SEPTEMBER 8, 2011

George Ambrosio, M.D. First Care Medical Group 750 Valley, Brook Avenue Lyndhurst, NJ 07071 Re: Mooren Lembo DOB: Dear Dr. Ambrosio: I saw this 51-year-old female who comes to me for pulmonary evaluation complaining of exertional dyspnea. Her history states the symptoms are mostly sporadic, no relation to any activity. No associated cough. Dyspnea usually at sitting and sometimes after meal. She claims she feels something like wheezing at times. She has been having increasing weight gain with 20-pound gain over the last one year with evidence of increased excessive daytime sleepiness and loud snoring. There is no history for any prior seasonal allergy or occupational dust exposure. She is a life-long nonsmoker. Gives a history for one sibling sister with history for sleep apnea. PHYSICAL EXAMINATION: On examination, this patient is normotensive with mild obesity with a BMI of 32. Physical exam suggest for a narrow oropharynx. Chest with no significant audible wheeze or rales. DIAGNOSTIC TESTS: Pulmonary function test shows normal flow rates with no acute bronchodilator response. Post MDI treatment, there is a 4-5% change in FEV1 and FEC, which is considered not significant. I reviewed the reports sent through your office with normal hemoglobin, platelets, and electrolytes. There is evidence of mild triglyceridemia and normal thyroid function test. EKG has been reported normal sinus rhythm and a chest x-ray done through your office reports with no acute disease. IMPRESSION AND PLAN: 1. This patient with dyspnea, probably psychosomatic in nature. I could not elicit subjectively or objective evidence of any obstructive airway disease. 2. There is a ____(3.56) suspicion of underlying obstructive sleep apnea with family history of OSA. I have asked her to avoid any bronchodilators at present and consider treating her anxiety and she has plans to see psychologist and/or psychiatry. In future, she will contact my office if wants to pursue workup and treatment for her suspected obstructive sleep apnea.

I thank you again to allowing me to participate in this patients care.

Viren Desai, M.D. VD/rct