C09998877 / invoice 10000

Reason: Skin IssuesAppointment Notes: cmHistory: Noticed an hour ago a rough, malodorous, swollen area along neck underneath collar Has been quiet the last 2 days Hasn't had a bath or gone to the beach in the last 3 weeks Otherwise well - EDUF good Have noticed brown staining on towels around the house in the last month - presumed to be from his mouth, now thinking it may have been from his neck lesion Collar usually always stays on Current Medication: none Examination: Demeanour: BAR, excitable. Loves treats BCS: 3/5HR/PR: 100. No murmur or arrhythmia, pulses strong and synchronous RR/Chest: panting. Normal effort and BV sounds MM/CRT: pink, moist/1.5Oral/Teeth/Gums: stage 1 dental disease Temp: not taken Ears: external pinna clean Eyes: nad LNs: SM, PS, P wnl Abdo/GIT: soft and comfortable U/G: not assessed M/Skel: ambulating well Neuro: mentation appropriate, no obvious deficits Derm: - 2 large hotspots along ventral neck - mild lip fold pyoderma along R lower lip Problem List:1. Hotspots2. Lip fold pyoderma A: suspect hotspots have been present for a while given size - likely due to moisture and contact from collar. Likely responsible for most of discharge noted on linens, although lip fold pyoderma has likely contributed to a lesser degree. Has always drooled a lot so advised will need to clean lip folds regularly with warm water.P: prednisolone 20mg SID tapering, amoxyclav 500mg BID 14 days. RV at end of course to confirm resolution, earlier if any concerns    Vital Signs