s******t
发帖数: 579 | 1 (The patient was admitted because of MDD secondary to her debilitating LLE weakness, numbness and tightness. I'd like to focus on her neurological symptoms.)
CC:
A 72 y/o white F complains of LLE weakness, numbness and tightness.
HPI:
Pt was diagnosed lumbar spondylosis, lumbar spinal stenosis, low back pain and lumbar radiculopathy 2 yrs ago. Had a lumbar fusion 1 yr ago. Started to recover at the beginning, but had worsening of weakness and eventually required a hardware removal 6 months ago. ... 阅读全帖 |
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A*******s
发帖数: 9638 | 2 A 49 yrs old male presented with loss of taste and smell. It happened
about 3-6 months ago and he could not specify which function he has lost
first. He denies any other symptoms.
PMH/SH/FMH/ROS are all unremarkable.
PEs are normal except ageusia and anosmia.
His MRI of Brain is normal.
ENT consult is pending.
What does he mostly like have? |
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b******a
发帖数: 704 | 3 "PMH/SH/FMH/ROS are all unremarkable.
PEs are normal except ageusia and anosmia.
His MRI of Brain is normal. "
Normal PE & history ruled out inflammation in sinus nasal & oral cavity/nasal
polyps, surgery or trauma, drug induced toxicity, Alzhermer dz, Pakingson's
dz.
Normal MRI may rule out brain tumor, MS, brain injury.
Patient has both ageusia and anosmia ruled out thalamus defect?
He is too young for a normal aging.
How about endocrine diseases such as diabetes (should have other sympteoms)... 阅读全帖 |
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m********4
发帖数: 607 | 4 40 yo-middle age, no much PMH
one year - chronic
Lose weight 40 LBs - r/o malignancy.
Crave salty food, thirsty, plus hypokalemia and hypochloreima metabolic
alkalosis- check renal and adrenal by image study and lab tests. If normal-
next to image brain and lung.
Some basic lab tests, such as CBC, BMP, LFTs, UA, Stool, are also needed.
Then, regards these result, go further and do more complex study tests.
was |
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A*******s
发帖数: 9638 | 5 PMH: DM, type 2.
Social: No Smoking/ETOH/Drug abuse.
FMH: No history of movement disorder.
ROS：Not remarkable.
PE: VSS: Normal
Except chorea movement and areflexia, all other exams are normal. |
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A*******s
发帖数: 9638 | 6 A real case to share:
A 67 yrs old female, with a history of HTN, presented with syncope. She
complained of a sudden onset of vertigo then LOC for 1 min. She was very
confused at the admission.
PMH: HTN.
SH: No smoking/ETOH
FMH: HTN
ROS: not remarkable except mild confusion.
PE: VSS stable. BP: 140/80 bilaterally per record.
OA x 2 and CVS:irregularly irregular. Other exams were not remarkable.
CNC/CMP/PT/PTT: nl
Cardiac enzyme: neg
EKG showed A-Fib （new onset).
A CT of brain was neg.
Carotid ... 阅读全帖 |
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A*******s
发帖数: 9638 | 7 A real case to share:
A 67 yrs old female, with a history of HTN, presented with syncope. She
complained of a sudden onset of vertigo then LOC for 1 min. She was very
confused at the admission.
PMH: HTN.
SH: No smoking/ETOH
FMH: HTN
ROS: not remarkable except mild confusion.
PE: VSS stable. BP: 140/80 bilaterally per record.
OA x 2 and CVS:irregularly irregular. Other exams were not remarkable.
CNC/CMP/PT/PTT: nl
Cardiac enzyme: neg
EKG showed A-Fib （new onset).
A CT of brain was neg.
Carotid ... 阅读全帖 |
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A*******s
发帖数: 9638 | 8 响应futurehw提议， 从今天开始， 我们向大家征集平时常见的病例，所有医学科目（包括牙医学和护理学）都欢迎参加， 包括麻醉，病理。 要求： 1. Presentation； 2. Pictures。 总奖金为3000， 其中10名参与奖， 200 wb/each， 2名优秀奖， 500 wb/each， 活动到5月底结束， 或者完成12篇文章。 欢迎大家积极参加，对有价值的评论， 我们也会给予奖励。
我先开个头：
A 87 yrs old AAM presented with 1 month history of left leg pain. His
symptoms started one day after he had his prostate biopsy. It was located in his left groin area then spread to his left medial aspect of thigh. It was so painful and he had to see his doctors for the pain. It was ... 阅读全帖 |
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R*******t
发帖数: 367 | 9 来自主题: Medicalpractice版 - 两个病例 第一个
31yo cf who is s/p bilateral reduction mammoplasty POD #19 presents to
breast clinic for bilateral fullness and tenderness more on the right than
the left, which started three days ago and has been progressively more
intense. She admits some tenderness to the touch diffusely over the right
breast, but can not pinpoint focal pain. She states the discomfort is worse
than freshly post-op. There is some drainage from the left breast incision
from the incomplete healing of the incisions.
She is c... 阅读全帖 |
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d**o
发帖数: 618 | 10 Per HIPPA, some details are modified.
CC: MX is a 43yo female visiting a PCP for diabetes mellitus diagnosis.
HPI: Pt was checked at the PCP office annually. Last year she requested a test of HbA1c; result was 5.5. Pt has been measuring glucose by herself at home using OTC glucose meter, and reports orally that her glucose has been all over the range (60 to 400). Per her request, she had HbA1c and glucose tolerance tests before today's visit. Pt complains of debilitating fatigue and hand numbnes... 阅读全帖 |
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A*******s
发帖数: 9638 | 11 Just saw a patient who is 20 yrs old. He has a spinal bifida but has to do
cath since age 16 after he had a surgery for a tethered spinal cord. He came
to see me for other medical problems. Since I saw his PMH, I mentioned Dr.
Xiao's procedure.
We watched the youtube togather and he got very excited. He is pretty
healthy otherwise. |
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f*********1
发帖数: 189 | 12 An old patient with PMH of laryngeal cancer, now presents with left upper
quadrant pain. What differential diagnosis is on your list?
A lot of Pictures are going to come back later. |
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s******v
发帖数: 477 | 13 We have an unresolved "疑难病例"( note exactly my patient, but I read the
whole chart)
Middle age female inmate transferred to our facility for chronic respiratory
failure. Patient first was intubated, now on trach-collar.
Patient is conscious, answers yes/no by opening mouth but no voice. I assume
her sensation is intact because she did complain pain in her legs. She has
signs of brain stem lesion: moves upper limbs, but not lower limbs, she also
has internuclear ophthalmoplegia. However, MRI twice... 阅读全帖 |
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s******v
发帖数: 477 | 14 We have one unresolved "疑难病例"( note exactly my patient, but I read the
whole chart). Middle age female inmate transferred to our facility for
chronic respiratory failure. Patient first was intubated, now on trach-
collar. Patient is conscious, answers yes/no by opening mouth but no voice.
I assume her sensation is intact because she did complain pain in her legs.
She has signs of brain stem lesion: moves upper limbs, but not lower limbs,
she also has internuclear ophthalmoplegia. However, MRI tw... 阅读全帖 |
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e****0
发帖数: 678 | 15 就是上个RESIDENT 没做啊！半年前他只查了尿检，没ORDER 培养啊。尿检阴性。
也怪我。。。。。。， 觉得就是一个简单直接的CASE，轻视了。
这病人还是我建议查尿检的， 因为病人的PMH情况， 没办法怀疑UTI。
总之是我的错啊。 |
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c***y
发帖数: 811 | 16 第三周，换了一个attending,他的病人剧多，脾气比较急，要求也严格。
第一天就有21个follow up的，还有4个new consults。
很多都是80s,90s多大爷大妈，并发症和药都一大堆，交流也不能利索，
费9牛2虎的劲抄完vitals和labs，已经头晕脑胀。
实在没时间在attending查房前看完所有病人，等他来的时候，被问得
张口结舌，偷瞄了一下他的脸色，都不敢看第二眼。
没时间参加noon lecture,也没时间吃午饭，半下午，还饿着肚子，被
chief resident叫去问感觉怎么样？我很强做镇静地答还行，稍微忙点。
其实，真想告诉他是剧忙，连想上吊的时间都没了。
等attending离开后，找来所有的chart,开始一个一个病人的review，
给每个病人做了单独的template，把重要的PMH和CV相关的检查，包括啥
时候做的echo,,stress test,cathe,cardiac enzymes的变化过程，
有没ICD,home meds,current meds，为啥用这些药。。。
虽然搞到后半夜，不过，还真有帮助。
第二天，所有的老病人... 阅读全帖 |
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b*****l
发帖数: 8603 | 17 Endo--
A 57-year-old female with a past medical history (PMH) of hypertension (HTN)
and depression was admitted for mental status change and fever for 1 week.
On admission, she was diagnosed with multilobar pneumonia and antibiotic
treatment with azithromycin and Zosyn (piperacillin and tazobactam injection
) was started. Blood cultures showed gram positive cocci in clusters and
vancomycin was added. LP was negative for meningitis.
Home medications
Toprol XL (metoprolol succinate), Neurontin (ga... 阅读全帖 |
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A*******s
发帖数: 9638 | 18 A 67 years old female with only history of DM presented with one day history
of involuntary movement in her left arm. She could not control her left
hand due to intermittent jerking. There were no other symptoms associated
with the jerking. Her PCP called me so she was brought in right away for
assessment.
PMH: DM only, last glucose a week ago was 120.
SH: No smoking/ETOH/drugs
FMH: DM
ROS: unremarkable.
PE: VSS normal.
Except left hand myoclonus, and mild ataxia, all others were wnl.
Labs/imag... 阅读全帖 |
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A*******s
发帖数: 9638 | 19 A 67 years old female with only history of DM presented with one day history
of involuntary movement in her left arm. She could not control her left
hand due to intermittent jerking. There were no other symptoms associated
with the jerking. Her PCP called me so she was brought in right away for
assessment.
PMH: DM only, last glucose a week ago was 120.
SH: No smoking/ETOH/drugs
FMH: DM
ROS: unremarkable.
PE: VSS normal.
Except left hand myoclonus, and mild ataxia, all others were wnl.
Labs/imag... 阅读全帖 |
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N****a
发帖数: 100 | 20 我的一个病人，女性，40+，没有PMH，psych hx with chronic paranoid
schizophrenia，stabilized with Clozapine 200mg daily 已经快半年了。最近出现
了双下肢pitting edema。 我有点担心是不是Clozapine造成了cardiomyopathy，一个
其不常见的药物副作用。我先让病人去看她的PCP。结果PCP給她Lasix 20mg daily，
EKG 未见异常。我給PCP打电话，问问他的意见，到底是何种原因造成了水肿。这个PCP
说，肯定不是心脏的原因，应该是下肢静脉thrombosis等堵塞原因引起。我问他那为何
双下肢都有，为什么你用Lasix，为什么不马上做sonogram做诊断。此PCP说他会留下
sonogram的order，让病人第二天去拿，他第二天要去休假。现在病人的双下肢pitting
edema已经明显减轻，after 服用Lasix一周多。
想问问Garland, Benpu 和各位前辈，下一步最好怎么做？ |
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B******f
发帖数: 2489 | 21 见到这个case很久了，一直想post上来分享，觉得A＋＋和小粉可能会喜欢，嘿嘿
20+ yo F
HPI: multiple episodes of altered mental status (AMS), shortness of breath,
slowed speech since 8 months ago. An episode can last days, and she returns
to base line function between episodes. During the periods of AMS, patient
was unable to care for herself, and the mother had to dress and feed her.
PMH: she had multiple hospital admissions to outside Hospital for similar
complaint, however, work up has been negative
Head CT: Normal
Brain MRI: No... 阅读全帖 |
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