Morning Report. Thursday, April 9, 2015 Danielle Eggie
|
|
- Angelina Green
- 6 years ago
- Views:
Transcription
1 Morning Report Thursday, April 9, 2015 Danielle Eggie
2 It s finally here!
3 Chief complaint: 18 year old male with vomiting and aches
4 H: E: A: D: D: S: S: Lives in LSU dorms during school, and at home with parents when out of school, good relationship with family Freshman at LSU, plans to go to nursing school, doing well, attending classes. No extracurricular activities, no job Denies drug use, occasional alcohol use, new tattoo 1/1/15 Denies depressive symptoms +sexually active, +intermittent condom use, only female partners, 1 partner in last 6 months, no history of STDs Denies suicidal thoughts or history of past SI/SA
5 HPI: Chief complaint: vomiting and body aches 18 year old male with non-bloody, non-bilious emesis with body aches for the past 3 days. No associated abdominal pain. Also complains of a mild sore throat and mild intermittent headache for the past 4 days. ROS: no chest pain, no dyspnea, +dec appetite, +fatigue, no cough/congestion, no diarrhea
6 HPI: PMHx: DM Type I on Humalog/Humalin PSHx: None Meds: Humalog/Humalin Shots: UTD, +flu shot this year
7 What is your differential diagnosis?
8 Differential Diagnosis Infectious Acute gastroenteritis Viral (influenza, rotavirus, norovirus, adeno virus) Bacterial (Campylobacter, C.diff, E.coli, Salmonella) Parasitic (Cryptosporidium, Giardia) GI/Kidneys Cholecystitis Hepatitis Pancreatitis Kidney stones Obstruction/gastric outlet ob. Functional GI disorders IBS CNS Migraines Increased ICP tumor/infarct Pseudotumor cerebri Endo DKA Uremia Hyper/hypoparathyroidism Addison s disease Cardiac CHF Pericarditis / Endocarditis Medications NSAIDs, Aspirin, antibiotic use
9 Let s examine the patient
10 Physical Exam VS: T 100.6, HR 85, RR 20, BP 109/58, GEN: HEENT: NECK: SKIN: Pox 100% on RA, Wt 65kg, BMI 20.5 Asleep, but arousable, NAD Dry mucus membranes, slightly erythematous tonsils without exudate Supple, no palpable lymphadenopathy No rashes. Normal skin turgor.
11 Physical Exam CV: RESP: ABD: EXT: Neuro: RRR, soft murmur at left sternal border, 2+pulses in all 4 extremities, CR <3 seconds. CTA bilaterally, no increased WOB soft, thin, non-distended, non-tender with normoactive bowel sounds, no rebound, no guarding, no HSM warm and well perfused, no cyanosis or edema, PIV to LUE no focal deficits on exam
12 What would you like to order?
13 LABS VBG: 7.34 / 44 / 28 / 23.7 / < 212 Ca 8.4 AST 41 / ALT HbA1C: 8.3% UA: (-)LE/nit, (-)protein, (-)blood, 3+ ketones, 5-10 wbc
14 LABS S36 B47 L9 M5 E3 CRP: 0.4 (0-1) Amylase: 58 (25-180) Lipase: 357 (48-176) Bcx: pending Ucx: pending RVP: (-) Strep: (-) Rapid flu: (-)
15 What is your assessment at this point? 18 y/o male with DMT1 here with fever, dehydration secondary to emesis, and hyperglycemia without acidosis
16 Are you going to admit this patient?
17 Management: Dehydration NS Bolus, then 1.5 MIVF until PO improved Emesis Resolved upon admission. Likely secondary to AGE. Hyperglycemia Resumed home insulin regimen. New onset murmur Cardiology consulted. Echo and EKG normal.
18 Management: Bandemia Repeated CBC Elevated Lipase S48 B19 L29 M4 Discussed with GI. Not due to pancreatitis. Plan to repeat in 1 week. Ultimately, discharged home with diagnosis of viral illness and to follow up in 1 week with PCP
19 1 week later, the patient returns to the ER with rash and sore throat Now what do you want to know?
20 HPI: Chief complaint: rash and sore throat Was well for 1 day following discharge, then developed red rash that began on his wrists and spread to his entire body. Rash has been itchy, but not painful. Sore throat returned and is worse now. ROS: no fevers, +dec PO intake, no vomiting/nausea, +inc voiding
21 Now what are you concerned about?
22 Differential Diagnosis Mononucleosis (EBV/CMV) Toxoplasmosis Rubella Syphilis Viral hepatitis Disseminated gonococcal infection New onset autoimmune disease (SLE) HIV Strep Rocky Mountain Spotted Fever
23 Physical Exam VS: T 97.8, HR 96, RR 18, BP 105/71, GEN: HEENT: NECK: SKIN: Pox 98% on RA, Wt 57.8kg Awake, alert, NAD erythema with some ulcers and plaques to soft palate and bilateral tonsils Supple, some swelling/fullness at the angle of the mandible confluent, flat, erythematous rash to entire body
24 Physical Exam CV: RRR, no murmur, 2+pulses in all 4 extremities, CR <3 seconds. RESP: ABD: EXT: Neuro: CTA bilaterally, no increased WOB soft, thin, non-distended, non-tender with normoactive bowel sounds warm and well perfused, no cyanosis or edema, PIV to LUE no focal deficits on exam
25 What labs would you order?
26 LABS CBG: 7.30 / 40 / 52 / 19.7 / < 670 Ca 10.2 AST 29 / ALT HbA1C: 8.3% UA: (-)LE/nit, (-)protein, (-)blood, 1+ketones, 3+ glucose, no wbc
27 LABS S61 B16 L7 M13 AL3 CRP: 0.4 (0-1) Amylase: 71 (25-180) Lipase: 625 (48-176) Mono spot: (-) RPR: NR HIV PCR: (+)
28 Acute Retroviral Syndrome
29 Acute Retroviral Syndrome AKA, Acute HIV infection The effect of the immune response to a primary infection of HIV-1 or HIV-2 following dissemination of HIV.
30
31
32
33
34
35
36 Acute Retroviral Syndrome 40-90% of acute HIV infections are symptomatic. The usual time from HIV exposure to onset of symptoms is 2-4 weeks. Symptoms can last from days to weeks. Acute phase lasts for as long as the immune response takes to control viral replication
37 Clinical Manifestations Most common complaints Fever Fatigue Myalgia Suggestive of HIV diagnosis: mucocutaneous ulcers and. prolonged duration of symptoms
38 Clinical Manifestations Constitutional symptoms Fever, fatigue and myalgias Adenopathy Nontender axillary, cervical, and occipital nodes Develops during the second week of illness Oropharyngeal findings Sore throat with pharyngeal edema and hyperemia, without tonsillar enlargement or exudate Ulcerations can be found on oral mucosa, as well as anus and penis
39 Clinical Manifestations Rash Generalized maculopapular rash, non-pruritic Occurs hours after onset of fever Persists 5-8 days GI symptoms Nausea, diarrhea, anorexia, and weight loss (~5kg) Neurologic symptoms Headache described as retro-orbital pain that worsens with eye movement Aseptic meningitis
40 Rash
41 Rash
42 Opportunistic Infections Rare in the acute phase Most common opportunistic infection seen in this phase is. oral and esophageal candidiasis Esophageal ulceration provides local environment that promotes growth of Candida Administration of empiric antibiotics for symptoms of acute HIV can alter normal oropharyngeal flora
43 Labs Viral RNA level very high (>100,000 copies/ml) and CD4 cell count can drop transiently Period of rapid viral replication and infection of CD4 T cells Negative HIV antibody Leukopenia Elevations of liver enzymes Mild anemia Thrombocytopenia
44
45 Stages based on lab testing
46 Time to positivity
47 Back to our patient
48 LABS HIV viral load: 2,900,000 Genotype: HIV-1, no resistance CD4: 350 CD8: 250 CD4:CD8 ratio: 1.41 RPR NR; GC/CT neg; HSV neg HepA AB: positive Baseline Vitamin D, TFTs, and lipid panel
49 The End! Noon conference: Dr. Jeyakumar Noisy Airway Across the street
50
51
Didactic Series. Primary HIV Infection. Greg Melcher, M.D. UC Davis AETC 8 Nov 2012
Didactic Series Primary HIV Infection Greg Melcher, M.D. UC Davis AETC 8 Nov 2012 ACCREDITATION STATEMENT: University of California, San Diego School of Medicine is accredited by the Accreditation Council
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session 11, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION 11 Renal Block Acid- Base Disorders November 7, 2016 MHD I, Session 11, Student Copy Page 2 Case #1 Cc: I have had
More informationReal Cases: Bad Outcomes
Real Cases: Bad Outcomes Fredrick M. Abrahamian, D.O., FACEP, FIDSA Clinical Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical
More informationThe how and why of Acute HIV Infection 1. How do we best diagnosis patients with acute HIV?
Acute HIV infection Eric Rosenberg, MD Associate Professor of Pathology Director, Clinical Microbiology Laboratory Massachusetts General Hospital Harvard Medical School The how and why of Acute HIV Infection
More informationSeptic Shock. Kathryn Sims, PGY I
Septic Shock Kathryn Sims, PGY I A 6 y.o. previously healthy boy presents to the ED with 7 days of fever accompanied by chills. Further history reveals the patient has also been experiencing dysuria for
More informationMHD I SESSION X. Renal Disease
MHD I, Session X, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION X Renal Disease Monday, November 11, 2013 MHD I, Session X, Student Copy Page 2 Case #1 Cc: I have had weeks of diarrhea
More informationCASE-BASED SMALL GROUP DISCUSSION MHD II
MHD II, Session 11, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD II Session 11 April 11, 2016 STUDENT COPY MHD II, Session 11, Student Copy Page 2 CASE HISTORY 1 Chief complaint: Our baby
More informationMedical Hockey Scenarios What Would You Do? Case Presentation. Dr. Noah Forman AOSSM August 2015
Medical Hockey Scenarios What Would You Do? Case Presentation Dr. Noah Forman AOSSM August 2015 What Would You Do? Discussion Points Mechanism of injury Assessment of injury and player presentation Are
More informationDocumentation Dissection
History of Present Illness: Documentation Dissection The patient is a 50-year-old male c/o symptoms for past 4 months 1, severe 2 bloating and stomach cramps, some nausea, vomiting, diarrhea. In last 3
More informationDischarge Summary-Page 1
Discharge Summary-Page 1 Admission diagnosis: 1. Gastritis. 2. Alcoholic cirrhosis, ascites, grade 1 esophageal varices. 3. Recent left knee arthroplasty. 4. Osteoporosis naqmq : 1. Three chest X-rays
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD II, Session XII, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION Session XII MHD II April 21, 2014 STUDENT COPY Helpful Resource: ACP Medicine online available through LUHS Library Infectious
More information11 year-old female with altered mental status in the setting of diabetic ketoacidosis
11 year-old female with altered mental status in the setting of diabetic ketoacidosis Katie O Sullivan, M.D. Fellow Adult/Pediatric Endocrinology University of Chicago Thursday, January 23 rd, 2014 Chief
More informationCase conference. Welcome Dr. Lawrence Tierney
Case conference Welcome Dr. Lawrence Tierney Case: 18 year-old male CC) hamatomesis, Fever and cough HPI) 1 st admission One month ago, he admitted to our hospital because of hematemesis. He had weight
More informationQuick Study: Sexually Transmitted Infections
Quick Study: Sexually Transmitted Infections Gonorrhea What is it: A bacterial infection of the genitals, anus, or throat. How common: The CDC estimates 820,000 people in the United States get Gonorrhea
More informationClinical Manifestations of HIV
HIV Symptoms Diane Havlir, MD Professor of Medicine and Chief, HIV/AIDS Division University of California, San Francisco (UCSF) WorldMedSchool; July 2, 2013 1 Clinical Manifestations of HIV! Result from
More informationClinical Case Scenario. HIVeEducation Workshop, Sint Maarten 2009
Clinical Case Scenario HIVeEducation Workshop, Sint Maarten 2009 Background Mrs. S is a 34 year-old woman who was referred from the VCT center after testing HIV positive three weeks ago. Her husband recently
More informationACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN. 11/29/18 Muhammad Ahmed, MD
ACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN 11/29/18 Muhammad Ahmed, MD H&P 61-year-old male with a history of chronic ethanol use (4-6 beers/day x decades), hypertension, and a family history of hemochromatosis
More informationAnother New HIV Diagnosis
Another New HIV Diagnosis P. Young, RPAC Shelley A Gilroy, MD Albany Medical College June 3, 2014 The Patient 21-year-old male college student with rash x 1 month, beginning on his face Non-tender & non-pruritic
More informationCARDIOVASCULAR CASE-BASED SMALL GROUP DISCUSSION
MHD I Session VIII Student Copy Page 1 CARDIOVASCULAR CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION VIII OCTOBER 22, 2014 STUDENT COPY MHD I Session VIII Student Copy Page 2 Case 1 Chief Complaint I
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session 13, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION 13 MHD I Autoimmunity November 10, 2016 STUDENT COPY MHD I, Session 13, STUDENT Copy Page 2 Case 1 CHIEF COMPLAINT: I am
More informationTreating A Sore Throat With Intubation. A case of Epiglottitis in an elderly patient. Sherif Yani, PGY3 St Joseph s FM Residency
Treating A Sore Throat With Intubation A case of Epiglottitis in an elderly patient. Sherif Yani, PGY3 St Joseph s FM Residency Outline H&P Diagnosis Management Discussion Take-Home Points History 88 y/o
More informationCitywide Infectious Disease Conference. March 27 th, 2018
Citywide Infectious Disease Conference March 27 th, 2018 Citywide Show and Tell Case 1 Summary 60 s year old Puerto Rican born man SCC of Esophagus, treated with radiation and chemotherapy and then esophageal
More informationGeneral Medical Concerns
General Medical Concerns General Medical Concerns Fred Reifsteck MD Head Team Physician University of Georgia Missed Time: school, work, practice, games Decreased Performance Physical/ Mental stress: New
More informationGOOD MORNING! Thursday, July Heidi Murphy, MD Leslie Carter-King, MD
GOOD MORNING! Thursday, July 10 2014 Heidi Murphy, MD Leslie Carter-King, MD PREP QUESTION Almost all infants experience a transient increase in bilirubin concentrations known as physiologic jaundice during
More information11/9/2015. Childhood Nephrotic Syndrome: The Clinical Pathway. Learning Objectives. Nephrotic Syndrome - Definition. Proteinuria.
Childhood Nephrotic Syndrome: The Clinical Pathway Cherry Mammen, MD, FRCPC, MHSc Douglas G. Matsell, MDCM, FRCPC Division of Nephrology, BC Children s Hospital Grand Rounds Nov 13th, 2015 Learning Objectives
More informationTRAINER: Read this page ahead of time to prepare for teaching the module.
Module 2 Overview: Employee Illness TRAINER: Read this page ahead of time to prepare for teaching the module. PARTICIPANTS WILL: 1. Describe FOODBORNE ILLNESS symptoms. 2. Explain the difference between
More informationDoctor, I Have Strep Throat. Nancy W Weber D.O. FACOEP FACEP MBA Sparrow/MSU Emergency Medicine Residency October 22, 2018
Doctor, I Have Strep Throat Nancy W Weber D.O. FACOEP FACEP MBA Sparrow/MSU Emergency Medicine Residency October 22, 2018 Disclosures None The Patient: 41YOF CC: Sore throat x 3 days HPI: Sore throat increasing
More informationJohn Sanchez, D.O. August 18, 2013
John Sanchez, D.O. August 18, 2013 Ø Coding Caps Ø Relevance to Clinical Practice Ø Current Guidelines 1995 (organ systems) 1997 (bullets) Ø Definitions ICD- 9 CPT E/M ( 99 _ ) Ø Who Should Determine the
More informationHow is it transferred?
STI s What is a STI? It is a contagious infection that is transferred from one person to another through sexual intercourse or other sexually- related behaviors. How is it transferred? The organisms live
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session XII, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION Session XII MHD I Friday, November 15, 2013 STUDENT COPY MHD I, Session XII, Student Copy Page 2 Case 1 CHIEF COMPLAINT: I am very
More informationGood Morning! Welcome Applicants! FRIDAY, N OVEMBER, 7 TH 2014
Good Morning! Welcome Applicants! FRIDAY, N OVEMBER, 7 TH 2014 Prep Question You are camping with a group of boys at a rural campground in the southeastern Unites States when one of the campers is bitten
More informationBlood Borne Pathogens. November 2010
Blood Borne Pathogens November 2010 Objectives Meet requirements of OSHA Standard 29 CFR 1910.1030 OSHA Blood Borne Pathogens Post Test Routes of Transmission Types of Pathogens BSI / PPE Common Diseases
More informationTOO MUCH OF A GOOD THING. Mitra Barahimi, MD, PGY-1 University of Washington Internal Medicine Residency Lauren Beste, MD, MSc Jeremiah Alexander, MD
TOO MUCH OF A GOOD THING Mitra Barahimi, MD, PGY-1 University of Washington Internal Medicine Residency Lauren Beste, MD, MSc Jeremiah Alexander, MD Collaborators Lauren Beste, MD, MSc Jeremiah Alexander,
More informationChronic Hepatitis C. Risk Factors
Chronic Hepatitis C The hepatitis C virus is one of the most important causes of chronic liver disease in the United States. Almost 4 million Americans or 1.8 percent of the U.S. population have an antibody
More information9 year-old Female with Papillary Thyroid Cancer. Katie O Sullivan, M.D. Fellow Medicine/Pediatric Endocrinology Thursday, January 16 th, 2014
9 year-old Female with Papillary Thyroid Cancer Katie O Sullivan, M.D. Fellow Medicine/Pediatric Endocrinology Thursday, January 16 th, 2014 Chief Complaint Mass on the right side of the neck x 2-3 weeks
More informationCASE-BASED SMALL GROUP DISCUSSION MHD II SESSION 6. Friday, MARCH 18, 2016 STUDENT COPY
MHD II, Session 6, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD II SESSION 6 Friday, MARCH 18, 2016 STUDENT COPY Resource for cases: ACP Medicine (Scientific American Medicine) - Vaginitis
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session IV, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION IV Wednesday, September 18, 2013 MHD I, Session IV, STUDENT Copy Page 2 Resource for cases: Robbins Basic Pathology,
More informationCase TWO. Vital Signs: Temperature 36.6degC BP 137/89 HR 110 SpO2 97% on Room Air
Mr N is a 64year old Chinese gentleman who is a heavy drinker, still actively drinking, and chronic smoker of >40pack year history. He has a past medical history significant for Hypertension, Hyperlipidemia,
More informationPUFF THE MAGIC DRAGON
PUFF THE MAGIC DRAGON AN UNUSUAL CASE OF A PUFFY FACE MA ACP Annual Scientific Meeting Gurbir Gill, M.D., PGY-3 (Associate) George M. Abraham, MD, MPH, FACP Department of Medicine, Saint Vincent Hospital,
More information15 month-old female with a cystic brain lesion. Magdalena Dumin, MD Pediatric Endocrinology Fellow University of Chicago December 4, 2014
+ 15 month-old female with a cystic brain lesion Magdalena Dumin, MD Pediatric Endocrinology Fellow University of Chicago December 4, 2014 + Chief Complaint 15 month-old female admitted to PICU for concern
More informationEVALUATION OF A SICK CHILD WITH FEVER
EVALUATION OF A SICK CHILD WITH FEVER Learning objectives At the conclusion of this learning activity, participants should be able to; Discuss the different etiologies of acute illness in a child Identify
More informationHASPI Medical Biology Lab 01a
! What Does It Test For? Very Low Low Glucose Electrolytes Ferritin Blood ph The glucose test measures the amount of sugar, or glucose, in the blood or urine. A very high or very low glucose test can indicate
More informationHASPI Medical Biology Lab 03
Patient 1001 is a 42-year-old female that is experiencing severe heartburn, abdominal pain, bloating, nausea, and vomiting. Ulcers Bleeding sores in the stomach or intestine Gallbladder Disease Gallstones
More informationGlucose Electrolytes Ferritin Blood ph. Possible Results White Bright pink Clear White. Bright pink; fades to light pink. Light Pink fades to clear
What Does It Test For? Very Low Low Glucose Electrolytes Ferritin Blood ph The glucose test An electrolyte Ferritin is a protein The blood ph test The liver is an White blood cells measures the test measures
More informationAbdominal Pain. Luke Donnelly, MD Emergency Medicine
Abdominal Pain Luke Donnelly, MD Emergency Medicine Objectives Approach to abdominal pain Evaluation Critical diagnoses and treatments Abdominal Pain Most Common ER Complaint Broad Differential Can often
More informationPet Pigs and Pyrexia
Pet Pigs and Pyrexia 7 th Annual SHM Iowa Chapter Conference Dianna Edwards, MD Hospitalist UnityPoint Health- St. Luke s Cedar Rapids No disclosures 10/29/2016 HPI: 6/2016 45 yo male with OSH ED with
More informationCleaning for Additional Precautions Table symptom based
for Additional Precautions Table symptom based The need to wear personal protective equipment () for Routine Practices is dependent on the risk of contact or contamination with blood or body fluids. should
More informationCommunicable Disease Guidelines
Communicable Disease Guidelines Note: This information is to assist in making decisions regarding the control of communicable diseases. It is NOT intended for the purposes of making diagnoses. Refer to
More informationPractical Approaches to Medical Necessity
Practical Approaches to Medical Necessity CAROLYN AVERY, CPC, CEMC CAROLYN AVERY & ASSOCIATES, PC ROBERT OSSOFF DMD, MD, CHC ASSISTANT VICE CHANCELLOR FOR COMPLIANCE &CORPORATE INTEGRITY VANDERBILT MEDICAL
More informationDisclaimer. This is a broad survey and cannot cover all differential diagnoses or each condition in thorough detail
Objectives Pediatric Infections: Differentiating Benign from Serious Eileen Klein, MD, MPH Rashes Infectious vs non-infectious Viral vs bacterial Respiratory and GI illnesses When do you treat When do
More information38 yo obese F w/crohns presents with nausea/vomiting. 1/24/13 Jess Hwang
38 yo obese F w/crohns presents with nausea/vomiting 1/24/13 Jess Hwang 1 week prior to admission Seen in ED with fevers, nausea, vomiting, worsening rash Hypotensive to 70/40 with lactate of 4.5 Acute
More informationBeating outside the Box a case presentation on pericarditis. Kathryn R. Brim, DO, PGY1 Internal Medicine Resident
Beating outside the Box a case presentation on pericarditis Kathryn R. Brim, DO, PGY1 Internal Medicine Resident Presentation Mr. P.A. is a 47 year old male who presented to the emergency department with
More information* Final Report * ED Triage Entered On: 01/16/2014 8:45 EST Performed On: 01/16/2014 8:42 EST by
Result date: Result status: 16 January 2014 8:42 EST Auth (Verified) * Final Report * ED Triage Entered On: 01/16/2014 8:45 EST Performed On: 01/16/2014 8:42 EST by Assessment I Chief Complaint : Diarrhea
More informationCommunicable Disease Guidelines
Note: This information is to assist in making decisions regarding the control of communicable diseases. It is not intended for the purposes of making diagnoses. Refer to disease specific information sheets
More information61 yo M w/heart disease presenting in decompensated HF. 1/24/13 Jess Hwang
61 yo M w/heart disease presenting in decompensated HF 1/24/13 Jess Hwang HPI 3 weeks worsening orthopnea, PND, DOE Referred to UCMC for transplant evaluation Found to have 100% afib burden 1 month prior
More informationPediatric Case Studies. Case 1
Pediatric Case Studies James Naprawa, MD Assistant Clinical Professor Pediatric Emergency Medicine Children s Hospital, Columbus Case 1 Almost 4 year old AA girl PMH UTI x 2 with abdominal pain and fever
More informationLSU Medicine Case Conference. Tuesday May 17, 2011 Gisella Tay, M.D.
LSU Medicine Case Conference Tuesday May 17, 2011 Gisella Tay, M.D. Chief Complaint I fell down on my porch. HPI 60yo man with past medical history of HTN and recurrent sebaceous cysts was transferred
More informationAPPENDICITIS IN THE YOUNG CHILD. By Rebecca Lucas
1 APPENDICITIS IN THE YOUNG CHILD By Rebecca Lucas 2 When time counts the most Patient Profile 3 The patient 3 years old 2 months girl Usually is vibrant, articulate, incorrigible enjoys telling me how
More informationKawasaki Disease. 1:45 2:30 p.m. James Nocton, MD Benjamin Goot, MD. Children s Specialty Group. All rights reserved.
Kawasaki Disease 1:45 2:30 p.m. James Nocton, MD Benjamin Goot, MD Disclosures We have no relevant financial relationships to disclose. Objectives Describe the characteristic signs and symptoms of Kawasaki
More information53 year old Female with Hypoglycemia. Colleen Flynn, MD April 5, 2012
53 year old Female with Hypoglycemia Colleen Flynn, MD April 5, 2012 HPI 53 yo F referred to the endocrine clinic for hypoglycemia x 1 year. History of a non secreting metastatic neuroendocrine tumor diagnosed
More information67 year-old Male with Flu-like Symptoms. Jess Hwang 12/6/12
67 year-old Male with Flu-like Symptoms Jess Hwang 12/6/12 HPI Fishing trip with son, had chills/fatigue 4 days later, went on business trip Severe nausea/vomiting x 2 days Found tachypneic, somnolent
More informationFocus on Visual skills. The Fine Art of Visual Diagnosis. The Fine Art of Visual Diagnosis. The Fine Art of Visual Diagnosis.
The Fine Art of Visual Diagnosis of Pediatric Infectious Diseases Atlanta, GA April 29 30, 2017 James H. Brien, DO The Fine Art of Visual Diagnosis I have nothing to declare. James H. Brien, DO The Fine
More informationInfection Prevention and Control in Long Term Care Part 2
Infection Prevention and Control in Long Term Care Part 2 Course ID: 1029 - Credit Hours: 2 Author(s) Bonnie Chustz,RN, BSN WCC Disclosures None Accreditation KLA Education Services LLC is accredited by
More informationCase 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017
Case 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017 Chief Complaint The ER calls about a 24 year old, 12 weeks pregnant. She presented with tachycardia
More informationCASE STUDY: ULCERATIVE COLITIS. Sammi Montag Dietetic Intern
CASE STUDY: ULCERATIVE COLITIS Sammi Montag Dietetic Intern 2013-2014 PATIENT (CK) INTRODUCTION 26 year old female Chief complaint: bloody diarrhea and abdominal pain Admitting diagnosis: Ulcerative colitis
More informationChallenging STD Cases. Chris Davis, PA-C University of Utah Clinic 1A
Challenging STD Cases Chris Davis, PA-C University of Utah Clinic 1A Case #1 28 year old HIV + MSM presents for first HIV visit with lesion on glans of penis CD4 count of 3 and viral load of 610,000 Multiple
More informationROS: all remaining ROS negative
Case # 1 CC: altered mental status HPI: 13 yo male presents with altered metal status. Child`s mother was called by the school nurse to pick her child up from school today due to child`s unusual behavior.
More informationBiology 3201 Unit 2 Reproduction: Sexually Transmitted Infections (STD s/sti s)
Biology 3201 Unit 2 Reproduction: Sexually Transmitted Infections (STD s/sti s) STI s once called venereal diseases More than 20 STIs have now been identified most prevalent among teenagers and young adults.
More informationObjectives. 3HP and Flu Syndrome What is the Underlying Mechanism? Case #1 3/23/2016. Christina T. Fiske, MD MPH March 30, 2016
Objectives 3HP and Flu Syndrome What is the Underlying Mechanism? Christina T. Fiske, MD MPH March 30, 2016 Illustrate the side effect of 3HP flu like syndrome after its initiation to raise awareness in
More informationTeaching Clinical Reasoning. Clinical Reasoning Strategy. Clinical Reasoning Strategy 11/27/2018. Teaching of Tomorrow November 2018
Teaching Clinical Reasoning Teaching of Tomorrow November 2018 Clinical Reasoning Strategy The following teaching paradigm is appropriate for these scenarios: Case Conference discussions Robust case presentations
More informationTo appreciate the unique problems of older surgical patients. To describe the differential and management
To appreciate the unique problems of older surgical patients. t To describe the differential and management of acute abdomen in the older. To recognize and tend to hospital complications in olderpatients.
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session 13, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION 13 MHD I November 12, 2015 STUDENT COPY MHD I, Session 13, STUDENT Copy Page 2 Case 1 CHIEF COMPLAINT: I am very tired and
More informationRheumatic Fever And Post-streptococcal Reactive Arthritis
www.printo.it/pediatric-rheumatology/gb/intro Rheumatic Fever And Post-streptococcal Reactive Arthritis Version of 2016 1. WHAT IS RHEUMATIC FEVER 1.1 What is it? Rheumatic fever is a disease caused by
More informationIt s Monday! July 28, 2014
It s Monday! July 28, 2014 Prep Question The mother of a 6-year-old girl reports during a health supervision visit that her daughter has nighttime wetting and occasional daytime accidents with urgency.
More informationCASE-BASED SMALL GROUP DISCUSSION MHD II SESSION VI. Friday, MARCH 20, 2015 STUDENT COPY
MHD II, Session VI, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD II SESSION VI Friday, MARCH 20, 2015 STUDENT COPY Resource for cases: ACP Medicine (Scientific American Medicine) - Vaginitis
More informationNASRONUDIN 4/17/2013. DENVs of each type are grouped into several genotypes.
NASRONUDIN Institute of Tropical Disease, Airlangga University-Tropical and Infectious Diseases Division, Department of Internal Medicine Medical Faculty-Dr. Soetomo Hospital Disampaikan pada 14 th Jakarta
More informationUW MEDICINE PATIENT EDUCATION. Discharge Checklist. After a kidney/pancreas transplant. When can I leave the hospital?
UW MEDICINE PATIENT EDUCATION Discharge Checklist After a kidney/pancreas transplant Before you work through the checklist in this chapter, please review these chapters: UWMC Clinic Care After Discharge
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health
More informationInfectious Disease. Chloe Duke
Infectious Disease Chloe Duke Learning Objectives Essential - Causes, recognition and Treatment of: Meningitis Sepsis Purpura Important Cervical Adenopathy Tonsillitis and Pharyngitis Otitis Media Pneumonia
More informationA Man with a Rash and Pink Eye. STD Case Studies from the Denver Metro Health Clinic
A Man with a Rash and Pink Eye STD Case Studies from the Denver Metro Health Clinic Case 45 year-old HIV+ gay male, presented to the STD clinic as a contact to gonorrhea Generalized rash since 6 weeks
More informationThrombocytopenia, fever, rash, hypotension. Alexander D. Hristov MD University of Wisconsin Hospital and Clinic Internal Medicine PGY 2
Thrombocytopenia, fever, rash, hypotension Alexander D. Hristov MD University of Wisconsin Hospital and Clinic Internal Medicine PGY 2 Case Chief Complaint: Fever, diarrhea, bloody nose, rash HPI: 38 y/o
More informationVS: BP 165/90, P 98, RR 18, T 37 C; waist circ 38 in, Wt 240 lbs (109 kg), Ht 5'8''
IMC Didactic Case-Diabetes Mellitus Chief Complaint "I was recently diagnosed with diabetes and would like to have my blood sugar tested. I think that my blood sugar is running low because I have the shakes
More informationSCRIPT 1 - PHYSICIAN COMMUNICATION Localizing Signs and Symptoms with Warning Signs
SCRIPT 1 - PHYSICIAN COMMUNICATION Localizing Signs and Symptoms with Warning Signs Wisconsin Healthcare Associated Infections in LTC Coalition PHONE CONTACT NECESSARY Resident: Jimmy Issick Date: 11/7/15
More informationClinical Radiological Pathological Conference
Clinical Radiological Pathological Conference CASE 1: A 59-year-old female Housekeeper Live in Phuket, Thailand Progressive dyspnea for 1 year Present illness 1 year PTA : She developed dyspnea on exertion
More informationGASTROENTEROLOGY ESSENTIALS
GASTROENTEROLOGY ESSENTIALS Practical Gastroenterology 8/25/2018 Jahnavi Koppala, MBBS Abdullah Abdussalam, MD A 48-year-old male was evaluated for noncardiac chest pain. Treatment with PPI twice daily
More informationPLEASE COMPLETE ALL SECTIONS OF THIS FORM
PLEASE COMPLETE ALL SECTIONS OF THIS FORM Patient Name: Date of Birth: Referring Doctor? (Name, telephone number and address) Chief Complaint: Why have you come here? How did it start? What are the symptoms?
More informationAugust 2014 A GUIDE FOR SCHOOLS AND DAYCARES
August 2014 A GUIDE FOR SCHOOLS AND DAYCARES Chicken Pox (Can be prevented by immunization) Common Cold Itchy, red spots that dry and form scabs in 4 or 5 days. Usually starts with fever. Nasal congestion,
More informationRed Stick ID Visual Diagnosis Questions August 22, 2014
Red Stick ID Visual Diagnosis Questions August 22, 2014 James H. Brien, DO Case #1 The setting is a Pediatric Clinic in San Antonio, Texas on a Saturday in 1989. However, it could have been yesterday in
More informationSMALL GROUP DISCUSSION SESSION
MHD I Session 1 Student Copy Page 1 SMALL GROUP DISCUSSION SESSION 1 MHD I Friday, September 4, 2015 STUDENT COPY MHD I Session 1 Student Copy Page 2 Helpful Resources for Session Murray s Medical Microbiology,
More informationChief complaint. A mass at right chest
Chief complaint A mass at right chest Present illness This 1-year-5-month-old girl had a mass at right side chest since one month ago. flat and not tender at first In the recent 2 days, the mass enlarged
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session 4, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION 4 Tuesday, September 15, 2015 MHD I, Session 4, STUDENT Copy Page 2 Resource for cases: Robbins Basic Pathology, Chapter
More informationCASE-BASED SMALL GROUP DISCUSSION
MHD I, Session XIII, STUDENT Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION SESSION XIII MHD I November 13, 2014 STUDENT COPY MHD I, Session XIII, STUDENT Copy Page 2 Case 1 CHIEF COMPLAINT: I am very tired
More informationEmergency Surgery Board Department of General Surgery Rambam Health Care Campus
Emergency Surgery Board Department of General Surgery Rambam Health Care Campus Surgical Complications of Peptic Ulcer Disease Case Presentation and Review of the Literature Case Presentation 40y male
More informationExclusion Periods for Infectious Diseases
Exclusion Periods for Infectious Diseases Amoebiasis (Entamoeba Histolytica) Campylobacter Candidiasis Chickenpox (Varicella) CMV (Cytomegalovirus Infection) Conjunctivitis Cryptosporidium Infection Diarrhoea
More informationMore than meets the eye
More than meets the eye Ana Paula Abreu, MD, PhD American Association of Clinical Endocrinologists New England Chapter Annual Meeting September 8, 2018 Disclosures No conflict of interest or significant
More informationRecognizing the Clinical and Laboratory Presentation of Human Granulocytic Anaplasmosis
Recognizing the Clinical and Laboratory Presentation of Human Granulocytic Anaplasmosis NICOLE FENNIMORE, 3 RD YEAR MEDICAL STUDENT UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH FRIDAY,
More informationSystemic examination
PROLONGED FEVER IN AN ADOLESCENT BOY Dr.Praveena Lionel, DNB PG, Dr.Kannan (HOD) Railway Hospital, Perambur History 11 yrs old adolescent boy was admitted with c/o Fever -1 wk Myalgia -1 wk Arthralgia
More informationSexually Transmitted Infections (STIs)
Sexually Transmitted Infections (STIs) Overview Definition of STIs: What are they? Transmission: How are they spread? Types of infection: Bacterial (Chlamydia, Gonorrhea, Syphilis) Viral (Hepatitis B,
More informationIn Canada and around the world, the trend is clear: sexually transmitted infections (STIs) are on the rise.
Adapted From: Sexually Transmitted Infections Pamphlet. Public Health Agency of Canada, 2007 In Canada and around the world, the trend is clear: sexually transmitted infections (STIs) are on the rise.
More informationAcute Genital Ulcerations
Acute Genital Ulcerations Rachel Clarke, MD Chief Resident Weijen Chang, MD FAAP SFHM Associate Professor Baystate Children s Hospital University of Massachusetts Medical School Disclosures In the past
More information