CHIEF COMPLAINT: Hiccups.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old Hispanic male who comes in with a complaint of hiccups over the last six days. He is unable to sleep; they wake him up. He states that the hiccups started a couple of days after he was placed on dexamethasone and hydroxyzine for poison ivy. He also complains of some mild hoarseness. He denies chest pain or shortness of breath. The patient denies dysphagia. No fever or chills, no abdominal pain, no nausea or vomiting. He states that he has had some indigestion over the last three days that he has taken Tums for and that does relieve his symptoms.
PAST MEDICAL HISTORY: History of sleep apnea. He does use a CPAP machine.
ALLERGIES: PENICILLIN.
MEDICATIONS: Dexamethasone and hydroxyzine.
REVIEW OF SYSTEMS: The patient denies fever, chills, shortness of breath, chest pain or difficulty breathing. He also denies runny nose, watery itchy eyes or cough. Review of systems is otherwise negative.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 99.6, pulse 88, respirations 18, blood pressure 134/82, and pulse oximetry 97% on room air.
GENERAL: This is a (XX)-year-old Hispanic male. The patient is awake and alert, sitting in chair, appears to be resting comfortably, nontoxic. Throughout the interview with the patient, we did not notice any hiccups.
HEENT: Head is normocephalic, atraumatic. Pupils are equal, round, and reactive to light and accommodation. No scleral icterus. Cranial nerves III, IV, and VI intact. The oropharynx has some mild erythema, no edema. There are some signs of cobblestoning. Uvula midline, no elevation of the tongue.
NECK: There is no lymphadenopathy, no masses, no thyromegaly.
HEART: Regular rate and rhythm.
LUNGS: Clear to auscultation, equal breath sounds bilaterally. No wheezes, rales, rhonchi or crackles noted. Respiratory excursion symmetrical.
ABDOMEN: There is slight tenderness in the epigastric region. He had positive bowel sounds all four quadrants. No guarding or rebound noted. No bruits appreciated.
DIAGNOSTIC TESTS: None.
PROCEDURE: None.
CONSULTATIONS: None.
IMPRESSION:
1. Hiccups, questionable drug induced.
2. Acid reflux.
PLAN:
1. Stop the dexamethasone.
2. Given the patient GERD instructions. Prescription for Pepcid 40 mg one p.o. q. day, #20 given.
3. Follow up with PCP in two to five days.
4. The patient is to return for shortness of breath, chest pain, dysphasia or worsening of signs and symptoms.
DISPOSITION: The patient was released in good condition.
