- A 73-year-old female patient presented with shortness of breath for 3 months. On examination, decreased breath sounds and dullness were found on the right lung. Chest X-ray and ultrasound showed a pleural effusion.
- Diagnostic thoracentesis revealed an exudative pleural fluid. The patient has a history of weight loss and being a passive smoker, placing her at higher risk for lung cancer.
- A preliminary diagnosis of malignant pleural effusion, likely due to lung adenocarcinoma or metastases, was made. Further diagnostic tests such as thoracentesis, biopsy and imaging are planned to confirm the diagnosis.
This patient is a 20-year-old male who presented with sudden difficulty breathing, non-productive cough, and chest pain. His history includes treatment for pulmonary tuberculosis in 2018. Physical exam and chest X-ray revealed a massive left-sided pneumothorax. A chest tube was inserted, providing some relief. Further imaging showed evidence of prior PTB as well as pulmonary blebs. The patient was admitted and treated conservatively with oxygen, analgesics, and incentive spirometry. His pneumothorax gradually resolved over four days of inpatient monitoring.
1. A 43-year-old woman presented with abdominal pain, nausea, and vomiting for the past 3 days. She has a history of epigastric pain and nausea.
2. Physical examination found epigastric tenderness and tachycardia. Laboratory tests showed anemia.
3. Chest x-ray showed a massive fibrotic process in the left hemithorax. Initial diagnoses considered were peptic ulcer disease, gastritis, or GERD given her abdominal symptoms, and further tests were planned.
This morning report from RSSA provides details on a 60-year-old male patient presenting with chest pain. Key details include:
- The patient presented with chest pain for over 30 minutes, accompanied by cold sweats. Initial vitals and exam findings are provided.
- The patient has a history of NSTEMI 1 year ago with 3 vessel CAD on angiography but refused further treatment. He also has a history of hypertension for 20 years.
- Initial labs, ECGs, chest x-ray, and past medical records are summarized. Echocardiogram from last year showed LV hypertrophy and diastolic dysfunction. Coronary angiogram showed 3 vessel CAD.
-
Ny. R, a 68-year-old woman, presented to the emergency department with shortness of breath for 3 weeks. She reported dry cough, fever, and chest pain for 3 weeks since experiencing an episode of choking while eating porridge. Her symptoms worsened over the past 2 weeks, causing her to remain bedridden. She has a history of ischemic cardiovascular disease. Physical examination found tachycardia, fever, decreased oxygen saturation. Chest X-ray showed pneumonia infiltrates. She was diagnosed with aspiration pneumonia.
- A 6-year-old female patient presented with headache after a traffic accident where her head hit the pavement. On examination, she had a 3cm cephalhematoma and 2x1cm wound on her left parietal region.
- Imaging showed an epidural hematoma and depressed skull fracture in the left parietal region. Her GCS was 15/15.
- The working diagnosis was mild head injury, left parietal epidural hematoma, and depressed skull fracture. The plan was for craniotomy for hematoma evacuation and reconstruction of the depressed fracture.
This patient is a 20-year-old male who presented with sudden difficulty breathing, non-productive cough, and chest pain. His history includes treatment for pulmonary tuberculosis in 2018. Physical exam and chest X-ray revealed a massive left-sided pneumothorax. A chest tube was inserted, providing some relief. Further imaging showed evidence of prior PTB as well as pulmonary blebs. The patient was admitted and treated conservatively with oxygen, analgesics, and incentive spirometry. His pneumothorax gradually resolved over four days of inpatient monitoring.
1. A 43-year-old woman presented with abdominal pain, nausea, and vomiting for the past 3 days. She has a history of epigastric pain and nausea.
2. Physical examination found epigastric tenderness and tachycardia. Laboratory tests showed anemia.
3. Chest x-ray showed a massive fibrotic process in the left hemithorax. Initial diagnoses considered were peptic ulcer disease, gastritis, or GERD given her abdominal symptoms, and further tests were planned.
This morning report from RSSA provides details on a 60-year-old male patient presenting with chest pain. Key details include:
- The patient presented with chest pain for over 30 minutes, accompanied by cold sweats. Initial vitals and exam findings are provided.
- The patient has a history of NSTEMI 1 year ago with 3 vessel CAD on angiography but refused further treatment. He also has a history of hypertension for 20 years.
- Initial labs, ECGs, chest x-ray, and past medical records are summarized. Echocardiogram from last year showed LV hypertrophy and diastolic dysfunction. Coronary angiogram showed 3 vessel CAD.
-
Ny. R, a 68-year-old woman, presented to the emergency department with shortness of breath for 3 weeks. She reported dry cough, fever, and chest pain for 3 weeks since experiencing an episode of choking while eating porridge. Her symptoms worsened over the past 2 weeks, causing her to remain bedridden. She has a history of ischemic cardiovascular disease. Physical examination found tachycardia, fever, decreased oxygen saturation. Chest X-ray showed pneumonia infiltrates. She was diagnosed with aspiration pneumonia.
- A 6-year-old female patient presented with headache after a traffic accident where her head hit the pavement. On examination, she had a 3cm cephalhematoma and 2x1cm wound on her left parietal region.
- Imaging showed an epidural hematoma and depressed skull fracture in the left parietal region. Her GCS was 15/15.
- The working diagnosis was mild head injury, left parietal epidural hematoma, and depressed skull fracture. The plan was for craniotomy for hematoma evacuation and reconstruction of the depressed fracture.
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Mr. T, a 21-year-old male, presented with a 4-day history of cough with white phlegm and a 10-month history of frequent coughing. Imaging showed an inhomogeneous solid mass in the right lung that appeared to encase the superior vena cava and compress the right lung. Biopsies and tests were negative for malignancy but showed xanthogranulomatous inflammation. A diagnosis of a possible right lung tumor versus mediastinal tumor was made, and oncology consultation was planned along with further biopsies to determine the nature of the mass.
- Mrs. Nelwati, a 67-year-old female, presented to the emergency department with palpitations and shortness of breath.
- Her past medical history included atrial fibrillation, congestive heart failure, and a recent stroke.
- On examination, she was tachycardic with irregular rhythm and signs of congestive heart failure.
- Laboratory and imaging findings were consistent with atrial fibrillation and heart failure. She was admitted to the CVCU ward for management of her conditions.
This case presentation describes a 49-year-old female patient who presented with a 3-year history of flank pain associated with dysuria and hematuria. Imaging and lab results showed poorly functioning left kidney secondary to xanthogranulomatous pyelonephritis, and obstructive uropathy of the right kidney due to pelviolithiasis. The patient was diagnosed with xanthogranulomatous pyelonephritis of the left kidney, pelviolithiasis of the right kidney, and diabetes mellitus type 2. She was admitted and managed conservatively with IV fluids and pain medication. The treatment plan includes a left nephrectomy, left flank exploration, cystoscopy, and right
trixie-final power point presentation acutedisgurlistaken
- 20 year old female presented with a history of ear infection, 2 weeks of headache, nausea, vomiting and fever, and new onset seizure
- Physical exam revealed she was drowsy and confused, with neck rigidity and positive Brudzinski's and Kernig's signs
- Imaging and labs supported an impression of acute bacterial meningitis
- She was started on empirical antibiotics and antivirals for treatment
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This document summarizes the morbidity and mortality conference of a 20-year-old female patient who was admitted for difficulty breathing on postpartum day 11. Her symptoms progressed to include shortness of breath, tachycardia, tachypnea and edema. She was diagnosed with postpartum cardiomyopathy and bronchial asthma exacerbation. Over her hospital stay her symptoms improved with diuretic and cardiac medications. However, on day 3 she experienced a seizure with headache and pallor.
The document describes a case of acute chest syndrome in a 13-year old male patient with sickle cell anemia. He presented with fever, cough, chest pain, and respiratory distress. Imaging showed infiltrates in both lungs. He required intubation and mechanical ventilation for respiratory failure and developed pneumothoraces requiring chest tubes. After 7 days of intensive treatment his condition was stabilizing.
This patient is a 32-year-old male who presented with intermittent right chest stabbing pain since November 29th. He had a history of COVID-19 infection in September 2021. Imaging showed signs suggestive of chronic pulmonary embolism including Hampton's hump on CXR and enlargement of the right pulmonary artery on CT scan. Echocardiogram also supported chronic thromboembolic pulmonary hypertension. He was treated with 5 days of enoxaparin and then switched to dabigatran. Further workup was suggested to investigate possible causes of thrombophilia. The duration of anticoagulation in chronic thromboembolic pulmonary hypertension is indefinite to prevent recurrent pulmonary embolism.
Non small cell carcinoma, squamous cell carcinoma,DrAmbikaGupta
The 62-year-old female presented with cough, hemoptysis, left-sided chest pain, and shortness of breath for several months. Her history of chronic smoking and findings on examination and investigations led to a provisional diagnosis of left lung mass, most likely lung carcinoma. A biopsy confirmed squamous cell carcinoma of the left lower lobe of the lung. Further workup was needed to determine staging and treatment planning.
This document presents a case study of a 36-year-old man admitted to the hospital with fever, abdominal pain, and lack of appetite. Initial tests showed jaundice and liver abnormalities. Further evaluation found a liver abscess. The patient was treated but had a similar prior illness in Malaysia. Tests identified the cause as melioidosis, a tropical disease caused by the bacterium Burkholderia pseudomallei. The patient received long-term antibiotic treatment and follow-up showed the infection had resolved. The presentation discusses the epidemiology, pathogenesis, diagnosis and treatment of melioidosis.
A 4-year-old Filipino boy presented with fever and joint pain for 2 weeks. Physical exam found swelling of both ankles and knees with slight limitation of movement. Tests showed leukocytosis and elevated ASO and ESR levels. He was diagnosed with rheumatic fever based on meeting major Jones criteria of polyarthritis and minor criteria of fever, leukocytosis and elevated ESR. He was treated with antibiotics and aspirin and showed improvement before discharge.
This case presentation describes a 35-year-old male with sickle cell disease (SCD) presenting with shortness of breath. He has a history of end stage renal disease requiring dialysis and obstructive jaundice from gallbladder stones. On examination, he has jaundice and lower extremity edema. Investigations show abnormal renal and liver function tests. Dyspnea in SCD can be caused by acute chest syndrome, pulmonary hypertension, asthma, pulmonary fibrosis, or venous thromboembolism. SCD is also associated with renal complications like acute kidney injury, proteinuria, and focal segmental glomerulosclerosis.
The morning report summarizes the physician in charge, consultations, patients in the HCU and ER. It includes the chief complaint, history of present illness, past medical history, family history and social history for a patient based on their autoanamnesis and heteroanamnesis. It also summarizes the physical examination, laboratory and test findings such as chest x-ray, ECG, and abdominal ultrasound. The POMR section analyzes the patient's problems, develops diagnoses and treatments, and discusses management, social considerations, the patient's condition, and prognosis.
This document contains a morning report from a hospital that includes:
- The physician and consultants on duty
- A summary of a patient's history, examination, lab results, imaging studies, and problem oriented medical record
- An analysis of the patient's problems, risk factors, pathophysiology, diagnosis, management, and prognosis
The document appears to be a report submitted by a student, Souvik Bera, for their internship in the Department of Emergency and OPD at Narayan Memorial Hospital. It includes 5 case studies with provisional diagnoses of UTI, LRTI, acute myocardial infarction, CVA, and AGE. For each case, the patient's history, examination findings, investigations, management, and advice are described. The internship summary discusses the areas of training covered, including history taking, patient monitoring, examinations, basic management, counseling, and BLS.
1. A 63-year-old man presented with blunt chest trauma after being hit by a bull, complaining of right lower chest pain and vomiting. Examination found abrasions over his ribs with crepitus and tenderness. Imaging showed a liver laceration and hemoperitoneum.
2. A 65-year-old hypertensive and diabetic man presented with right chest wall pain after a fall from his bike. Examination found step deformity and crepitus over his right ribs. Imaging showed multiple right rib fractures and a small right hemothorax.
3. Both patients were managed conservatively with analgesics, blood transfusions, antibiotics, bed rest, and physiotherapy. Their symptoms improved with
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
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This document describes the case of a 24-year-old intravenous drug user who presented with a 15-day history of fever, malaise, and shortness of breath for 7 days. On examination, he was found to be pale with a heart murmur. Investigations showed anemia, hepatitis C, and HIV positivity. Echocardiography revealed vegetation on the tricuspid valve. He was diagnosed with right-sided infective endocarditis and treated with antibiotics.
This document summarizes the morbidity and mortality conference of a 20-year-old female patient who was admitted for difficulty breathing on postpartum day 11. Her symptoms progressed to include shortness of breath, tachycardia, tachypnea and edema. She was diagnosed with postpartum cardiomyopathy and bronchial asthma exacerbation. Over her hospital stay her symptoms improved with diuretic and cardiac medications. However, on day 3 she experienced a seizure with headache and pallor.
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4. HISTORY OF PRESENT ILLNESS
3 Month before admission
Shortness of breath since 3 months before admission to the hospital. The
shortness of breath worsens when the sleeping position is tilted to the right
(+), worsens with activity (-). shortness of breath is felt to come and go.
wheezing (-). History of using breath lozenges (-). The patient is
comfortable sleeping with 1 pillow.Cough (+). Dry cough (+) has been
coming and going for 3 months. coughing up blood (-). history of coughing
up blood (-).Pain on the right side of the chest (+) no pain radiating. Pain is
felt when sleeping on your right side.Fever (-). summer fever (-). decreased
appetite (+). nauseous (-). vomit (-). weight loss (+) has been 3 months from
35 kg to 30 kg. Defecation and urination no complaints
5. HISTORY OF PAST ILLNESS
⮚ History of Tuberculosis Drug : (-)
⮚ History of DM : (-)
⮚ History of heart disease : (-)
⮚ History of Cerebrovaskular : (-)
⮚ History of malignancy : (-)
6. HISTORY OF SOCIOECONOMIC
⮚ Occupation : farmer
⮚ History of smoking : passive smoker
⮚ History of noxious gas exposure : firewood smoke (+) it's been 40 years
⮚ History of living near industrial area : -
⮚ History of family with TB patient : -
⮚ History of contact with patien COVID-19 : -
⮚ Hobby : -
⮚ Habits : -
⮚ Vaccine : 3x with ?
7. HISTORY OF HOSPITALIZATION
• History of staying at Aisyiyah Hospital and
2x Thorax Photos and 1x Ultrasound
• History Evacuation puncture of right pleural
fluid as much as 700 cc brownish yellow in
Aisiyah Hospital
27-29 Juli 2022
9. History of anti tuberculosis drug
Month/Years Bacterologic
examination
Regimen Place/ Specialist Duration Outcome
10. Physical Examination General condition : moderate illness
Leverl of consciousness : fully allert
Vital sign
▪ Blood pressure : 112/89 mmHg
▪ Heart Rate : 83 beats per minute, regular, fill and pressure
enough
▪ Respiration rate : 20 times per minute,
▪ Temprature : 36.1oC axillary
▪ SpO2 : 97% dengan O2 room air
▪ qSOFA : 0
▪ SOFA score : 0
▪ VAS : 2 (Right back and right arm pain))
▪ SIRS : 0
▪ NEWS : 0
▪ MEWS : 0
▪ Height : 156 cm
▪ weight : 30 kg
▪ BMI : 12,34 kg/m2
▪ Nutritional status : underweight
regular, fill and pressure enough
11. Physical Examination
Head : Deformity (-)
Eye : Pale conjunctiva (-/-), icteric sclera (-/-)
Neck : Lymphadenopathy (-), JVP upgrade (-), swelling of the
cheek and neck (-)
Cor : Heart sound I & II regular, Murmur (-), Gallop (-)
Thorax : Asymetrical chest (-), Retraction (-), Venectation (-),
pain (-).
Abdomen : Bowel sound degression, supel, tympany (+),
distension abdomen (-)
Extremitas : Edema (-/-), cold extremities (-), Cappilary reffil time <2s
12. ANTERIOR LUNG
EXAMINATION
Pulmo Anterior Right Left
Inspection Right chest expansion decreased compared to left
Palpation Tactile fremitus right descends from left
Percusion Dullness from ICS IV
below
Sonor
Auscultation
Basic sound
Additional sounds
- Ronchi
- Wheezing
- Bronchophony
- Egophony
- Whisper pectoriloquy
Vesicular base (+) sound
decrease from ICS IV
below
(-)
(-)
(-)
(+)
(-)
Vesicular base (+)
(-)
(-)
(-)
(-)
(-)
13. POSTERIOR LUNG
EXAMINATION
Pulmo Posterior Right Left
Inspection Right chest expansion decreased compared to left
Palpation Tactile fremitus left decreased compared to right
Percusion Dullness from ICS IV
below
Sonor
Auscultation
Basic sound
Additional sounds
- Ronchi
- Wheezing
- Bronchophony
- Egophony
- Whisper pectoriloquy
Vesicular base (+) sound
decrease from ICS IV
below
(-)
(-)
(-)
(+)
(-)
Vesicular base (+)
(-)
(-)
(-)
(-)
(-)
15. Analisis
PLEURAL FLUIDS
(8/8/2022)
diagnostic proof was
carried out on SIC V
right posterior axillary
line, the result was
xerosantocrome colored
fluid
Color : Yellow
Clarity : Cloudy
Clot : there is a clot
Quantitative protein : 3,4 g/dL
Glucose : 100 mg/dL
LDH : 695 U/L
Number of cells : 433 /Ul
Count MN cell type : 69%
Calculate PMN type : 31%
1. Protein PLEURAL FLUIDS / serum > 0,5
2. LDH PLEURAL FLUIDS / serum > 0,6
3. LDH PLEURAL FLUIDS > 2/3 upper limit of normal
value serum LDH
Results : xerosantocrome
20. LIST OF PROBLEMS
Shortness of breath since 3 months
• I: right chest expansion decreased compared to leftP:
fremitus palpation of the right chest decreases from
the leftQ: Dim in SIC IV and below / SonorA: Vesicular
base sound decreased in SIC IV downwards/ Vesicular
base sound (+), RBK (-/-), Whz (-/-), egophony (+/-)
• USG shows : fluid images
• chest radiograph :
• diagnostic puncture :
21. LIST OF PROBLEMS
• passive smoker
• Chronic respiratory complaints
risk factors for
malignancy
systemic symptoms
• decreased appetite (+)
• weight loss (+) has been 3 months, has
been 3 months from 35 kg to 30 kg.
23. DIAGNOSIS
• Malignant pleural effusion adenocarcinoma mutase type EGFR
(?) PS 70-80
• Ca metastases in the lung dd primary in the lung
• with underweight problem
25. DIAGNOSTIC PLAN
• Evacuate pleural fluid with WSD
• Pleural Fluid Cytology
• MSCT Thorax contrast when fluid is minimal
• Bronchoscopy
• TTNA whenever possible
• Consul of the Invasive Division
• Clinical Nutrition Consul
26. Follow up day 1 (8/8/2022)
S O A P
Shortness
of breathe
General condition: moderetely
ill, CM
TD : 118/70 mmHg
HR : 78 x/menit
RR : 20 x/menit
T : 36,1°C
SpO2 : 98% O2 room air
Lung examination
•I: right chest expansion
decreased compared to left
•P: fremitus palpation of the
right chest decreases from the
left
•P: Dim in SIC IV and below /
Sonor
•A: Vesicular base sound
decreased in SIC IV
downwards/ Vesicular base
sound (+), RBK (-/-), Whz (-/-),
egophony (+/-)
• Malignant pleural effusion
adenocarcinoma mutase
type EGFR (?) PS 70-80
• Ca metastases in the lung
dd primary in the lung
• with underweight problem
Therapy plan :
•O2 2-3 lpm NK
•Diet TKTP 1700 kkal
•Infus NaCL 0,9 % 20 tpm
•Paracetamol 4x650 mg
Diagnostic plan :
•Evacuate pleural fluid with WSD
•Pleural Fluid Cytology
•MSCT Thorax contrast when fluid is
minimal
•Bronchoscopy
•TTNA whenever possible
•Consul of the Invasive Division
•Clinical Nutrition Consul