主辦 / 主持人
阮綜合醫療社團法人阮綜合醫院胸腔內科、胸腔外科
積分
B類 1 分
分類
未分類
聯絡人
阮綜合醫療社團法人阮綜合醫院 07-3351121 ext 3075
活動日期
2020-11-11 (三) 15:00 ~ 17:00
地點
阮綜合醫療社團法人阮綜合醫院B棟十樓大教室
說明

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: 

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: 

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, 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.

 


摘要檔案: 場次一2020南區胸腔病例討論會摘要1006.doc
2020-11-11 阮綜合醫療社團法人阮綜合醫院B棟十樓大教室
時間主題
沒有資料