I saw an interesting but complex case. Some details are left out to protect patient privacy, including potential assessment/plan.

ID

X is a 5x year old female with a history of thyroid nodules who presents to family clinic today for review of recent thyroid ultrasound results.

HPI

Thyroid ultrasound revealed benign nodules. Radiologist states no need for biopsy or specific follow-up.

On general review of systems, X raises concern of recurernt, severe, episodic back pain lasting 10+ years with recent increase in frequency.

She first began experiencing episodes of back pain 10+ years ago when she was living with her ex. Episodes were often triggered after eating food cooked by her ex, and evolved over seconds from an initial ‘swelling’ sensation to a 10/10 ‘eruption/explosion’ that she describes as her ‘organs tearing apart.’ The pain is localized to the left mid-thoracic paraspinal region, and does not radiate.

5+ years ago, she left her ex and lived in a transition home, where she experienced remission. Since leaving the transition home, her episodes have increased in frequency. Her recent episodes are also often triggered by eating food cooked by others, so she now mainly eats out.

During and after episodes, she reports symptoms including visual changes (dry eyes, blurry vision, flashes of light, and increased acuity); intense pruritus over her shins; diffuse weakness without difficulty standing, breathing, keeping her eyes open, or maintaining consciousness; and increased urinary frequency, especially at night (e.g. waking up 7-10x/night). She denies chest pain, sweating, shaking/trembling, dyspnea, vomiting, nausea, or abdominal pain.

PmHx

• Benign thyroid nodules, confirmed by thyroid ultrasound.
• Depression - she mentioned this, but did not wish to explore further.

Medications

Mentions previously having used anti-depressant(s), but did not identify the type, duration, dose, or whether she is currently using them or not.

FmHx

• Father died with liver cancer
• Mother died from unclear medical condition

SHx

X describes a history of intimate partner violence, including emotional, physical, financial, and social abuse.

X also expresses prominent and pervasive persecutory and paranoid beliefs, e.g. being stalked and hidden cameras in her room. When challenged, she resists and provides illogical explanations.

She lives alone and has no children. She has a sister who she has cut ties with due to alleged ties with her ex.

She denies consumption of tobacco, alcohol, or recreational drugs.