpable dorsalis pedis and posterior tibial pulse there is otherwise no lower extremity edema so what does that what does that mean kenneth so that so that means that you essentially i agree with you you had quite quite an injury to your knee and you do have a little bit of fluid in your knee there and just some inflammation which i think we need to talk about okay so i wan na go ahead and just talk a little bit about you know my assessment and my plan for you so for your first problem of your right knee pain i do believe you have what we call a a medial collateral ligament strain you know i wan na go ahead and just order an x-ray of your right knee just to make sure that we're not missing any broken bones which i do n't think we are but what's good about this particular injury is that people typically heal quite well from this and they typically do n't need surgery we can just go ahead and refer you to physical therapy to to strengthen those muscles around your knee so that you do n't have another injury and i wan na go ahead and just prescribe meloxicam fifteen milligrams once a day and that will help take down the swelling and help with some of the pain and you only have to take it once a day and it wo n't really cause any upset stomach or anything like that do you have any questions about that [patient] yeah if i start that medicine today am i going to be able to ski tomorrow because we got a a big weekend plan [doctor] i would say i would like you to rest your knee i i think that my concern is that if you go skiing again and you fall that you might injure your knee even more so i think you'll recover from this injury right now but i do n't want you to injure it anymore so i would rest it for a little while at least until we have the results of the x-ray and that type of thing okay for your second problem of your hypertension i wan na just go ahead and continue on lisinopril twenty milligrams a day i wan na just go ahead and order an a lipid panel just to make sure everything is okay from that standpoint and then i'm just looking through your health record and it looks like you're due for a tetanus shot so we'll go ahead and just give you a a tetanus shot for a from a health maintenance perspective any other questions [patient] i think so sounds like a good plan to me [doctor] okay sounds good alright so i'll see you later we'll get those ordered and i'll be in touch okay take care bye [patient] thank you
ASSESSMENT AND PLAN

1. Right knee pain.
 - Medical Reasoning: Based on the patient's symptoms and exam, I believe he has a medial collateral ligament strain.
 - Patient Education and Counseling: We discussed the nature of this injury as well as the expected recovery outcome. He was advised surgery is typically not needed and that physical therapy will be beneficial for strengthening to prevent future injuries. He was also counseled to rest his knee until we at least receive his x-ray results in order to prevent further injury and to allow for a quicker recovery.
 - Medical Treatment: X-ray of the right knee was ordered for further evaluation. Referral to physical therapy was provided for strengthening. A prescription for meloxicam 15 mg once a day for pain and swelling was also provided.
 
 2. Hypertension.
 - Medical Reasoning: The patient is doing well on his current medication regimen. He is monitoring his blood pressure at home and has not had any elevated readings.
 - Medical Treatment: He will continue taking lisinopril 20 mg a day. Lipid panel was ordered today.
 
 3. Health Maintenance.
 - Patient Education and Counseling: I advised the patient that his records indicate that he is due for a tetanus vaccine.
 - Medical Treatment: The patient will receive his tetanus vaccine in office today.
 
 