2020年南區胸腔病例討論會
摘要課程表
地 點:阮綜合醫院 B棟十樓大教室
地 址:高雄市苓雅區成功一路162號 連絡人:
內科部曾玲雯07-3351121#3075
林莞茹專科護理師07-3351121#2258
場次 |
會議日期 |
時間 |
主持人 |
1 |
2020年11月11日 |
15:00〜17:00 |
梁宇峰、楊明泉等 |
2 |
2020年12月09日 |
15:00〜17:00 |
梁宇峰、楊明泉等 |
場次1
15:00-15:30討論病例
Name: 方xx
Age : 36 years old woman
Chart NO: 102XX22
C/C : Presented of fever on and off for about one week
Past history :
-Mitral and tricuspid prolapse for about 3 years (高榮 treatment)
Operation history:
-C/S x I, 2 years ago
家族史:
grandfather : Diabetes mellitus
grandmother:Lymphoma
旅遊史:
嘉義市區 (2020/02/13~02/14)
高雄西子灣 (02/19) : 巧遇鳥聚
個人病史:
[Personal History]--> Occupation:Housewife Education:senior-high Marital status:married Exercise:occasional Alcohol:no Tobacco:no Coffee:no Tea:occasional Betel nut:no Drugs:no Allergy:never
動物接觸史:狗;鳥類
理學發現:
[Vital Sign]--> BH:無測量 cm BW:無測量 kg Temp:36.5 度C BP:118/65 mmHg PR:93 /min RR:19 /min
[General appearance]--> Consciousness:alert GCS:(E4V5M6 ) Development:normal Nourishment:well
[Ear]--> EEC:clear Hearing:normal
[Throat]--> Tonsil:normal Tongue:normal Pharynx:normal Mouth floor:normal
[Nose]--> Discharge:no
[Thyroid]--> Size:non-palpable
[Eye]--> Conjunctiva:pink Sclera:not icteric Pupil size, R't:3mm Pupil size, L't:3mm Light reflex (R/L):+/+
[Lymph Node]--> Cervical:non palpable Axillary:non palpable Inguinal:non palpable
[Chest]--> Contour:normal Percussion:reasonant Breathing sound:crackles Heart beat:regular Heart sound:no murmur
[Abdomen]--> Liver:non palpable Spleen:non palpable Mass:no Tenderness:no Bowel Sound:normal Rigidity:non Ascites:non Distension:mild
Hernia:normal
[Spine & Extremities]--> Upper extremities:normal Lower extremities:normal
入院經過:
According to the statment of patient. This 36 years-old female has past history of Mitral and tricuspid prolapse for about 3 years. Now follow up in our OPD. She suffered from presented of fever on and off for about one week. She came to local clinic, give Ostelmivir 1# bid x 5days use, but symptoms persisted. It's also assoicated with severe cough with SOB, myalgia develops after severe cough, sorethroat, rhinorrhea, hoarseness and headaceh. Dull pain around the navel, nausea, vomit and diarrhea was told, too. Therefore she was sent to our ER. At ER, Lab data showed elevated CRP. Chest x-ray showed Air space infiltration in right lower lung, consistent with pneumonia, then was suggested to admit. The physical examination and associated symptoms included chest breath sound: crackle in right lower lung; Heart sound: regular without murmur; Abdomen : soft and ovoid, no tenderness or muscle guarding, mild distension. There was no chest tightness, chest pain, acid regurgitation, hiccup, bloody or coffee ground vomitus, flank pain, dysuria, skin rash nor petachiae. Under the impression of pneumonia and Urinary tract infection, she was admitted for further evaluation and management.
15:30-16:00討論病例
Name: xx
Age : 61 year old men
Chart NO: 47XX00
C/C : 主訴: unsteady gait and slurr speech,dysuria and poor memory and unable to walk wellfor 3 months ago.
Past history :
1. DM (-), HTN (-)
OP history: Nil
OPD medications: Nil
家族史 : Nil (no lung cancer in his relative)
個人病史:
DM(-)
Hypertension(-)
Heroin abuse for several years
Op history: Perforated peptic ulcer s/p primary repair of Perforated duodenal ulcer in 2008
Allergy: denied
家族史:
The family history was unremarkable.
旅遊史:Denied
個人病史:
[Personal History]--> Occupation:Worker
Education:elementary
Marital status:married
Exercise:no
Alcohol:no
Tobacco:regular, 0.5PPD/day
Coffee:no Tea:no
Betel nut:no
Drugs:heroin abuse
Allergy:never
動物接觸史:無
理學發現:
[General appearance]--> Consciousness:alert GCS:(E4V5M6 ) Development:normal Nourishment:well
[Ear]--> EEC:clear Hearing:normal
[Throat]--> Tonsil:normal Tongue:normal Pharynx:normal Mouth floor:normal
[Nose]--> Discharge:no
[Thyroid]--> Size:non-palpable Nodule:non
[Eye]--> Conjunctiva:not anemic Pupil size, R't:2mm Pupil size, L't:2mm Light reflex (R/L):+/+
Shape:regular
[Lymph Node]--> Cervical:non palpable
[Neck]--> Neck:supple
[Chest]--> Contour:normal Percussion:reasonant Breathing sound:clear Heart beat:regular Heart sound:no murmur
[Abdomen]--> Liver:non palpable Spleen:non palpable Mass:no Tenderness:no Bowel Sound:normal Ascites:non Distension:no
[Spine & Extremities]--> Spine:normal Upper extremities:normal Lower extremities:normal Nail:normal
入院經過:
A63-year-old male patient got unsteady gait and slurr speech,dysuria for 3 months ago.
To checked his left lower limb weakness and poor memory was noted.incontinence(-);flank pain.(-);unsteady gait(+)but he denied fell down recently 3 months.Image of L-spine A-P and lateral: L5 spondylolithesis Grade 1. Poor memory and unable to walk well; L-spine MRI: L5 spondllolithesis grade 1 with L3,4,5 spinals tenosis. Brain CT revealed: Bilateral frontal matestases .S.L.R.T.:right leg about 60 degree; left one about 60 degree.Under impression of : Bilateral frontal matestases ; he admitted for further evaluation and management.
16:00-16:30討論病例
Name: 陳x德
Age : 67year old men
Chart NO: 114XX96
C/C : General weakness, feverish in recent 2 days.
Past history :
1.H/T(+).
2.Tongue CA(+) s/p op.
家族史:Nil.
旅遊史:Nil.
個人病史:
[Personal History]-->
Occupation:Others
Education:elementary
Marital status:married
Exercise:no
Alcohol:no
Tobacco:no
Coffee:no
Tea:no
Betel nut:no
Drugs:no
Allergy:never
動物接觸史:無
理學發現:
[General appearance]--> Consciousness:alert GCS:(E4V5M6 ) Development:normal Nourishment:well
[Ear]--> EEC:clear Hearing:normal
[Throat]--> Tonsil:normal Tongue:normal Pharynx:normal Mouth floor:normal
[Nose]--> Discharge:no
[Thyroid]--> Size:non-palpable Nodule:non
[Eye]--> Conjunctiva:not anemic Pupil size, R't:2mm Pupil size, L't:2mm Light reflex (R/L):+/+
Shape:regular
[Lymph Node]--> Cervical:non palpable
[Neck]--> Neck:supple
[Chest]--> Contour:normal Percussion:reasonant Breathing sound:clear Heart beat:regular Heart sound:no murmur
[Abdomen]--> Liver:non palpable Spleen:non palpable Mass:no Tenderness:no Bowel Sound:normal Ascites:non Distension:no
[Spine & Extremities]--> Spine:normal Upper extremities:normal Lower extremities:normal Nail:normal
入院經過:
This 67years-old male patient has been a victim of Tongue cancer s/p op and Hypertension irregular follow up for years. He was just discharged from our Infectious diseases ward on 2020/06/18 under the diagnosis of Septic shock and Small cell carcinoma of right lower lung, complicated with Multiple mediastinal lymphadenopathy and Multiple liver metastasis.
This time, he was admitted for the first time chemotherapy will be arranged. The physical examination and associated symptoms included chest breath sound: clear in bilateral lung field; Heart sound: regular without murmur. There was no fever, cold sweating, myalgia, short of breath, sorethroat, rhinorrhea, nasal obstruction, chest tightness, chest pain, poor appetite, nausea, vomiting, flank pain, dysuria. Under the impression of Small cell carcinoma of right lower lung. he was admitted for further evaluation and management.
This 67y/o male patient has Tongue CA s/p op and H/T with irregular F/U for years. This time, due to Septic shock, r/o atypical infection related, he was admitted to ICU for further evaluation and treatment.
In 2-ICU, antibiotics therapy with Cefepime inj. 2000mg q12h was shifted to Ceftriaxone 2000gmn q12h for possible bacterial infections.
Vasopressor (Dopamine => Levophed) for unstable blood pressure. Intravenous steroid were used (Hydrocortisone 50mg q6h). On 6/4, chest CT revealed: 1.In favor of lung cancer in right lower lobe with bilateral mediastinal lymph node metastases. T1cN3. 2.Dependent atelectasis in both lower lobes. (6/5)Abdomen sono revealed Hepatic tumors over both lobes, r/o metastasis. On 6/5, unstable cardiac enzymes level (2020/06/04 CK-MB(mass)=15.2 ng/mL; CK=505 U/L; Troponin I(AMI≧0.5)=1.482 ng/mL => 06/05 Troponin I(AMI≧0.5)=1.821 ng/mL; CK-MB(mass)=11.7 ng/mL; CK=222 U/L; ), suspect infective myocarditis. Consulted 心臟內科 Dr.楊惠中, and LVEF: 69.3% was noted-->sepsis related myocarditis. On 6/5, 通報恙蟲病, Q熱, 地方性斑疹傷寒, 鉤端螺旋體病(Q-fever was NEGATIVE, others 二採). Zantac 50mg ivp q8h to prevent stress ulcer.
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