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Case Presentation in Medicine

Transcript: Key Takeaways from the Case Presentation This case illustrates the critical role of comprehensive patient history and detailed clinical assessments in the diagnostic process. Effective communication and attentive observation are essential in identifying underlying issues and tailoring appropriate treatment plans, ultimately improving patient outcomes. Introduction to the Patient This case involves a 20-year-old male mechanic from Baldia Town who has been admitted for evaluation and treatment. His age, profession, and background provide important context for understanding his health condition. Prolonged Fever Complications The prolonged fever presented significant diagnostic challenges, necessitating a comprehensive approach to rule out various infectious and non-infectious causes. Respiratory Assessment Necessity Discussion The presence of cough alongside fever indicated a need for respiratory assessment, which complicated the diagnostic process and required careful evaluation of potential conditions such as pneumonia or bronchitis. Case Presentation in Medicine Importance of Comprehensive History Lessons learned from this case emphasize the importance of a detailed patient history and timely diagnostic testing to guide effective treatment plans and improve patient outcomes. An overview of effectively presenting medical cases for better understanding and learning Follow-Up Plan Treatment Outcome The follow-up plan includes regular check-ups after discharge to monitor the patient's progress, ensuring that any complications are promptly addressed. These appointments will focus on assessing recovery, managing any residual symptoms, and reinforcing health education to prevent future issues. The treatment outcome showed significant improvement in the patient's overall condition, aligning closely with our initial expectations. The fever subsided within a few days of implementing the treatment plan, and the cough gradually resolved, indicating a positive response to the interventions. Treatment Plan Antibiotic Therapy Medication for Fever Supportive Care Antibiotics will be prescribed if a bacterial infection is suspected based on diagnostic results. Antipyretics will be administered to manage the high-grade fever and alleviate discomfort experienced by the patient. Supportive care will include hydration and nutritional support to aid recovery and enhance overall health. Prolonged High-Grade Fever The patient has experienced a high-grade fever that has persisted for 25 days. This fever is continuous, undocumented, and has episodes of rigor and chills accompanying it. Patient History Overview Persistent Cough In addition to the fever, the patient has been suffering from a cough that has lasted for 10 days, indicating a possible respiratory involvement in his condition. Timeline of Diagnostic Tests Progression of tests conducted to determine the cause of the patient's symptoms Day 10 Day 15 Day 1 Further tests, such as a CT scan and cultures, were ordered to identify any infections or abnormalities. Final diagnostic tests, including specific serological tests, were completed to confirm the diagnosis. Initial blood tests were performed to check for infections and inflammatory markers. Day 5 Imaging studies, including a chest X-ray, were conducted to assess for any pulmonary issues. Clinical Findings Upon examination, all clinical findings were normal, showing no immediate abnormalities that could account for the patient's prolonged fever and cough.

Functional Medicine Case Presentation

Transcript: Functional Medicine Case Presentation Organ Systems Interaction The interconnectedness of organ systems within the body impacts overall health and well-being. Evaluating the function and interaction of various systems helps in identifying underlying health issues and developing targeted interventions for optimal health outcomes. The GO TO IT Model The GO TO IT Model in Functional Medicine serves as a structured framework for evaluating and treating patients. It encompasses various aspects including genetics, environment, lifestyle, and more to provide a comprehensive and personalized approach to healthcare. Genetics: Key Factor in Health Utilizing the GO TO IT Model Genetic predispositions play a crucial role in determining an individual's susceptibility to certain diseases and conditions. Understanding genetic profiles enables tailored treatment plans and personalized healthcare strategies. Understanding the GO TO IT Framework The GO TO IT Model stands for Genetics, Organ systems, Toxins, Optimizers, Inflammatory contributors, and Targeted treatments. This framework allows healthcare practitioners to systematically assess and address the key factors influencing an individual's health and wellness. Integrative Therapies and Interventions Combining various integrative therapies and interventions, such as acupuncture, herbal medicine, and mindfulness practices, can enhance the holistic approach to patient care in Functional Medicine. Integrative modalities address the physical, emotional, and mental aspects of health for comprehensive wellness outcomes. Follow-Up and Monitoring Process Outcomes and Future Directions Establishing a structured follow-up and monitoring process allows healthcare providers to track the progress of treatment plans, make necessary adjustments, and ensure patient compliance. Regular follow-ups help in evaluating the effectiveness of interventions and maintaining patient engagement for sustained health improvements. Tailoring Treatment to Individual Needs Evaluating patient response, progress, and long-term health management strategies are crucial aspects of Functional Medicine practice. By assessing outcomes and planning future directions, healthcare providers can continuously improve patient care and enhance overall well-being. Patient Response and Progress Personalizing treatment approaches in Functional Medicine involves considering the patient's genetic predispositions, lifestyle factors, and environmental influences. By addressing specific health needs and optimizing wellness strategies, healthcare providers can enhance the effectiveness of interventions and promote long-term health benefits. Treatment Plan and Implementation Monitoring and analyzing the patient's response to treatment interventions help in determining the effectiveness of the approach. Assessing progress towards health goals enables healthcare providers to make informed decisions, adjust treatment strategies, and ensure optimal outcomes for the patient. Long-Term Health Management Strategies Developing a tailored treatment plan based on the individual's unique health profile and needs is essential in Functional Medicine. Implementing integrative therapies, lifestyle modifications, and targeted interventions ensure a comprehensive approach to improving patient outcomes and overall well-being. Developing sustainable health management strategies involves creating personalized plans that focus on preventive care, lifestyle modifications, and ongoing support. By emphasizing long-term wellness maintenance, healthcare practitioners empower patients to take control of their health and prevent future health issues. Symptom Analysis using GO TO IT Model Diagnostic Approach Importance of Individualized Treatment Applying the GO TO IT framework allows for a systematic evaluation of the patient's symptoms from a multifaceted perspective. By considering genetic, environmental, and lifestyle factors, healthcare providers can determine the root causes of symptoms and develop personalized treatment plans. Case Study Presentation Utilizing advanced diagnostic tools and tests, healthcare professionals can pinpoint specific health markers and abnormalities to aid in accurate diagnosis and treatment planning. The diagnostic approach in Functional Medicine focuses on identifying underlying imbalances and dysfunctions to create targeted interventions for optimal patient outcomes. Individualized treatment in Functional Medicine ensures that interventions are personalized to meet the specific needs of each patient, considering factors like genetics, lifestyle, and environment. This personalized approach leads to more targeted and successful health outcomes. Patient Background and History Presenting a comprehensive case study allows for a practical application of the GO TO IT model in a real-life context. Analyzing patient background, symptoms, diagnostic approaches, and treatment strategies showcases the effectiveness of Functional

Oral medicine Case presentation

Transcript: personal data 0856200 Family History Refrences Radiographic Findings The 3 children with documented donor osteoblast engraftment had a median 7.5-cm increase in body length (range, 6.5-8.0 cm) 6 months after transplantation compared with 1.25 cm (range, 1.0-1.5 cm) for age-matched control patients. These patients gained 21.0 to 65.3 g total body bone mineral content by 3 months after treatment or 45% to 77% of their baseline values. With extended follow-up, the patients' growth rates either slowed or reached a plateau phase. Bone mineral content continued to increase at a rate similar to that for weight-matched healthy children, even as growth rates declined. These results suggest that BMT from HLA-compatible donors may benefit children with severe OI. Further studies are needed to determine the full potential of this strategy Need Oral Radiographe for further investigation on the Maxilla and Mandible ( osteopenea) Genatic counseling Give Oral Hygiene and balanced diet instructions Follow up Clinical responses to bone marrow transplantation in children with severe osteogenesis imperfecta 3 Years Old Dental History Treatment Bisphosphonates Low impact exercises such as swimming In more severe cases, surgery to place metal rods into the long bones ADEL RADWAN Male Atrophic red area on the dorsal surface of the tongue surrounded by an elevated whitish border Regular Check up Extra-Oral Examenation Preclinical models have shown that transplantation of marrow mesenchymal cells has the potential to correct inherited disorders of bone, cartilage, and muscle. The report describes clinical responses of the first children to undergo allogeneic bone marrow transplantation (BMT) for severe osteogenesis imperfecta (OI), a genetic disorder characterized by defective type I collagen, osteopenia, bone fragility, severe bony deformities, and growth retardation. Five children with severe OI were enrolled in a study of BMT from human leukocyte antigen (HLA)–compatible sibling donors. Linear growth, bone mineralization, and fracture rate were taken as measures of treatment response. The 3 children with documented donor osteoblast engraftment had a median 7.5-cm increase in body length (range, 6.5-8.0 cm) 6 months after transplantation compared with 1.25 cm (range, 1.0-1.5 cm) for age-matched control patients. These patients gained 21.0 to 65.3 g total body bone mineral content by 3 months after treatment or 45% to 77% of their baseline values. With extended follow-up, the patients' growth rates either slowed or reached a plateau phase. Bone mineral content continued to increase at a rate similar to that for weight-matched healthy children, even as growth rates declined. These results suggest that BMT from HLA-compatible donors may benefit children with severe OI. Further studies are needed to determine the full potential of this strategy. Osteogenesis Imperfecta diagnosed at 6 weeks of age Bronchopneumonia Multiple Bone Fractures Bisphosphanate Treatment Ca injections every 6 months Medical History Geographic Tongue The classic symptoms include: •Blue tint to the whites of their eyes (blue sclera) •Multiple bone fractures •Early hearing loss (deafness) Because type I collagen is also found in ligaments, persons with OI often have loose joints (hypermobility) and flat feet. Some types of OI also lead to the development of poor teeth. Symptoms Large Head Bilateral Flexed extremities Short Bilateral Humerus THANK YOU Provisional Diagnosis The 3 children with documented donor osteoblast engraftment had a median 7.5-cm increase in body length (range, 6.5-8.0 cm) 6 months after transplantation compared with 1.25 cm (range, 1.0-1.5 cm) for age-matched control patients. These patients gained 21.0 to 65.3 g total body bone mineral content by 3 months after treatment or 45% to 77% of their baseline values. With extended follow-up, the patients' growth rates either slowed or reached a plateau phase. Bone mineral content continued to increase at a rate similar to that for weight-matched healthy children, even as growth rates declined. These results suggest that BMT from HLA-compatible donors may benefit children with severe OI. Further studies are needed to determine the full potential of this strategy Chief Complaint Insignificant Description of the Lesion Oral Medicine Case Presentation Intra-Oral Examination sister - Died at 6 months of age (OI) 10y brother - OI and Blue sclera Osteogenesis imperfecta (OI) is a congenital disease, meaning it is present at birth. It is frequently caused by defect in the gene that produces type 1 collagen, an important building block of bone. There are many different defects that can affect this gene. The severity of OI depends on the specific gene defect. OI is an autosomal dominant disease. That means if you have one copy of the gene, you will have the disease. Most cases of OI are inherited from a parent, although some cases are the result of new genetic mutations. A person with OI has a 50% chance of

Internal Medicine Case Presentation

Transcript: ~8weeks prior to admission ER visit diagnosed with pneumonia and treated with a 5 day course of levaquin and prednisone CT of her chest showed ill defined bilateral patchy densities in the lungs and mild bronchiectasis. ~6wks prior to admission visited PCP and seemed to be improving. ~4wks prior to admission ER visit again for worsening dyspnea, xray remained unchanged, started on a 14 day course of prednisone and levaquin and again began to improve. 2 days prior to admission PCP Visit with worsening fatigue and dyspnea started on levaquin and prendnisone a 3rd time Xray showed Bilateral infiltrates in the mid and lower lung fields but, a comparison was not made between prior studies. Day of admit - PCP visit with further worsening of fatigue and dyspnea O2 sat mid 80's on RA so..... 1. Macrobid 100 MG Capsule 1 capsule qhs x 5yrs 2.Vitamin E 400 intl units CAP 1 cap(s) PO once a day 3.CoQ-10 100 MG Capsule 2 capsule with a meal Once a day 4.Aspir-81 81 MG Tablet Delayed Release 2 tablets Once a day 5.Potassium Chloride 10 MEQ Tablet ER 1 tablet 4 times a day 6.Levothyroxine Sodium 100 MCG 1 tablet Once a day 7.Toprol XL 25 MG ERT 1 tab Once a day, 8.Norvasc 5 MG TAB 1 tab Once a day, 9.Lisinopril 40 MG TAB 1 tab Once a day, 10.Oxybutynin Chloride 5 MG 1 tablet Once a day before breakfast/ takes when Vesicare doesn't work (currently taking instead of Vesicare) 11.Levaquin 500 MG Tablet 1 tablet Once a day for last 2 days General: Denied fevers. Skin: Denied lesions, rashes other than those noted in HPI. HEENT: Denied changes in vision nasal congestion, ear pain. Cardio: Denied Chest pain. Pulm: per HPI GI: Denied Nausea, vomiting or diarrhea GU: Denied Dysuria, hematuria. Musculoskeletal: Denied pain in extremities. Iatrogenic Colitis Mnemonic for Crohns Dz for Boards GIFTS for Crohns Dz Granulomas Ileum (most common location) Fistulas/ Fissures Transmural layers (all affected) Skip lesions Common Antibiotics Causing C. difficile Colitis: Father- Cerebral Aneurysm D 60’s Mother CVA D 81, Brother MI 58 Sister DM2 Pathophysiology of Ischemic Colitis Assessment: Clinical Sx: chronic watery, non-bloody diarrhea with nml colonoscopy results Etiology: contaminated water/ food caused by unwashed hands or soiled hands reaching the mouth Lives at home with family. Lifelong nonsmoker Denied drugs or alcohol use. No recent travel or exposure to asbestos or other irritating chemicals during her lifetime(is a retired secretary). Labs: increased lactate, LDH, CPK indicates tissue damage in colon, WBC above 20,000 + metabolic acidosis + GI Sx Imaging: 1st test- CT with contrast Definite dx- colonoscopy is required to dx ischemic colitis Ulcerative Colitis vs. Crohns disease Clinical Sx: GI Sx, Colitis, malnutrition, rectal prolapse, reactive arthritis, CNS, may also cause HUS-Hemolytic Uremic Syndrome (via Shiga-toxin similar to E.coli 0157:H7) SocialHx STUDY: more than 1000 patients with ischemic colitis demonstrated that Left Colon was involved in more than 75% of patients, with majority of lesions affecting the Splenic Flexure. Rectum was involved in only 5% of patients, which can be explained because of collateralization of IMA with systemic circulation through other vessels Gram negative, rod-shaped Retrospective study: 313 patients with ischemic colitis- patients with Left colon ischemic colitis less likely to require surgery & had a shorter length of stay than any other pattern of ischemic colitis. Allergies/Sensitivities Fidaxomicin- Macrolide, bactericidal (vs. Vanc/ Metro are bacteriostatic), approved in 2011 Study: Phase 3 randomized trial 629 patients with C. difficle colitis, clinical cure rates with Fidaxomicin 200 PO bid vs. Vancomycin 125 PO qid were similar but less recurrence with Fidaxomicin Shigella dysenteriae colitis Treatment: IVF and ususally conservative therapy Abx decreases duration of Sx by ~2days 1. Levofloxacin 500 mg PO qd X 3 days or 2. Ciprofloxacin 500 mg PO bid X 3 days or 3. Azithromycin 500 mg PO qd X 3 days or 4. Ceftriaxone IV 1gm 1d X 5 days Fidaxomicin versus vancomycin for Clostridium difficile infection. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, Gorbach S, Sears P, Shue YK, OPT-80-003 Clinical Study GroupSON Engl J Med. 2011;364(5):422. Final Diagnosis: Hypersensitivity Pneumonitis/pulmonary toxicity from nitrofurantonin or other unknown source vs mixed connective tissue disorder Vitals: BP 140/90, P105, R 26, T36.6, 96% on 6L via Nasal cannula. General: Alert and oriented x3, no acute distress. Skin: Pale petechiae over bilateral lower extremities and back, barely noticeable. No other rashes or worrisome lesions Eyes: Pupils equal round and reactive to light. Extraocular muscles intact. Sclera non-icteric HENT: atraumatic, normocephalic, mucosa moist and pink. Neck: No JVD, No palpable lymph nodes. Cardiovascular: Normal rhythm slightly tachycardic. No murmurs,rubs or gallops. Pulmonary: Normal respiratory effort, not using accessory muscles. Mildy tachepnic

medicine case presentation

Transcript: personal data Chief complaint Past Medical History extra oral examination normal Skin : Eye : Ear : Nose : TMJ : Intra Oral Examination Labial mucosa ventral surface of the tongue Floor of the Mouth Description of the lesion Long standing , Soft , elevated , rounded , yellowish lesion of 1-2 cm in diameter on the lingual frenum ; and non tender and move around with very little finger pressure Differential diagnosis Mucocele Ranula Dermoid cyst lipoma Salivary gland tumor Diagnosis lipoma treatment plan No treatment is usually necessary for a lipoma. However, if the lipoma is in a location that bothers you, is painful or is growing, might recommend that it be removed. Lipoma treatments include: Surgical removal Steroid injections Liposuction This treatment uses a needle and a large syringe to remove the fatty lump. lipoma slowly enlarging, soft, smooth-surfaced mass of the submucosal tissues when superficial there is a yellow surface discoloration When well-encapsulated tumors freely movable beneath the mucosa Usually found in the buccal mucosa And rare in the floor of mouth Oral Medicine Case Presentation female fatima ahmed mohamed samy mohamed shuweil mohamed hamdy mohamed tantawy presented by Dilated lingual veins in the ventral surface of the tongue Most lipomas are removed surgically 55 married _ve What is lipoma ?? benign mesenchymal ,slowly growing , neoplasm composed of mature Adipocytes usually surrounded by a thin capsule They are the most common soft tissue tumors and about 20% of the cases occur in the head and neck region However only 1% to 4% of cases involve the oral cavity Oral lipoma represents 0.5% to 5% of all benign oral cavity neoplasms and lesions involving the floor of the mouth are quite rare . 55 years old female patient was coming for making a removable partial denture and during the routine extra oral and intra oral examination we have found this lesion . marital status Past Dental History buccal mucosa but doesn't completely eliminate the tumor. by cutting them out adress . name abo soliman normal History of Multiple teeth Extraction due to Caries and Pain . Recurrences after removal are uncommon . This treatment shrinks the lipoma Age : Sex :

Integrative Medicine Case Presentation

Transcript: NutriEval Beaumont Labs Fermenatble Oligosaccharides, Disaccharides, Monosaccharides, and Polyols "65y.o. female is in for a follow up for digestion. She has lost weight and feels wonderful Ben, her son, has had anxiety and it has been better, so her her stress is better. This is the first time that her gut has been balanced in her life.Overall she feels good." Plan: Go to PCP for HRT Continue to increase Yoga or other forms of exercise- In the future we will assess mercury level if sleep is not 100% and you are not feeling 100% Follow up in 4-6 months for the Nutra Eval and we can go over results Fatigue Medications: Align brand probiotic Calm brand magnesium supplement Citrucel fiber supplement Sleep: Hx of Sleep apnea initiates sleep, but difficulty with maintenance. wakes often. reports palpitations, joint pains. Diet: All Organic, all home-made, includes ample spinach and berries, supplements with protein powder Our Patient Differential for GI Bleed/Abdominal Pain Colon Cancer Diverticulitis Ischemic Bowel Inflammatory Bowel Crohn's Colitis Dysbiosis Food Allergy Hemorrhoids, Anal Fissure Synthesized in sunlight and available in few foods common deficiency Decreased with Statins, NSAIDs Joint Pain Vitamin D GI Upset, Constipation Updates: Family History Mother: OA, HTN, CAD, Schizophrenia Father: OA, HTN, ETOH abuse, DM2, CAD s/p PCI & CABG. Sister: RA Sister: Glaucoma Brother: OA No known family Hx of Colon, Prostate, ovarian, or breast Cancer. DLD, CVA, enhances absorption of Calcium, Iron, Magnesium, Phosphate, Zinc Hormonal Properties in calcium homeostasis and metabolism Antioxidant Supports Mood Beaumont Labs Follow Up on Labs Visit 4 PTH: 35 pg/mL [9-69] Calcium: 9.5 [8.5-10.5] We begin with lifestyle and dietary modification (eg, exclusion of gas-producing foods; a diet low in fermentable oligo-, di-, and monosaccharides and polyols [FODMAPs]; and in select cases, lactose and gluten avoidance) Integrative Medicine Case Presentation moving, son w/ rehab, relationship w/ husband strained Vitamin D Deficiency Sleep having palpitations laying supine sleep study showed central sleep apnea C-pap does not work Still waking through the night Digestive System improved greatly "better than it has ever been her entire life" Stress much better, has decided to sell house and move to a much smaller house Elimination Diet Eliminate Dairy, Gluten, Sugar 1 month, add each independently 3 days apart Labs NutraEval CBC, CMP Relaxation Work on Letting go of control Couples retreat exercise 3x/week Supplements Adren-All 2 QAM Adren-Vive2 QPM Follow up on Sleep, inflammation, blood work, digestion, diet, supplements, afternoon fatigue Plan: Non-Celiac Gluten Sensitivity Participants were randomly assigned to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week 66 y/o Female with PMH AVNRT s/p ablation 2001, sleep apnea, presents with complaint of rectal bleed, joint pain, fatigue, stress, sleep problems. She reports constipation relieved with Miralax, worsening with stress. Denies bloating or flatulence. Hx benign colon polyps. Last scoped 2009 Reports episodes of abdominal pain and bleeding, 3-4x/yr, pain relieved with defecation. Pt concerned about ischemic bowel disease. FODMAPS Visit 3 OA,HTN,DM2, CAD, Galactosemia UpToDate Visit 2 Craig Erbach, OMS-IV Dairy: got constipated No issue with gluten Sugar makes inflammation worse Energy: better after lunch feeling better overall Evidence in Mouse Models Gut-Brain Connection Ectopic Pregnancy Lifestyle Anger and Emotion management consider returning to work consider having fillings removed Increase weight bearing exercise Supplements 5000 IU Vitamin D3 Osteoben TID AdrenAll2 QAM Adrenvivie2 QPM Probiotic to Lactoprime QD Multi: with high B content with trace minerals Metabolic Synergy TID INcrease Magnesium to 2 tsp per day sleep disturbance, apnea Plan: Summary

Case Presentation- DME Medicine

Transcript: 81 year old female PC: dizziness followed by Collapse 11 days ago Whilst sitting, initially light headed followed by vertigo Sudden onset Hot and sweating No nausea or vomiting, headaches, chest pain, difficulty breathing On standing patient saw black and slumpped back into chair Whitnessed by neighbour and son - patient looked grey Staring ahead but unresponsive for 30 minutes No incontinence, seizures, tongue biting After event, the patient had no recollection of event No confusion Episodes of vertigo becoming more frequent FH: Mother died at 60- heart attack Father died at 83- gastric cancer SH: None smoker Whisky 3 units a day=21 week OBS Pulse:72 RR:16 Temp:36.1 BP: 94/40 GCS:15 O2 sat: 100% Alert- frequent episodes of vertigo during examination Slight tremor in R hand Neurological exam: -Pronator drift: normal -Tone + clonus: normal in both sides -Power: 5/5 -Reflexes: UL and LL both ellicited -Coordination: tremor on finger nose -Sensation: normal on both sides UL and LL Cranial nerves: I-XII normal- No nystagmus, no double vision no ataxia. CV: Nothing of note, HS I-II-0, no murmurs GI: Mass felt R Side PMH Blood ++ Protein + Nitrites + Leukocytes +++ (cc) photo by Metro Centric on Flickr Urinary infection Medication More info on head lump: CT showed: Broad base attachment to meningies No associated brain odema No midline shift or signs of hydrocephalus Meningioma right frontal lobe, 3.3x3.4cm syncope secondary to GI bleed Budapest San Francisco FBC 7.5 Urea 14.0 Cr 200 ALT 23 Examination Stockholm DME Case Presentation (cc) photo by jimmyharris on Flickr Plan 75mg OD (cc) photo by Franco Folini on Flickr ROS -Black stools 1 week ago (no abdo pain, hameatemisis) Double click to crop it if necessary Meningioma ?? urine dipstick Clopidogrel 8 mg OD 80mg OD 500mg OD 40 mg OD 5 mg OD 15 mg OD 100mg OD 250mg OD Current cellulitis Prior 2 weeks lump (referral) -Paroxysmal palpatations -CKD -Essential hypertension -Angina History Investigations Worsening renal function secondary to poor oral intake Bloods 5+7= (cc) image by anemoneprojectors on Flickr Place your own picture behind this frame! (cc) photo by Metro Centric on Flickr Transfuse Hb aim for 10 Iv fluids 8 hourly gaps Stop temporary frusemide, losartan Strict fluid balance chart U/S kidneys OGD (stop clopidogrel until then) CT abdomen Brain MRI Dose Important Details Surgical history Left mastectomy 16 years ago for breast Ca hysterectomy 9 years NKDA Doxazosin Furosemide Methyldopa Atorvastatin Amlodopine Mirtazapine Losartan Cefalexin Flucloxacillin and amoxocillin Differentials

Internal Medicine Case Presentation

Transcript: Review of Systems WBC: 18.4 RBC: 5.08 HGB: 13.4 HCT: 42.4 MCV: 83.5 MCH: 26.5 PLT: 353 NEUT: 83 LYMPH: 9 MONO: 8 swelling worse returns to UPH CT scan performed sinusitis orbital/periorbital cellulitis transferred to ASEM Surgeries Blood transfusions Accidents 2 weeks prior to admission: Sodium: 137 Potassium: 4.0 Chloride: 99 CO2: 31.2 BUN: 6 Creat: 0.8 Gluc: 124 Calcium: 9.3 Albumin: 3.4 Bronchial Asthma last exacerbation (2003) Chicken Pox (2011) Social History Childhood illnesses Diagnosis Treatment Immunizations "Se me hinchó el ojo izquierdo y no lo puedo abrir hace 3 dias" worsening headache eyelid swelling inability to open his eye taken to UPH, Toradol and Benadryl given Group I: preseptal cellulitis, and group II is orbital cellulitis. The remaining groups are all abscesses: group III is subperiosteal abscess, group IV is intraorbital abscess, and group V is cavernous sinus thrombosis (septic abscess). headaches facial tenderness dizziness returned to PCP prescribed:Amoxicillin, Mucinex, Loratidine Up to date by hx Vital Signs: T: 36.8 P: 89 R: 18 BP: 117/58 General: AAOx3, in no acute distress Head: atraumatic, normocephalic, tender to palpation in frontal area no bulges or masses, normal hair distribution. ENT: MOM, no pharyngeal exudates, clear TM Most common route of infection ethmoid sinusitis subperiosteal abscess 15-59% orbital abscess 24% vision loss cavernous sinus thrombophlebitis brain abscess CT - confirmation of clinical suspicion MRI- also helpful Venography- include when CST is suspected Complications Family History Feature Preseptal Cellulitis Orbital Cellulitis Proptosis - + Motility + +/- Pain on motion - + Orbital pain - + Vision Normal May be decreased Pupillary reaction + ± Chemosis Rare Common Corneal sensation + May be decreased Ophthalmoscopy Normal May be abnormal Systemic signs Mild Commonly severe 19 y/o M patient with past medical hx of Bronchial Asthma and allergic to ASA presents with swelling, redness of his left upper and lower eyelids since 3 days ago Past Medical History Laboratories 1 week prior to admission: Eyes: PERRLA, EOMI.Left upper and lower eyelid swelling and erythema, no eye proptosis, exudates, erythema or hemorrhages.Mild swelling starting in right eyelids. Sinuses: Tenderness upon palpation of maxillary and frontal sinuses Nodes: Non palpable or tender 6. RESPIRATORY: + hx of BA, URI symptoms past 2 weeks. - cough, dyspnea, orthopnea, history of tuberculosis or emphysema. 7. CARDIAC: -chest pain, tightness, palpitations and exercise intolerance. 8. GI: - N/V, constipation, diarrhea, heartburn, bloody stools, abdominal pain, food intolerance, changes in bowel habits. 9. GENITOURINARY: - polyuria, nocturia, incontinence, dysuria. 10. EXTREMITIES: - pain, loss of muscle strength, loss of sensation or difficulty moving Multivitamin by Mariana Mercader Pérez MS4 Preseptal Cellulitis Orbital Cellulitis HZV/VZV infection involving eye Tumors Trauma Insect bites Graves disease Cavernous sinus thrombosis Severe conjunctivitis Vasculitis Mucormycosis/ Aspergillosis Aspirin Medications ESR: 49 CRP: 142.7 BC: negative 48h Epidemiology Day of Admission Chief Complaint Evaluated by Ophta and ENT services Admitted to IM to treat with IV Antibiotics Any questions 3 days prior to admission: 1. GENERAL: + fever. - chills, night sweats, recent weight changes, fatigue, lethargy, dizziness, changes in appetite, difficulty sleeping or rashes. 2. HEAD: +headaches. -trauma to head, lightheadness. 3. EYES: + L eye redness, swelling, discomfort, tenderness to palpation, lacrimation. -pain on L eye motion, blurry vision, photophobia and decreased perception of colors; diplopia, floaters, use of contact lenses, recent trauma, blindness, or similar symptoms in the past. 4.EAR, NOSE, THROAT: - otorrhea, tinnitus, vertigo, hearing loss, rhinorrhea, epistaxis, dysphagia, odynophagia or hoarseness. 5. NECK: - lumps, enlarged nodes, tender nodes or difficulties in ranges of motion. Mother: Asthma Hospitalizations 2011 UPH Spontaneous Pneumothorax Chest tube Chicken Pox Pneumoniae bleeding pus secretion N/V use of contact lenses sick contacts pets similar previous episodes Imaging Physical Exam Allergies 11. HEMATOLOGIC: - anemia, easy bruising or bleeding. 12. ENDOCRINE: - polydipsia, polyphagia or polyuria, no history of thyroid disorders, recent weight changes, abdominal striae, difficulty concentrating, or any other endocrine abnormalities. 13. NEURO-PSYCHIATRIC: - seizures, paralysis, loss of consciousness, gait disturbances, speech, memory deficits, hallucinations, tremors, poor balance, loss of sensation or muscle strength and sphincter dysfunction. IV Antibiotics: None Vancomycin with 1 of the following: Ceftriaxone Cefotaxime Piperacillin-tazobactam Ampicillin-sulbactam For a total of at least two to three weeks HPI Surgery: abscess > 10mm HPI Father DMII HTN OSA Spina Bifida Oculta Genitalia and Rectum: not evaluated; patient refused exam. Extremities: BL upper and lower

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