--- a +++ b/datasets/labelled_data/PROCEDURE/all.conll @@ -0,0 +1,18319 @@ +Patient O +presents O +with O +glaucoma O +, O +characterized O +by O +a O +definitive O +diagnosis O +of O +pigmentary O +glaucoma O +. O +Intraocular O +pressure O +measures O +at O +15 O +mmHg O +, O +while O +the O +visual O +field O +remains O +normal O +. O +Visual O +acuity O +is O +recorded O +as O +20 O +50 O +. O +The O +patient O +has O +not O +undergone O +prior O +cataract B-PROCEDURE +surgery I-PROCEDURE +, O +but O +has O +had O +LASIK B-PROCEDURE +surgery I-PROCEDURE +. O +Additionally O +, O +comorbid O +ocular O +diseases O +include O +macular O +degeneration O +. O + +Patient O +has O +been O +diagnosed O +with O +primary O +open O +angle O +glaucoma O +. O +The O +patient O +'s O +intraocular O +pressure O +is O +a O +concern O +and O +needs O +monitoring O +. O +There O +is O +moderate O +damage O +observed O +in O +the O +patient O +'s O +visual O +field O +. O +The O +visual O +acuity O +is O +recorded O +at O +0 O +. O +3 O +. O +The O +patient O +has O +not O +undergone O +prior O +cataract B-PROCEDURE +surgery I-PROCEDURE +or O +LASIK B-PROCEDURE +surgery I-PROCEDURE +. O +The O +presence O +of O +corneal O +edema O +, O +along O +with O +glaucoma O +, O +suggests O +comorbid O +ocular O +diseases O +. O +The O +definitive O +diagnosis O +is O +primary O +open O +angle O +glaucoma O +, O +and O +the O +patient O +'s O +ocular O +health O +requires O +close O +attention O +due O +to O +the O +combination O +of O +factors O +mentioned O +. O + +The O +patient O +has O +been O +diagnosed O +with O +glaucoma O +, O +specifically O +primary O +open O +angle O +glaucoma O +POAG O +. O +Their O +intraocular O +pressure O +measures O +at O +48 O +mmHg O +, O +indicating O +elevated O +pressure O +within O +the O +eye O +. O +The O +patient O +exhibits O +advanced O +glaucomatous O +field O +damage O +in O +their O +visual O +field O +, O +and O +their O +visual O +acuity O +is O +recorded O +at O +20 O +150 O +. O +Notably O +, O +the O +patient O +has O +undergone O +prior O +cataract B-PROCEDURE +surgery I-PROCEDURE +. O +However O +, O +they O +have O +not O +had O +LASIK B-PROCEDURE +surgery I-PROCEDURE +. O +In O +addition O +to O +glaucoma O +, O +the O +patient O +also O +presents O +with O +comorbid O +ocular O +diseases O +, O +including O +diabetic O +retinopathy O +. O + +Patient O +presents O +with O +uveitic O +glaucoma O +as O +the O +definitive O +diagnosis O +. O +Intraocular O +pressure O +measures O +at O +28 O +mmHg O +. O +Visual O +field O +assessment O +indicates O +early O +field O +damage O +. O +Visual O +acuity O +is O +measured O +at O +20 O +30 O +. O +No O +prior O +history O +of O +cataract B-PROCEDURE +surgery I-PROCEDURE +or O +LASIK B-PROCEDURE +surgery I-PROCEDURE +. O +Notably O +, O +patient O +also O +presents O +with O +comorbid O +ocular O +disease O +, O +specifically O +macular O +edema O +. O + + +The O +patient O +presents O +with O +neovascular O +glaucoma O +, O +as O +evidenced O +by O +an O +intraocular O +pressure O +of O +22 O +mmHg O +. O +Visual O +field O +assessment O +indicates O +normal O +results O +, O +and O +the O +visual O +acuity O +is O +measured O +at O +0 O +. O +2 O +. O +The O +patient O +has O +undergone O +prior O +cataract B-PROCEDURE +surgery I-PROCEDURE +but O +has O +not O +had O +LASIK B-PROCEDURE +surgery I-PROCEDURE +. O +There O +is O +no O +information O +available O +about O +comorbid O +ocular O +diseases O +. O + + + + + + + + + + +The O +patient O +, O +diagnosed O +with O +breast O +cancer O +, O +has O +undergone O +a O +definitive O +diagnosis O +. O +HER2 O +status O +is O +positive O +, O +while O +information O +about O +hormone O +receptors O +is O +not O +specified O +. O +The O +patient O +has O +not O +received O +prior O +chemotherapy O +or O +radiotherapy O +. O +No O +prior O +mastectomy B-PROCEDURE +has O +been O +performed O +The O +patient O +'s O +performance O +status O +is O +ECOG O +1 O +. O + +The O +patient O +'s O +definitive O +diagnosis O +is O +stage O +III O +breast O +cancer O +. O +HER2 O +status O +is O +negative O +, O +while O +hormone O +receptor O +status O +is O +ER O +and O +PR O +. O +The O +patient O +has O +undergone O +neoadjuvant O +chemotherapy O +and O +prior O +stereotactic O +radiotherapy O +. O +A O +prior O +mastectomy B-PROCEDURE +has O +been O +performed O +. O +Surgery O +related O +therapy O +included O +neoadjuvant O +chemotherapy O +. O +The O +patient O +'s O +performance O +status O +is O +ECOG O +2 O +. O + +The O +patient O +'s O +breast O +cancer O +is O +at O +stage O +2 O +. O +The O +HER2 O +status O +is O +positive O +, O +while O +hormone O +receptors O +PR O +and O +ER O +are O +negative O +. O +The O +patient O +hasn O +' O +t O +undergone O +prior O +chemotherapy O +, O +but O +has O +received O +prior O +radiotherapy O +. O +Mastectomy B-PROCEDURE +has O +not O +been O +performed O +previously O +. O +The O +patient O +'s O +performance O +status O +is O +Karnofsky O +70 O +. O + +The O +patient O +has O +been O +diagnosed O +with O +stage O +IV O +breast O +cancer O +. O +The O +cancer O +is O +HER2 O +positive O +and O +hormone O +receptor O +positive O +for O +PR O +. O +The O +patient O +has O +undergone O +prior O +chemotherapy O +and O +radiotherapy O +treatments O +. O +A O +mastectomy B-PROCEDURE +has O +also O +been O +performed O +previously O +. O +The O +treatment O +approach O +included O +neoadjuvant O +chemotherapy O +in O +relation O +to O +surgery O +. O +The O +patient O +'s O +performance O +status O +is O +ECOG O +3 O +, O +with O +a O +Karnofsky O +score O +of O +50 O +. O + + + + + + + + + + + + +The O +patient O +'s O +definitive O +diagnosis O +is O +sickle O +cell O +anemia O +SS O +genotype O +. O +A O +blood B-PROCEDURE +transfusion I-PROCEDURE +was O +administered O +one O +week O +ago O +. O +The O +hemoglobin O +level O +is O +currently O +5 O +. O +8 O +g O +dL O +. O +The O +patient O +'s O +last O +vaso O +occlusive O +crisis O +occurred O +two O +months O +ago O +. O +There O +is O +no O +history O +of O +stroke O +. O + +The O +individual O +has O +been O +diagnosed O +with O +sickle O +cell O +anemia O +SC O +, O +a O +hereditary O +blood O +disorder O +. O +Their O +hemoglobin O +level O +is O +8 O +. O +7 O +g O +dl O +. O +They O +have O +experienced O +five O +vaso O +occlusive O +crises O +in O +the O +last O +12 O +months O +. O +Additionally O +, O +the O +patient O +has O +a O +history O +of O +stroke O +that O +occurred O +12 O +years O +ago O +. O +Blood B-PROCEDURE +transfusion I-PROCEDURE +has O +never O +been O +administered O +to O +this O +patient O +. O + +The O +patient O +has O +been O +diagnosed O +with O +sickle O +cell O +anemia O +SB O +. O +Three O +weeks O +ago O +, O +the O +patient O +received O +a O +blood B-PROCEDURE +transfusion I-PROCEDURE +. O +Their O +current O +hemoglobin O +level O +is O +10 O +. O +5 O +. O +The O +patient O +'s O +last O +vaso O +occlusive O +crisis O +occurred O +six O +months O +ago O +, O +and O +they O +have O +never O +had O +a O +history O +of O +stroke O +. O + +Patient O +has O +been O +diagnosed O +with O +sickle O +cell O +anemia O +. O +Definitive O +diagnosis O +indicates O +the O +presence O +of O +SS O +. O +The O +patient O +received O +a O +blood B-PROCEDURE +transfusion I-PROCEDURE +six O +months O +ago O +. O +Hemoglobin O +level O +is O +recorded O +at O +9 O +. O +0 O +g O +DL O +. O +The O +patient O +'s O +most O +recent O +vaso O +occlusive O +crisis O +occurred O +2 O +years O +ago O +, O +while O +their O +medical O +history O +includes O +an O +ischemic O +stroke O +that O +occurred O +2 O +years O +ago O +. O + +This O +patient O +, O +diagnosed O +with O +sickle O +cell O +anemia O +, O +has O +a O +hemoglobin O +level O +of O +7 O +. O +5 O +g O +dL O +. O +They O +experienced O +a O +vaso O +occlusive O +crisis O +two O +weeks O +ago O +but O +have O +no O +history O +of O +stroke O +. O +Blood B-PROCEDURE +transfusions I-PROCEDURE +have O +not O +been O +required O +in O +their O +medical O +history O +. O + + + + + + + +78 O +M O +transferred O +to O +nursing O +home O +for O +rehab O +after O +CABG B-PROCEDURE +. O +Reportedly O +readmitted O +with O +a O +small O +NQWMI O +. O +Yesterday O +, O +he O +was O +noted O +to O +have O +a O +melanotic O +stool O +and O +then O +today O +he O +had O +approximately O +9 O +loose O +BM O +w O +some O +melena O +and O +some O +frank O +blood O +just O +prior O +to O +transfer O +, O +unclear O +quantity O +. O + +A O +75F O +with O +a O +PMHx O +significant O +for O +severe O +PVD O +, O +CAD O +, O +DM O +, O +and O +CKD O +presented O +after O +being O +found O +down O +unresponsive O +at O +home O +. O +She O +was O +found O +to O +be O +hypoglycemic O +to O +29 O +with O +hypotension O +and O +bradycardia O +. O +Her O +hypotension O +and O +confusion O +improved O +with O +hydration O +. O +She O +had O +a O +positive O +UA B-PROCEDURE +which O +eventually O +grew O +klebsiella O +. O +She O +had O +temp O +96 O +. O +3 O +, O +respiratory O +rate O +22 O +, O +BP O +102 O +26 O +, O +a O +leukocytosis O +to O +18 O +and O +a O +creatinine O +of O +6 O +baseline O +2 O +. O +Pt O +has O +blood O +cultures O +positive O +for O +group O +A O +streptococcus O +. O +On O +the O +day O +of O +transfer O +her O +blood O +pressure O +dropped O +to O +the O +60s O +. O +She O +was O +anuric O +throughout O +the O +day O +. O +She O +received O +80mg O +IV O +solumedrol O +this O +morning O +in O +the O +setting O +of O +low O +BPs O +and O +rare O +eos O +in O +urine O +. O +On O +arrival O +to O +the O +MICU O +pt O +was O +awake O +but O +drowsy O +. O +On O +ROS O +, O +pt O +denies O +pain O +, O +lightheadedness O +, O +headache O +, O +neck O +pain O +, O +sore O +throat O +, O +recent O +illness O +or O +sick O +contacts O +, O +cough O +, O +shortness O +of O +breath O +, O +chest O +discomfort O +, O +heartburn O +, O +abd O +pain O +, O +n O +v O +, O +diarrhea O +, O +constipation O +, O +dysuria O +. O +Is O +a O +poor O +historian O +regarding O +how O +long O +she O +has O +had O +a O +rash O +on O +her O +legs O +. O + +An O +87 O +yo O +woman O +with O +h O +o O +osteoporosis O +, O +multiple O +recent O +falls O +, O +CAD O +, O +who O +presents O +from O +nursing O +home O +with O +C2 O +fracture O +. O +The O +patient O +was O +in O +her O +usual O +state O +of O +health O +at O +her O +nursing O +home O +until O +yesterday O +morning O +when O +she O +sustained O +a O +fall O +when O +trying O +to O +get O +up O +to O +go O +to O +the O +bathroom O +. O +The O +fall O +was O +not O +witnessed O +, O +but O +the O +patient O +reportedly O +did O +not O +lose O +consciousness O +. O +The O +patient O +complained O +of O +neck O +and O +rib O +pain O +. O +She O +was O +taken O +to O +OSH O +, O +where O +she O +was O +found O +to O +have O +a O +comminuted O +fracture O +of O +C2 O +. O +In O +the O +ED O +, O +the O +patient O +'s O +VS O +were O +T O +99 O +. O +1 O +, O +BP O +106 O +42 O +, O +P O +101 O +, O +R O +24 O +. O +She O +had O +an O +ECG B-PROCEDURE +which O +showed O +sinus O +tachycardia O +and O +ST O +depressions O +in O +V3 O +and O +V4 O +. O +CT B-PROCEDURE +head I-PROCEDURE +was O +negative O +for O +ICH O +. O + +An O +82 O +man O +with O +chronic O +obstructive O +pulmonary O +disease O +, O +status B-PROCEDURE +post I-PROCEDURE +bioprosthetic I-PROCEDURE +atrial I-PROCEDURE +valve I-PROCEDURE +replacement I-PROCEDURE +for O +atrial O +stenosis O +, O +atrial O +fibrillation O +with O +cardioversion B-PROCEDURE +, O +right O +nephrectomy B-PROCEDURE +for O +renal O +cell O +carcinoma O +, O +colon O +cancer O +status O +post O +colectomy B-PROCEDURE +, O +presents O +with O +9 O +day O +history O +of O +productive O +cough O +, O +fever O +and O +dyspnea O +. O + +A O +94 O +year O +old O +female O +with O +hx O +recent O +PE O +DVT O +, O +atrial O +fibrillation O +, O +CAD O +presents O +with O +fever O +and O +abdominal O +pain O +. O +Earlier O +, O +she O +presented O +with O +back O +pain O +and O +shortness O +of O +breath O +. O +She O +was O +found O +to O +have O +bilateral O +PE O +'s O +and O +new O +afib O +and O +started O +on O +coumadin O +. O +Her O +HCT O +dropped O +slightly O +, O +requiring O +blood B-PROCEDURE +transfusion I-PROCEDURE +, O +with O +guaic O +positive O +stools O +. O +She O +was O +discharged O +and O +returned O +with O +abdominal O +cramping O +and O +black O +stools O +. O +EGD B-PROCEDURE +showed O +a O +small O +gastric O +and O +duodenal O +ulcer O +healing O +, O +esophageal O +stricture O +, O +no O +active O +bleeding O +. O +She O +also O +had O +an O +abdominal B-PROCEDURE +CT I-PROCEDURE +demonstrating O +a O +distended O +gallbladder O +with O +gallstones O +and O +biliary O +obstruction O +with O +several O +CBD O +stones O +. O + +This O +is O +a O +41 O +year O +old O +male O +patient O +with O +medical O +history O +of O +alcohol O +abuse O +, O +cholelithiasis O +, O +hypertension O +, O +obesity O +who O +presented O +to O +his O +local O +hospital O +with O +hematemasis O +. O +On O +Friday O +evening O +he O +had O +several O +episodes O +of O +vomiting O +of O +bright O +and O +dark O +red O +material O +. O +In O +the O +emergency O +department O +, O +initial O +vs O +were O +T O +98 O +. O +6 O +P66 O +BP145 O +89 O +R16 O +O2 O +sat O +98 O +RA O +. O +He O +was O +started O +on O +a O +protonix B-PROCEDURE +gtt I-PROCEDURE +and O +octreotide B-PROCEDURE +gtt I-PROCEDURE +given O +his O +elevated O +liver O +function O +tests O +. O +Lab O +tests O +show O +elevated O +lipase O +, O +pancytopenia O +and O +coagulopathy O +. O +He O +had O +a O +right O +upper O +abdominal O +quadrant O +ultrasound B-PROCEDURE +which O +demonstrated O +gallstones O +and O +sludge O +and O +ascites O +. O +As O +such O +given O +new O +ascites O +and O +abdominal O +pain O +he O +was O +given O +levofloxacin O +750mg O +IV O +and O +flagyl O +500mg O +IV O +reportedly O +for O +spontaneous O +bacterial O +peritonitis O +prophylaxis O +. O +On O +the O +floor O +, O +he O +reports O +that O +he O +had O +two O +episodes O +of O +vomiting O +of O +dark O +red O +emesis O +. O +Per O +his O +nurse O +it O +was O +about O +75ml O +and O +was O +gastrocult O +positive O +. O +He O +has O +right O +upper O +abdominal O +quadrant O +pain O +radiating O +to O +his O +back O +. O +He O +also O +reports O +slow O +increase O +in O +abdominal O +girth O +with O +more O +acute O +distention O +and O +lower O +extremity O +swelling O +over O +the O +two O +days O +prior O +to O +admission O +. O +The O +patient O +denies O +fever O +, O +chills O +, O +night O +sweats O +, O +headache O +, O +sinus O +tenderness O +, O +rhinorrhea O +or O +congestion O +. O +Denied O +cough O +, O +shortness O +of O +breath O +. O +He O +also O +denied O +chest O +pain O +or O +tightness O +. O + +A O +G2P0010 O +26 O +yo O +F O +, O +now O +estimated O +to O +10 O +weeks O +pregnant O +, O +with O +4yr O +hx O +of O +IDDM O +. O +Last O +menstrual O +period O +is O +not O +known O +but O +was O +sometime O +three O +months O +ago O +. O +Five O +days O +ago O +, O +the O +patient O +began O +feeling O +achy O +and O +congested O +. O +She O +had O +received O +a O +flu B-PROCEDURE +shot I-PROCEDURE +about O +1 O +week O +prior O +. O +She O +continued O +to O +feel O +poorly O +and O +developed O +hyperemesis O +. O +She O +was O +seen O +in O +the O +ED O +but O +not O +admitted O +, O +where O +she O +was O +given O +IVF O +, O +Reglan O +and O +Tylenol O +and O +she O +was O +found O +to O +have O +a O +positive O +pregnancy O +test O +. O +Today O +, O +she O +returned O +to O +the O +ED O +with O +worsening O +of O +symptoms O +. O +She O +was O +admitted O +to O +the O +OB O +service O +and O +given O +IVF O +and O +Reglan O +. O +Of O +note O +, O +her O +labwork O +demonstrates O +a O +blood O +glucose O +of O +160 O +, O +bicarbonate O +of O +11 O +, O +beta O +hCG O +of O +3373 O +and O +ketones O +in O +her O +urine O +. O +Her O +family O +noted O +that O +she O +was O +breathing O +rapidly O +and O +was O +quite O +somnolent O +. O +She O +appears O +to O +be O +in O +respiratory O +distress O +. O + +This O +is O +a O +24 O +and O +2 O +7 O +weeks O +, O +678 O +gm O +male O +, O +born O +to O +a O +34 O +year O +old O +G2 O +, O +P0 O +to O +3 O +woman O +. O +Prenatal O +screens O +were O +O O +positive O +, O +antibody O +negative O +, O +hepatitis O +B O +surface O +antigen O +negative O +, O +RPR O +nonreactive O +, O +rubella O +immune O +, O +and O +GBS O +unknown O +. O +This O +was O +an O +IVF O +pregnancy O +, O +notable O +for O +bleeding O +in O +the O +first O +trimester O +. O +The O +mother O +presented O +to O +the O +Hospital O +on O +the O +morning O +of O +delivery O +with O +premature O +rupture O +of O +membranes O +. O +Betamethasone O +was O +given O +approximately O +18 O +hours O +prior O +to O +delivery O +. O +The O +mother O +was O +also O +started O +on O +ampicillin O +, O +gentamycin O +, O +and O +magnesium O +sulfate O +. O +Mother O +'s O +labor O +progressed O +despite O +magnesium O +and O +she O +developed O +fever O +and O +chills O +. O +Maximum O +temperature O +was O +101 O +. O +2 O +degrees O +. O +Because O +of O +progressive O +labor O +and O +concerns O +for O +chorioamnionitis O +, O +the O +decision O +was O +made O +to O +deliver O +the O +infants O +. O +Delivery O +was O +by O +cesarean B-PROCEDURE +section I-PROCEDURE +. O +The O +infant O +was O +intubated O +in O +the O +Delivery O +Room O +and O +Apgars O +were O +5 O +at O +one O +and O +8 O +at O +five O +minutes O +. O +Examination O +was O +notable O +for O +an O +extreme O +pre O +term O +infant O +, O +intubated O +. O +Weight O +was O +678 O +gm O +. O +Chest O +x O +ray O +shows O +respiratory O +immaturity O +and O +diffuse O +bilateral O +opacities O +within O +the O +lungs O +, O +left O +greater O +than O +right O +, O +with O +increased O +lung O +volumes O +. O + +A O +55y O +o O +F O +with O +sarcoidosis O +, O +COPD O +, O +idiopathic O +cardiomyopathy B-PROCEDURE +with O +EF O +40 O +and O +diastolic O +dysfunction O +, O +varices O +s O +p O +TIPS O +and O +hypothyroidism O +presenting O +today O +with O +confusion O +. O +She O +was O +brought O +to O +the O +ED O +by O +her O +husband O +for O +evaluation O +after O +he O +noted O +worsening O +asterixis O +. O +While O +in O +the O +waiting O +room O +the O +pt O +became O +more O +combative O +and O +then O +unresponsive O +. O +In O +the O +ED O +VS O +Temp O +97 O +. O +9F O +, O +HR O +115 O +, O +BP O +122 O +80 O +, O +R O +18 O +, O +O2 O +sat O +98 O +2L O +NC O +. O +She O +was O +unresponsive O +but O +able O +to O +protect O +her O +airway O +and O +so O +not O +intubated O +. O +She O +vomited O +x1 O +and O +received O +Zofran O +as O +well O +as O +1 O +. O +5 O +L O +NS O +. O +Labs O +were O +significant O +for O +K O +5 O +. O +5 O +, O +BUN O +46 O +, O +Cr O +2 O +. O +2 O +up O +from O +baseline O +of O +0 O +. O +8 O +, O +and O +ammonia O +of O +280 O +. O +Stool O +was O +Guaiac O +negative O +. O +A O +urinalysis B-PROCEDURE +and O +CXR B-PROCEDURE +were O +done O +and O +are O +pending O +, O +and O +a O +FAST B-PROCEDURE +revealed O +hepatosplenomegaly O +but O +no O +intraperitoneal O +fluid O +. O + + +66 O +yo O +female O +pedestrian O +struck O +by O +auto O +. O +Unconscious O +and O +unresponsive O +at O +scene O +. O +Multiple O +fractures O +and O +complication O +secondary O +to O +the O +primary O +injury O +. O +S O +p O +embolization O +of O +the O +avulsed O +second O +branch O +of O +brachial O +artery O +, O +complicated O +by O +exp O +lap O +secondary O +to O +suspicion O +of O +abdominal O +compartment O +syndrome O +. O +Not O +much O +of O +the O +response O +after O +weaning O +the O +sedation O +with O +CT B-PROCEDURE +of O +the O +head O +showing O +extensive O +interparenchymal O +hemorrhages O +throughout O +. O + + +A O +52 O +year O +old O +woman O +with O +chronic O +obstructive O +pulmonary O +disease O +and O +breast O +cancer O +who O +presented O +to O +an O +outside O +hospital O +with O +shortness O +of O +breath O +and O +back O +pain O +for O +several O +weeks O +. O +Had O +been O +seen O +by O +primary O +care O +provider O +for O +the O +back O +pain O +and O +treated O +with O +pain O +medications O +. O +Subsequently O +developed O +rash O +that O +was O +thought O +to O +be O +zoster O +. O +In O +the O +last O +few O +days O +, O +oxygen O +requirement O +increased O +and O +she O +had O +cough O +, O +fevers O +and O +sore O +throat O +. O +Noted O +oxygen O +saturation O +of O +79 O +with O +ambulation O +at O +home O +. O +At O +outside O +hospital O +she O +was O +diagnosed O +with O +" O +multi O +focal O +pneumonia O +. O +" O +In O +the O +process O +of O +obtaining O +a O +computerized O +tomography B-PROCEDURE +scan O +, O +contrast O +infiltrated O +her O +arm O +with O +skin O +blistering O +and O +swelling O +. O +She O +was O +treated O +with O +ceftriaxone O +and O +transferred O +to O +current O +hospital O +. O + +A O +67 O +y O +. O +o O +. O +M O +with O +end O +stage O +COPD O +on O +home O +oxygen O +, O +tracheobronchomalacia O +s O +p O +Y O +stent O +, O +h O +o O +RUL B-PROCEDURE +resection I-PROCEDURE +for O +squamous O +cell O +carcinoma O +with O +Cyberknife O +treatment O +. O +Patient O +had O +Y O +stent O +placed O +complicated O +by O +cough O +and O +copious O +secretions O +requiring O +multiple O +therapeutic O +aspirations O +. O +Last O +bronchoscopy B-PROCEDURE +was O +at O +OSH O +, O +where O +patient O +had O +copious O +secretions O +that O +were O +aspirated O +. O +Pt O +reports O +compliance O +with O +Mucomyst O +nebs O +and O +Mucinex O +. O +Patient O +reports O +decreaed O +appetitie O +, O +50 O +lb O +wt O +loss O +in O +6 O +months O +. O +Decreased O +activity O +tolerance O +. O +Smokes O +5 O +cig O +day O +. O +PET B-PROCEDURE +scan O +revealed O +FDG O +avid O +soft O +tissue O +mass O +adjacent O +to O +lung O +resection O +site O +with O +some O +FDG O +avid O +nodes O +concerning O +for O +recurrence O +. O +On O +arrival O +, O +vitals O +were O +T98 O +. O +6 O +HR86 O +BP106 O +78 O +O289 O +. O +Pt O +denied O +chest O +pain O +, O +palpitations O +, O +trauma O +, O +F O +C O +, O +N O +V O +D O +. O +Pt O +. O +presents O +with O +worsening O +SOB O +with O +R O +shoulder O +pain O +and O +weakness O +. O + + + +A O +40 O +year O +old O +woman O +with O +a O +history O +of O +alcoholism O +complicated O +by O +Delirium O +Tremens O +and O +seizures O +2 O +years O +ago O +, O +polysubstance O +abuse O +ncluding O +IV O +heroin O +, O +cocaine O +, O +crack O +last O +use O +2 O +years O +ago O +, O +heroin O +inhalation O +last O +use O +2 O +days O +ago O +, O +hep O +C O +, O +presents O +for O +voluntary O +admission O +for O +detox B-PROCEDURE +. O +The O +patient O +would O +like O +to O +undergo O +detoxification B-PROCEDURE +so O +she O +can O +take O +care O +of O +her O +children O +. O +She O +also O +complains O +of O +abdominal O +pain O +in O +lower O +quadrants O +, O +radiating O +to O +the O +back O +since O +yesterday O +. O +She O +says O +the O +pain O +has O +worsened O +since O +yesterday O +and O +is O +not O +related O +to O +food O +intake O +. O +She O +also O +complains O +of O +nausea O +, O +vomitting O +bilious O +but O +nonbloody O +, O +and O +diarrhea O +no O +black O +or O +red O +stools O +. O +She O +stopped O +her O +methadone O +1 O +week O +ago O +in O +an O +effort O +to O +quit O +drug O +abuse O +. O +She O +reports O +dyspnea O +on O +exertion O +, O +orthopnea O +. O +Also O +describes O +weight O +gain O +. O +Labs O +are O +significant O +for O +elevated O +lipase O +. O + + + +94M O +with O +CAD O +s O +p O +4v O +CABG O +, O +CHF O +, O +CRI O +presented O +with O +vfib O +arrest O +. O +Initial O +labs O +significant O +for O +K O +2 O +. O +7 O +. O +EKG B-PROCEDURE +showed O +sinus O +rhythm O +, O +HR O +80 O +with O +LAD O +, O +prolonged O +PR O +, O +TD O +0 O +. O +5 O +to O +1mm O +in O +V4 O +V6 O +. O +Echo O +showed O +Mildly O +depressed O +global O +left O +ventricular O +function O +, O +mild O +to O +moderate O +aortic O +regurgitation O +and O +mild O +mitral O +regurgitation O +. O + +A O +63 O +yo O +man O +with O +h O +o O +biphenotypic O +ALL O +, O +now O +Day O +32 O +from O +allogeneic B-PROCEDURE +SCT I-PROCEDURE +, O +who O +presents O +with O +one O +week O +of O +worsening O +SOB O +and O +two O +days O +of O +a O +clear O +productive O +cough O +. O +The O +patient O +states O +his O +SOB O +occured O +when O +lying O +flat O +, O +but O +not O +with O +activity O +. O +Also O +admitted O +to O +chest O +pressure O +which O +would O +come O +and O +go O +in O +his O +left O +chest O +no O +related O +to O +the O +SOB O +. O +Sleeps O +with O +3 O +pillows O +no O +change O +from O +baseline O +, O +denies O +PND O +; O +admits O +to O +a O +slight O +increase O +in O +lower O +extremity O +edema O +. O +Admits O +to O +low O +grade O +fevers O +to O +the O +99 O +'s O +and O +crampy O +abdominal O +pain O +. O +Denies O +chills O +, O +night O +sweats O +, O +vomiting O +, O +or O +diarrhea O +. O +Patient O +also O +has O +a O +history O +of O +CMV O +infection O +, O +aspergillus O +and O +Leggionare O +'s O +disease O +and O +is O +on O +posaconazole O +. O +His O +CXR B-PROCEDURE +showed O +an O +opacification O +of O +the O +left O +basilar O +lobe O +and O +also O +right O +upper O +lobe O +concerning O +for O +pneumonia O +as O +well O +as O +a O +small O +loculated O +right O +pleural O +effusion O +. O + +85M O +dementia O +, O +colon O +cancer O +and O +recent O +colectomy B-PROCEDURE +with O +primary O +reanastomosis B-PROCEDURE +p O +w O +melena O +. O +HCT O +30 O +to O +23 O +but O +hemodynamically O +stable O +. O +NGL O +negative O +. O +Exam O +notable O +for O +Tm O +99 O +BP O +128 O +50 O +HR O +70 O +RR O +16 O +with O +sat O +100 O +on O +RA O +. O +WD O +man O +, O +NAD O +. O +Chest O +clear O +, O +JVP O +8cm O +. O +RR O +s1s2 O +. O +Soft O +abdomen O +, O +well O +healed O +surgical O +scar O +. O +No O +edema O +or O +cord O +. O +Labs O +notable O +for O +WBC O +7K O +, O +HCT O +24 O +, O +K O +4 O +. O +0 O +, O +Cr O +0 O +. O +7 O +. O + +51 O +year O +old O +man O +with O +multiple O +sclerosis O +, O +quadriparesis O +, O +hypertension O +, O +restrictive O +lung O +disease O +, O +chronic O +constipation O +and O +small O +bowel O +obstruction O +after O +ileostomy B-PROCEDURE +, O +multiple O +urinary O +tract O +infections O +also O +after O +placement O +of O +suprapubic O +tube O +, O +presents O +with O +small O +bowel O +obstruction O +and O +urinary O +tract O +infection O +. O +Admitted O +today O +as O +his O +home O +health O +aide O +noticed O +his O +urine O +output O +was O +low O +, O +75cc O +overnight O +when O +he O +usually O +has O +about O +1 O +liter O +overnight O +. O +Over O +the O +past O +two O +weeks O +he O +has O +had O +mild O +earaches O +, O +a O +sorethroat O +as O +well O +as O +some O +rhinorrhea O +. O +He O +denies O +any O +abdominal O +pain O +, O +has O +not O +sujectively O +noticed O +any O +change O +in O +abdominal O +distention O +. O +In O +the O +Emergency O +Department O +, O +he O +was O +noted O +to O +be O +severely O +dehydrated O +on O +exam O +, O +and O +creatinine O +level O +was O +1 O +. O +4 O +up O +from O +0 O +. O +6 O +. O + +The O +patient O +is O +a O +79 O +yoF O +w O +a O +h O +o O +CAD O +s O +p O +RCA B-PROCEDURE +stenting I-PROCEDURE +, O +diastolic O +CHF O +, O +1 O +MR O +, O +HTN O +, O +Hyperlipidemia O +, O +previous O +smoking O +history O +, O +and O +atrial O +fibrillation O +who O +presents O +for O +direct O +admission O +from O +home O +for O +progressive O +shortness O +of O +breath O +. O +According O +to O +Pt O +, O +her O +primary O +complaint O +is O +not O +shortness O +of O +breath O +, O +but O +cough O +X O +1 O +week O +which O +has O +been O +rarely O +productive O +of O +white O +sputum O +. O +She O +denies O +associated O +fevers O +, O +chills O +, O +nausea O +, O +vomiting O +, O +pleuritic O +pain O +, O +weight O +gain O +, O +or O +dietary O +indiscretion O +. O +She O +also O +reports O +a O +sore O +throat O +over O +the O +past O +3 O +days O +. O +She O +recently O +underwent O +thoracentesis B-PROCEDURE +for O +a O +moderate O +size O +pleueral O +effusion O +. O +Cytology O +of O +the O +effusion O +was O +negative O +for O +malignant O +cells O +. O +Pt O +denies O +recent O +palpitations O +, O +and O +reports O +that O +she O +has O +been O +compliant O +with O +all O +medications O +. O +She O +admits O +to O +recent O +fatigue O +and O +2 O +pillow O +orthopnea O +which O +has O +been O +present O +for O +months O +. O +Current O +etiology O +considerations O +include O +CHF O +vs O +intrinsic O +pulmonary O +disease O +infiltrative O +vs O +embolic O +disease O +. O +In O +order O +to O +optimize O +cardic O +function O +with O +atrial O +kick O +, O +pt O +underwent O +cardioversion B-PROCEDURE +and O +became O +hypotensive O +with O +a O +junctional O +rhythm O +requiring O +intubation O +. O +She O +was O +placed O +on O +dobutamine O +. O +Off O +of O +dobutamine O +, O +cardiac O +monitoring O +demonstrated O +a O +long O +QTc O +of O +700 O +and O +an O +atrial O +escape O +rhythm O +. O + +A O +64 O +yo O +female O +with O +with O +history O +of O +atrial O +fibrillation O +, O +Chronic O +Obstructive O +Pulmonary O +Disease O +, O +hypertension O +, O +hyperlipidemia O +, O +repair O +of O +an O +atrial O +septum O +defect O +which O +was O +complicated O +by O +sternal O +wound O +infection O +and O +post O +operative O +atrial O +fibrillation O +treated O +with O +amiodarone O +, O +was O +initially O +admitted O +through O +the O +Emergency O +Department O +with O +shortness O +of O +breath O +and O +back O +pain O +, O +and O +was O +noted O +to O +have O +atrial O +fibrillation O +with O +rapid O +ventricular O +response O +. O +A O +computed B-PROCEDURE +tomography I-PROCEDURE +angiography I-PROCEDURE +demonstrated O +diffuse O +left O +anterior O +descending O +artery O +and O +post O +obstructive O +pneumonia O +concerning O +for O +malignancy O +. O +For O +her O +atrial O +fibrillation O +, O +she O +was O +started O +on O +diltiazem O +. O +For O +the O +pneumonia O +, O +she O +was O +treated O +with O +antibiotics O +. O +She O +was O +then O +transferred O +to O +the O +floor O +later O +that O +same O +night O +on O +metoprolol O +50 O +mg O +tid O +. O +While O +on O +the O +floor O +, O +she O +had O +a O +bronchoscopy B-PROCEDURE +performed O +which O +showed O +external O +compression O +of O +her O +left O +mainstem O +bronchus O +, O +and O +she O +had O +a O +biopsy B-PROCEDURE +via O +fine O +needle O +aspiration O +, O +which O +showed O +large O +cell O +carcinoma O +. O +She O +denies O +chest O +pain O +, O +shortness O +of O +breath O +and O +tachypnea O +. O +She O +does O +note O +some O +diaphoresis O +and O +occasional O +palpitations O +. O + + +A O +96 O +y O +o O +female O +found O +unresponsive O +on O +ground O +at O +nursing O +home O +. O +Pt O +was O +in O +dining O +room O +and O +found O +by O +staff O +. O +Unresponsive O +for O +1 O +min O +after O +found O +. O +Pt O +cannot O +recollect O +events O +preceding O +fall O +but O +with O +some O +c O +o O +HA O +and O +some O +neck O +shoulder O +discomfort O +. O +NCHCT O +showed O +9mm O +L O +parietal O +SDH O +. O +C O +spine O +negative O +. O +Imaging O +CT B-PROCEDURE +head I-PROCEDURE +w O +o O +contrast O +Acute O +left O +subdural O +hematoma O +measuring O +1 O +. O +5 O +cm O +maximal O +dimensions O +with O +leftward O +subfalcine O +herniation O +of O +8 O +mm O +, O +downward O +transtentorial O +herniation O +with O +obliteration O +of O +the O +left O +suprasellar O +cistern O +, O +and O +uncal O +herniation O +. O +No O +fx O +, O +destructive O +infiltrative O +lesion O +involving O +the O +skull O +base O +. O + +85 O +y O +o O +F O +with O +PMHx O +of O +HTN O +, O +HL O +, O +h O +o O +breast O +CA O +and O +3cm O +renal O +pelvis O +transitional O +cell O +tumor O +who O +presented O +for O +nephrectomy B-PROCEDURE +. O +Her O +post O +op O +course O +was O +complicated O +by O +agitation O +thought O +due O +to O +narcotics O +. O +Today O +, O +she O +was O +restarted O +on O +her O +home O +meds O +and O +while O +on O +telemetry O +, O +pt O +was O +noted O +to O +be O +bradycardic O +to O +40s O +. O +Pt O +was O +triggered O +for O +SBP O +of O +70 O +and O +HR O +of O +40 O +during O +which O +she O +remained O +asymptomatic O +. O +She O +was O +given O +1L O +IVF O +and O +her O +HR O +BP O +trended O +back O +up O +to O +baseline O +. O +However O +, O +there O +was O +a O +second O +event O +an O +hour O +later O +when O +she O +sat O +up O +and O +became O +bradycardic O +in O +the O +30s O +with O +associated O +hypotension O +. O +Second O +episode O +occurred O +with O +position O +change O +and O +again O +, O +pt O +developped O +junctional O +rhythm O +in O +30s O +. O + +This O +is O +a O +54 O +year O +old O +male O +patient O +with O +an O +idiopathic O +pulmonary O +fibrosis O +, O +who O +called O +today O +with O +worsening O +dyspnea O +for O +3 O +days O +. O +He O +had O +been O +in O +unusual O +state O +of O +good O +health O +at O +baseline O +respiratory O +status O +using O +4L O +nasal O +canula O +at O +rest O +and O +6L O +with O +exertion O +when O +3 O +days O +prior O +to O +admission O +, O +he O +hugged O +his O +cousin O +who O +has O +rats O +for O +pets O +and O +also O +the O +heat O +came O +up O +from O +the O +basement O +of O +his O +house O +. O +He O +feels O +that O +with O +these O +two O +events O +, O +his O +breathing O +became O +acutely O +worse O +and O +he O +is O +concerned O +for O +allergen O +exposure O +. O +He O +denies O +any O +sick O +contacts O +, O +fevers O +, O +chills O +, O +rhinorrhea O +. O +He O +did O +receive O +flu O +and O +pneumovax O +vaccines O +. O +He O +has O +had O +a O +recent O +admission O +last O +month O +with O +progressive O +dyspnea O +on O +exertion O +. O +The O +computed B-PROCEDURE +tomography I-PROCEDURE +revealed O +increased O +ground O +glass O +opacity O +in O +lower O +lobes O +superimposed O +on O +pulmonary O +fibrosis O +with O +elevated O +eosinophils O +peripherally O +12 O +. O +A O +bronchoalveolar O +lavage O +was O +also O +positive O +for O +eosinophils O +. O +He O +was O +started O +on O +high O +dose O +steroids O +prednisone O +60mg O +with O +plan O +for O +close O +outpatient O +follow O +up O +for O +eosinophilic O +lung O +disease O +. O +He O +was O +discharged O +on O +2 O +3L O +nasal O +canula O +. O +He O +then O +represented O +to O +the O +emergency O +department O +for O +spontaneous O +pneumomediastinum O +of O +unclear O +etiology O +. O +On O +day O +of O +current O +admission O +, O +the O +patient O +called O +his O +pulmonologist O +complaining O +of O +worsening O +shortness O +of O +breath O +since O +Saturday O +. O +Yesterday O +he O +was O +at O +pulmonary O +rehab O +and O +desaturated O +to O +the O +70s O +on O +6L O +with O +minimal O +exertion O +, O +and O +he O +is O +currently O +on O +4L O +nasal O +canula O +at O +rest O +. O +No O +sick O +contacts O +recently O +. O +He O +was O +asked O +to O +go O +to O +ED O +. O +In O +the O +ED O +, O +initial O +vs O +were O +98 O +. O +3 O +, O +96 O +, O +144 O +97 O +, O +24 O +, O +97 O +6L O +NC O +. O + + + + +The O +patient O +is O +an O +87 O +yo O +woman O +with O +h O +o O +osteoporosis O +, O +multiple O +recent O +falls O +, O +CAD O +, O +who O +presents O +from O +nursing O +home O +with O +C2 O +fracture O +and O +evidence O +of O +pulmonary O +emoblus O +. O +The O +patient O +was O +in O +her O +usual O +state O +of O +health O +at O +her O +nursing O +home O +until O +yesterday O +morning O +when O +she O +sustained O +a O +fall O +when O +trying O +to O +get O +up O +to O +go O +to O +the O +bathroom O +. O +The O +fall O +was O +not O +witnessed O +, O +but O +the O +patient O +reportedly O +did O +not O +lose O +consciousness O +. O +At O +3 O +30 O +that O +afternoon O +, O +the O +patient O +complained O +of O +neck O +and O +rib O +pain O +. O +She O +was O +taken O +to O +OSH O +, O +where O +she O +was O +found O +to O +have O +a O +comminuted O +fracture O +of O +C2 O +. O +She O +was O +transferred O +to O +Hospital1 O +1 O +for O +further O +evaluation O +. O +Of O +note O +, O +the O +patient O +was O +recently O +treated O +for O +CDiff O +infection O +at O +her O +nursing O +facility O +, O +per O +discussion O +with O +her O +daughter O +. O +. O +In O +the O +ED O +, O +the O +patient O +'s O +VS O +were O +T O +99 O +. O +1 O +, O +BP O +106 O +42 O +, O +P O +101 O +, O +R O +24 O +. O +She O +had O +an O +ECG B-PROCEDURE +which O +showed O +sinus O +tachycardia O +and O +ST O +depressions O +in O +V3 O +and O +V4 O +. O +CT B-PROCEDURE +head I-PROCEDURE +was O +negative O +for O +ICH O +. O +She O +was O +seen O +by O +Trauma O +surgery O +, O +who O +recommended O +stabalization O +with O +a O +cervical O +collar O +for O +the O +next O +six O +to O +eight O +weeks O +, O +but O +they O +deemed O +that O +she O +is O +not O +an O +operable O +candidate O +. O + +An O +82 O +M O +with O +COPD O +, O +s O +p O +bioprosthetic B-PROCEDURE +AVR I-PROCEDURE +for O +AS O +, O +afib O +s O +p O +CV B-PROCEDURE +, O +right O +nephrectomy B-PROCEDURE +for O +RCC O +, O +colon O +ca O +s O +p O +colectomy B-PROCEDURE +who O +presents O +with O +9 O +day O +hostory O +of O +productive O +cough O +and O +fevers O +. O +light O +of O +stairs O +baseline O +. O +dyspnea O +and O +productive O +cough O +of O +several O +weeks O +. O +Otherwise O +patient O +is O +without O +any O +complaints O +In O +the O +ED O +, O +initial O +vs O +were O +80 O +, O +sbp O +100 O +, O +mid O +90s O +on O +6L O +NC O +. O +Last O +vital O +signs O +prior O +to O +ER O +transfer O +were O +98 O +. O +1 O +, O +83 O +, O +116 O +40 O +, O +20 O +, O +95 O +on O +3L O +NC O +. O +Patient O +looked O +comnfortable O +. O +90 O +room O +air O +, O +INR O +8 O +, O +ABG O +, O +ARF O +, O +2 O +liters O +ivf O +. O +guiac O +brown O +, O +got O +levo O +, O +ceftriaxone O +. O +Physical O +Examination O +General O +Appearance O +No O +acute O +distress O +Eyes O +Conjunctiva O +PERRL O +Head O +, O +Ears O +, O +Nose O +, O +Throat O +Normocephalic O +Cardiovascular O +PMI O +Normal O +, O +S1 O +Normal O +, O +S2 O +Normal O +, O +Murmur O +Systolic O +Peripheral O +Vascular O +Right O +radial O +pulse O +Present O +, O +Left O +radial O +pulse O +Present O +, O +Right O +DP O +pulse O +Present O +, O +Left O +DP O +pulse O +Present O +Respiratory O +Chest O +Expansion O +Symmetric O +, O +Breath O +Sounds O +Crackles O +RLL O +, O +Wheezes O +diffuse O +Abdominal O +Soft O +, O +Non O +tender O +, O +Bowel O +sounds O +present O +Extremities O +Right O +lower O +extremity O +edema O +Absent O +, O +Left O +lower O +extremity O +edema O +Absent O +Skin O +Warm O +Neurologic O +Attentive O +, O +Follows O +simple O +commands O +, O +Responds O +to O +Verbal O +stimuli O +, O +Oriented O +to O +x3 O +, O +Movement O +Purposeful O +, O +Tone O +Normal O + +This O +is O +a O +Age O +over O +90 O +year O +old O +female O +with O +hx O +recent O +PE O +DVT O +, O +atrial O +fibrillation O +, O +CAD O +who O +is O +transfered O +from O +Hospital3 O +915 O +Hospital O +for O +ERCP B-PROCEDURE +. O +She O +has O +had O +multiple O +admissions O +to O +Hospital3 O +915 O +this O +past O +month O +, O +most O +recently O +on O +2963 O +11 O +24 O +. O +In O +early O +Month O +only O +776 O +, O +she O +presented O +with O +back O +pain O +and O +shortness O +of O +breath O +. O +She O +was O +found O +to O +have O +bilateral O +PE O +'s O +and O +new O +afib O +and O +started O +on O +coumadin O +. O +Her O +HCT O +dropped O +slightly O +, O +requiring O +blood O +transfusion O +, O +with O +guaic O +positive O +stools O +. O +She O +was O +discharged O +and O +returned O +with O +abdominal O +cramping O +and O +black O +stools O +. O +She O +was O +found O +to O +have O +a O +HCT O +drop O +from O +32 O +to O +21 O +. O +She O +was O +given O +vit O +K O +, O +given O +a O +blood O +transfusion O +and O +started O +on O +protonix O +. O +She O +received O +an O +IVF O +filter O +and O +EGD O +. O +EGD O +showed O +a O +small O +gastric O +and O +duodenal O +ulcer O +healing O +, O +esophageal O +stricture O +, O +no O +active O +bleeding O +. O +She O +also O +had O +an O +abdominal O +CT B-PROCEDURE +demonstrating O +a O +distended O +gallbladder O +with O +gallstones O +and O +biliary O +obstruction O +with O +several O +CBD O +stones O +. O +Since O +12 O +AM O +Tmax O +38 O +C O +100 O +. O +4 O +Tcurrent O +37 O +. O +4 O +C O +99 O +. O +4 O +HR O +92 O +83 O +94 O +bpm O +BP O +89 O +32 O +54 O +89 O +32 O +54 O +94 O +37 O +60 O +mmHg O +RR O +23 O +23 O +33 O +insp O +min O +SpO2 O +100 O +Heart O +rhythm O +SR O +Sinus O +Rhythm O + +Ms O +. O +Known O +patient O +lastname O +is O +a O +G2P0010 O +26 O +yo O +F O +, O +now O +estimated O +to O +10 O +weeks O +pregnant O +. O +Pt O +has O +4yr O +hx O +of O +IDDM O +. O +LMP O +is O +not O +known O +but O +was O +sometime O +in O +Month O +only O +. O +On O +3243 O +11 O +10 O +, O +the O +patient O +began O +feeling O +achy O +and O +congested O +. O +She O +had O +received O +a O +flu O +shot O +about O +1 O +week O +prior O +. O +She O +continued O +to O +feel O +poorly O +on O +3243 O +11 O +11 O +, O +and O +developed O +hyperemesis O +. O +She O +was O +seen O +in O +the O +ED O +but O +not O +admitted O +at O +Hospital3 O +, O +where O +she O +was O +given O +IVF O +, O +Reglan O +and O +Tylenol O +and O +she O +was O +found O +to O +have O +a O +positive O +pregnancy O +test O +. O +Today O +, O +she O +returned O +to O +the O +ED O +with O +worsening O +of O +symptoms O +. O +She O +was O +admitted O +to O +the O +OB O +service O +and O +given O +IVF O +and O +Reglan O +. O +Of O +note O +, O +her O +labwork O +demonstrates O +a O +blood O +glucose O +of O +160 O +, O +bicarbonate O +of O +11 O +, O +beta O +hCG O +of O +3373 O +and O +ketones O +in O +her O +urine O +. O +Her O +family O +noted O +that O +she O +was O +breathing O +rapidly O +and O +was O +quite O +somnolent O +. O +She O +appears O +to O +be O +in O +respiratory O +distress O +. O +. O +The O +falling O +beta O +HCG O +and O +trans B-PROCEDURE +abdominal I-PROCEDURE +ultrasound I-PROCEDURE +indicate O +intra O +uterine O +fetal O +demise O +. O +Medications O +on O +Admission O +Lantus O +65 O +units O +qAM O +Novolog O +SSI O +Cortef O +3mg O +qAM O +, O +1mg O +qHS O +. O +Meds O +on O +Transfer O +Levophed O +Dopamine O +Solumedrol O +80mg O +IV O +Amiodarone O +load O +Insulin O +in O +D10 O + +Mr O +. O +Known O +patient O +lastname O +7952 O +is O +a O +41 O +yo O +M O +with O +PMH O +ETOH O +abuse O +, O +cholelithiasis O +, O +HTN O +, O +obesity O +who O +presented O +to O +Hospital3 O +with O +hematemasis O +. O +He O +reports O +that O +for O +the O +past O +6 O +years O +he O +has O +been O +drinking O +2 O +9 O +of O +a O +1 O +. O +7L O +bottle O +of O +vodka O +daily O +. O +On O +Friday O +evening O +he O +had O +several O +episodes O +of O +vomiting O +of O +bright O +and O +dark O +red O +material O +for O +which O +he O +presented O +to O +Hospital1 O +. O +He O +had O +an O +NG O +tube O +which O +reportedly O +failed O +to O +clear O +with O +lavage O +and O +patient O +self O +d O +c O +' O +d O +the O +NGT O +because O +he O +was O +vomiting O +around O +the O +tube O +. O +He O +was O +given O +4mg O +IV O +morphine O +for O +abdominal O +pain O +, O +ativan O +2mg O +IV O +for O +withdrawal O +, O +protonix O +40mg O +IV O +, O +zofran O +8mg O +IV O +, O +octreotide O +50mcg O +IV O +, O +and O +1 O +unit O +of O +platelets O +. O +In O +the O +ED O +, O +initial O +vs O +were O +T O +98 O +. O +6 O +P66 O +BP145 O +89 O +R16 O +O2 O +sat O +98 O +RA O +. O +He O +was O +started O +on O +a O +protonix O +gtt O +and O +octreotide O +gtt O +given O +his O +elevated O +LFT O +'s O +. O +He O +was O +also O +given O +a O +bananna O +bag O +. O +He O +had O +a O +RUQ B-PROCEDURE +ultrasound I-PROCEDURE +which O +demonstrated O +gallstones O +and O +sludge O +and O +per O +ED O +resident O +report O +ascites O +. O +As O +such O +given O +new O +ascites O +and O +abdominal O +pain O +he O +was O +given O +levofloxacin O +750mg O +IV O +and O +flagyl O +500mg O +IV O +reportedly O +for O +SBP O +prophylaxis O +. O +He O +was O +evaluted O +by O +GI O +in O +the O +ED O +. O +. O +On O +the O +floor O +, O +he O +reports O +that O +he O +had O +two O +episodes O +of O +vomiting O +of O +dark O +red O +emesis O +. O +Per O +his O +nurse O +it O +was O +about O +75ml O +and O +was O +gastrocult O +positive O +. O +He O +otherwise O +endorese O +RUQ O +pain O +radiating O +to O +his O +back O +. O +He O +also O +reports O +slow O +increase O +in O +abdominal O +girth O +with O +more O +acute O +distention O +and O +lower O +extremity O +swelling O +over O +the O +two O +days O +prior O +to O +admission O +. O +Physical O +Examination O +Vitals O +BP O +153 O +92 O +P O +64 O +R O +20 O +O2 O +97 O +RA O +General O +Alert O +, O +oriented O +, O +no O +acute O +distress O +, O +no O +asterixis O +HEENT O +Sclera O +icteric O +, O +dry O +mucous O +membranes O +Neck O +supple O +, O +obese O +, O +JVP O +not O +elevated O +Lungs O +bibasilar O +crackles O +, O +no O +wheezes O +CV O +Regular O +rate O +and O +rhythm O +, O +3 O +16 O +soft O +nonradiating O +systolic O +murmur O +Abdomen O +obese O +distended O +, O +RUQ O +and O +epigastric O +tenderness O +to O +palpation O +, O +normoactive O +bowel O +sounds O +, O +no O +rebound O +or O +guarding O +. O +Ext O +warm O +, O +well O +perfused O +, O +1 O +pitting O +edema O +bilaterally O +, O +2 O +pulses O +Labs O +WBC O +2 O +. O +5 O +Hct O +36 O +. O +2 O +Plt O +28 O +Cr O +0 O +. O +5 O +Glucose O +111 O +Other O +labs O +PT O +PTT O +INR O +19 O +. O +1 O +31 O +. O +6 O +1 O +. O +7 O +, O +ALT O +AST O +37 O +165 O +, O +Alk O +Phos O +T O +Bili O +130 O +6 O +. O +9 O +, O +Amylase O +Lipase O +145 O +288 O +, O +Albumin O +2 O +. O +5 O +g O +dL O +, O +LDH O +278 O +IU O +L O +, O +Ca O +7 O +. O +9 O +mg O +dL O +, O +Mg O +1 O +. O +7 O +mg O +dL O +, O +PO4 O +3 O +. O +0 O +mg O +dL O + +Infant O +is O +a O +24 O +1 O +31 O +week O +, O +678 O +gm O +male O +triplet O +II O +who O +was O +admitted O +to O +the O +NICU O +for O +management O +of O +extreme O +prematurity O +. O +Infant O +was O +born O +to O +a O +34 O +y O +. O +o O +. O +G2P0 O +now O +3 O +mother O +. O +Prenatal O +screens O +O O +, O +antibody O +negative O +, O +HBsAg O +negative O +, O +RPR O +NR O +, O +RI O +, O +GBS O +unknown O +. O +IVF O +pregnancy O +notable O +for O +bleeding O +in O +the O +first O +trimester O +, O +cerclage O +placement O +at O +19 O +weeks O +, O +and O +premature O +rupture O +of O +membranes O +on O +3435 O +11 O +28 O +am O +. O +Mother O +presented O +to O +Hospital1 O +53 O +. O +Betamethasone O +given O +11 O +28 O +at O +0640 O +. O +Also O +started O +on O +ampicillin O +, O +gentamicin O +, O +and O +magnesium O +sulfate O +. O +Mother O +'s O +labor O +progressed O +despite O +magnesium O +and O +she O +developed O +chills O +and O +a O +fever O +Tm O +101 O +. O +2 O +. O +Due O +to O +progressive O +labor O +and O +concerns O +for O +infection O +, O +decision O +made O +to O +deliver O +infants O +. O +Delivery O +by O +Cesarean B-PROCEDURE +section I-PROCEDURE +. O +Infant O +intubated O +in O +the O +Delivery O +Room O +and O +Apgars O +were O +5 O +at O +one O +and O +8 O +at O +five O +minutes O +. O +Infant O +transported O +to O +NICU O +. O +Exam O +VS O +per O +CareView O +, O +of O +note O +has O +required O +several O +boluses O +of O +NS O +for O +low O +BP O +. O +Exam O +notes O +recorded O +on O +newborn O +examination O +form O +. O +Growth O +measurements O +Wt O +678 O +25 O +. O +Resp O +Infant O +placed O +on O +SIMV O +. O +Rec O +' O +d O +1 O +dose O +of O +surfactant O +. O +CXR O +FINDINGS O +There O +are O +diffuse O +bilateral O +opacities O +within O +the O +lungs O +, O +left O +greater O +than O +right O +, O +with O +increased O +lung O +volumes O +. O +No O +pleural O +effusion O +or O +pneumothorax O +. O +An O +endotracheal O +tube O +is O +seen O +with O +tip O +approximately O +one O +vertebral O +body O +above O +the O +carina O +. O +An O +umbilical O +vein O +catheter O +is O +seen O +with O +tip O +in O +the O +superior O +vena O +cava O +and O +an O +umbilical O +artery O +catheter O +is O +seen O +with O +tip O +in O +the O +mid O +thoracic O +region O +. O +The O +imaged O +portions O +of O +the O +abdomen O +show O +a O +few O +Last O +Name O +un O +36399 O +filled O +loops O +of O +bowel O +within O +the O +left O +abdomen O +. O +No O +abnormal O +soft O +tissue O +mass O +or O +calcifications O +. O +No O +free O +interperitoneal O +air O +. O +The O +imaged O +bony O +structures O +are O +unremarkable O +. O + +The O +patient O +is O +a O +55 O +year O +old O +woman O +with O +hepatic O +sarcoidosis O +and O +regenerative O +hyperplasia O +s O +p O +TIPS B-PROCEDURE +10 O +3245 O +placed O +1 O +27 O +variceal O +bleeding O +and O +portal O +hypertensive O +gastropathy O +s O +p O +TIPS B-PROCEDURE +re O +do O +with O +angioplasty B-PROCEDURE +and O +portal B-PROCEDURE +vein I-PROCEDURE +embolectomy I-PROCEDURE +, O +who O +was O +brought O +to O +the O +ED O +by O +her O +husband O +for O +evaluation O +after O +he O +noted O +worsening O +asterixis O +. O +While O +in O +the O +waiting O +room O +the O +pt O +became O +more O +combative O +and O +then O +unresponsive O +. O +In O +the O +ED O +VS O +Temp O +97 O +. O +9F O +, O +HR O +115 O +, O +BP O +122 O +80 O +, O +R O +18 O +, O +O2 O +sat O +98 O +2L O +NC O +. O +She O +was O +unresponsive O +but O +able O +to O +protect O +her O +airway O +and O +so O +not O +intubated O +. O +She O +vomited O +x1 O +and O +received O +Zofran O +as O +well O +as O +1 O +. O +5 O +L O +NS O +. O +Labs O +were O +significant O +for O +K O +5 O +. O +5 O +, O +BUN O +46 O +, O +Cr O +2 O +. O +2 O +up O +from O +baseline O +of O +0 O +. O +8 O +, O +and O +ammonia O +of O +280 O +. O +Stool O +was O +Guaiac O +negative O +. O +A O +urinalysis O +and O +CXR O +were O +done O +and O +are O +pending O +, O +and O +a O +FAST B-PROCEDURE +revealed O +hepatosplenomegaly O +but O +no O +intraperitoneal O +fluid O +. O +On O +arrival O +to O +the O +ICU O +the O +pt O +had O +another O +episode O +of O +emesis O +. O +NGT O +was O +placed O +to O +suction O +and O +1 O +. O +5L O +bilious O +material O +was O +drained O +. O +Allergies O +Cipro O +Oral O +Ciprofloxacin O +Hcl O +Hives O +; O +Doxycycline O +Hives O +; O +hallucin O +Paxil O +Oral O +Paroxetine O +Hcl O +hair O +loss O +; O +Quinine O +Rash O +; O +Compazine O +Injection O +Prochlorperazine O +Edisylate O +muscle O +spasm O +; O +Levaquin O +Oral O +Levofloxacin O +tendinitis O +of O +t O +Lithium O +Hives O +; O + +Mr O +. O +Name13 O +STitle O +5827 O +is O +an O +80yo O +M O +with O +dementia O +, O +CAD O +s O +p O +CABG B-PROCEDURE +in O +3420 O +LIMA O +LAD O +, O +SVG O +to O +OM2 O +, O +SVG O +to O +RPDA O +, O +then O +s O +p O +CABG B-PROCEDURE +redo O +in O +3426 O +, O +then O +s O +p O +2 O +caths O +this O +year O +with O +patent O +LIMA O +, O +totally O +occluded O +SVG O +to O +RPDA O +, O +SVG O +to O +OM2 O +, O +s O +p O +BMS O +to O +LCX O +on O +1 O +26 O +who O +presented O +to O +Hospital3 O +53 O +Hospital O +with O +increasing O +chest O +pain O +and O +nausea O +over O +the O +past O +few O +days O +. O +Per O +report O +, O +patient O +has O +presented O +several O +times O +since O +last O +cathed O +for O +recurrent O +angina O +. O +Admitted O +to O +Hospital3 O +on O +3436 O +4 O +2 O +with O +recurrent O +chest O +pain O +. O +Ruled O +out O +for O +MI O +. O +Last O +episode O +of O +chest O +pressure O +was O +the O +morning O +of O +transfer O +, O +associated O +with O +dry O +heaves O +and O +belching O +relieved O +with O +morphine O +. O +Pt O +was O +continued O +on O +ASA O +, O +Plavix O +, O +Statin O +, O +BBker O +, O +Imdur O +and O +placed O +on O +Heparin O +gtt O +. O +Cath O +last O +Month O +only O +here O +at O +Hospital1 O +5 O +showed O +a O +patent O +BMS O +in O +LCX O +and O +no O +new O +lesions O +. O +According O +to O +the O +family O +he O +usually O +has O +angina O +once O +every O +day O +or O +two O +, O +but O +for O +the O +past O +2 O +weeks O +he O +has O +been O +having O +angina O +with O +any O +minimal O +exertion O +eg O +putting O +on O +his O +shirt O +, O +and O +waking O +him O +several O +times O +per O +night O +. O + + + + +Mr O +. O +Known O +patient O +lastname O +3887 O +is O +a O +67 O +y O +. O +o O +. O +M O +with O +end O +stage O +COPD O +on O +home O +O2 O +3 O +L O +NC O +, O +tracheobronchomalacia O +s O +p O +Y B-PROCEDURE +stent I-PROCEDURE +, O +s O +p O +RUL B-PROCEDURE +resection I-PROCEDURE +for O +squamous O +cell O +carcinoma O +with O +Cyberknife O +treatment O +in O +2764 O +. O +Patient O +had O +Y O +stent O +placed O +in O +2769 O +1 O +1 O +complicated O +by O +cough O +and O +copious O +secretions O +requiring O +multiple O +therapeutic O +aspirations O +. O +Last O +bronchoscopy B-PROCEDURE +was O +5 O +2769 O +at O +OSH O +, O +where O +patient O +had O +copious O +secretions O +that O +were O +aspirated O +. O +Pt O +reports O +compliance O +with O +Mucomyst O +nebs O +and O +Mucinex O +. O +He O +wears O +O2 O +" O +almost O +" O +24 O +hours O +day O +, O +but O +always O +at O +night O +. O +He O +does O +not O +wear O +his O +CPAP O +. O +Endorses O +inability O +to O +expectorate O +secretions O +and O +having O +" O +full O +feeling O +" O +for O +1 O +7 O +weeks O +. O +Decreaed O +appetitie O +, O +50 O +lb O +wt O +loss O +in O +6 O +months O +. O +Decreased O +activity O +tolerance O +. O +Smokes O +5 O +cig O +day O +. O +PET O +scan O +in O +6 O +12 O +revealed O +FDG O +avid O +soft O +tissue O +mass O +adjacent O +to O +RUL O +resection O +site O +with O +some O +FDG O +avid O +nodes O +concerning O +for O +recurrence O +. O +On O +arrival O +to O +Hospital1 O +17 O +, O +vitals O +were O +T98 O +. O +6 O +HR86 O +BP106 O +78 O +O289 O +. O +Pt O +denied O +chest O +pain O +, O +palpitations O +, O +trauma O +, O +F O +C O +, O +N O +V O +D O +. O +R O +shoulder O +full O +PROM O +, O +limited O +abduction O +on O +active O +ROM O +. O + + + + + + +Mr O +. O +Known O +patient O +lastname O +4075 O +is O +a O +63 O +yo O +man O +with O +h O +o O +biphenotypic O +ALL O +, O +now O +Day O +32 O +from O +allogeneic B-PROCEDURE +SCT I-PROCEDURE +, O +who O +presents O +to O +clinc O +with O +one O +week O +of O +worsening O +SOB O +and O +two O +days O +of O +a O +clear O +productive O +cough O +. O +The O +patient O +states O +his O +SOB O +occured O +when O +lying O +flat O +, O +but O +not O +with O +activity O +. O +Also O +admitted O +to O +chest O +pressure O +which O +would O +come O +and O +go O +in O +his O +left O +chest O +no O +related O +to O +the O +SOB O +. O +Sleeps O +with O +3 O +pillows O +no O +change O +from O +baseline O +, O +denies O +PND O +; O +admits O +to O +a O +slight O +increase O +in O +lower O +extremity O +edema O +. O +Admits O +to O +low O +grade O +fevers O +to O +the O +99 O +'s O +and O +crampy O +abdominal O +pain O +. O +Denies O +chills O +, O +night O +sweats O +, O +vomiting O +, O +or O +diarrhea O +. O +Assessment O +and O +Plan O +Assesment O +This O +is O +a O +63 O +year O +old O +male O +with O +a O +history O +of O +h O +o O +biphenotypic O +ALL O +, O +now O +Day O +32 O +from O +allogeneic B-PROCEDURE +SCT I-PROCEDURE +, O +who O +presents O +with O +hypoxia O +, O +one O +week O +of O +worsening O +SOB O +, O +and O +two O +days O +of O +productive O +cough O +. O +Plan O +Hypoxia O +The O +patient O +developed O +acute O +onset O +of O +hypoxia O +accompanied O +by O +fever O +and O +a O +one O +day O +cough O +with O +sputum O +production O +. O +Given O +that O +the O +patient O +is O +about O +1 O +month O +s O +p O +allogenic B-PROCEDURE +SCT I-PROCEDURE +the O +differential O +is O +broad O +and O +would O +include O +bacterial O +pneumonia O +, O +viral O +pneumonia O +CMV O +, O +flu O +, O +and O +opportunistic O +infections O +including O +fungal O +infections O +. O +Patient O +also O +has O +a O +history O +of O +CMV O +infection O +, O +aspergillus O +and O +Leggionare O +'s O +disease O +and O +is O +on O +posaconazole O +. O +His O +CXR O +showed O +an O +opacification O +of O +the O +left O +basilar O +lobe O +and O +also O +right O +upper O +lobe O +concerning O +for O +pneumonia O +as O +well O +as O +a O +small O +loculated O +right O +pleural O +effusion O +. O +Also O +in O +the O +differential O +is O +noninfectious O +causes O +such O +as O +PE O +, O +CHF O +, O +or O +MI O +. O +US O +were O +negative O +for O +clot O +and O +his O +first O +set O +of O +CE O +were O +negative O +. O + +94 O +M O +with O +CAD O +s O +p O +4V B-PROCEDURE +CABG I-PROCEDURE +3420 O +and O +CRI O +had O +been O +doing O +well O +until O +this O +AM O +when O +he O +was O +out O +walking O +with O +his O +wife O +. O +Name O +NI O +abruptly O +syncopized O +and O +a O +bystander O +started O +CPR B-PROCEDURE +quickly O +. O +The O +local O +fire O +department O +delivered O +two O +shocks O +without O +success O +. O +Then O +EMS O +came O +and O +gave O +two O +more O +shocks O +and O +he O +went O +back O +into O +sinus O +. O +It O +is O +unclear O +whether O +he O +regained O +consciousness O +. O +He O +was O +intubated O +then O +brought O +to O +Hospital1 O +5 O +ED O +. O +. O +In O +the O +ED O +, O +his O +intial O +SBP O +was O +reported O +to O +be O +110 O +. O +Labs O +show O +K O +2 O +. O +7 O +and O +Hct O +25 O +. O +He O +was O +given O +40mEq O +of O +KCL O +. O +On O +repeat O +labs O +, O +his O +K O +normalized O +and O +his O +Hct O +was O +33 O +without O +any O +blood O +. O +It O +is O +unclear O +whether O +one O +of O +the O +labs O +was O +erroneous O +. O +the O +vitals O +were O +recorded O +as O +T O +34 O +. O +8 O +, O +HR O +62 O +, O +132 O +74 O +, O +18 O +, O +100 O +on O +AC O +18x500 O +, O +FiO2 O +100 O +. O +EKG O +Sinus O +at O +80 O +BPM O +with O +LAD O +, O +prolonged O +PR O +, O +TD O +0 O +. O +5 O +to O +1mm O +in O +V4 O +V6 O +. O +ECHO O +The O +left O +atrium O +and O +right O +atrium O +are O +normal O +in O +cavity O +size O +. O +There O +is O +mild O +symmetric O +left O +ventricular O +hypertrophy O +with O +normal O +cavity O +size O +. O +There O +is O +mild O +global O +left O +ventricular O +hypokinesis O +LVEF O +45 O +50 O +. O +The O +right O +ventricular O +free O +wall O +is O +hypertrophied O +. O +Right O +ventricular O +chamber O +size O +is O +normal O +. O +with O +normal O +free O +wall O +contractility O +. O +The O +aortic O +root O +is O +mildly O +dilated O +at O +the O +sinus O +level O +. O +The O +ascending O +aorta O +is O +moderately O +dilated O +. O +The O +aortic O +valve O +leaflets O +3 O +are O +mildly O +thickened O +but O +aortic O +stenosis O +is O +not O +present O +. O +Mild O +to O +moderate O +1 O +13 O +aortic O +regurgitation O +is O +seen O +. O +The O +mitral O +valve O +leaflets O +are O +mildly O +thickened O +. O +There O +is O +no O +mitral O +valve O +prolapse O +. O +Mild O +1 O +mitral O +regurgitation O +is O +seen O +. O +The O +tricuspid O +valve O +leaflets O +are O +mildly O +thickened O +. O +The O +estimated O +pulmonary O +artery O +systolic O +pressure O +is O +normal O +. O +There O +is O +a O +trivial O +physiologic O +pericardial O +effusion O +. O +IMPRESSION O +Mildly O +depressed O +global O +left O +ventricular O +function O +. O +Mild O +to O +moderate O +aortic O +regurgitation O +. O +Mild O +mitral O +regurgitation O +. O + +85y O +o O +m O +w O +hx O +AD O +, O +diverticulosis O +, O +recently O +dx O +colon O +ca O +s O +. O +p O +hemicolectomy B-PROCEDURE +p O +w O +dark O +stools O +and O +dropping O +Hct O +30 O +26 O +23 O +. O +NG O +lavage O +was O +negative O +in O +ED O +, O +however O +, O +pt O +with O +duodenal O +ulcer O +on O +EGD B-PROCEDURE +7 O +2 O +. O +Possibly O +recent O +PUD O +vs O +anastomotic O +site O +vs O +1 O +26 O +colon O +ca O +vs O +diverticulosis O +. O +Review O +of O +systems O +Constitutional O +No O +t O +Fever O +Cardiovascular O +No O +t O +Chest O +pain O +, O +No O +t O +Palpitations O +Respiratory O +No O +t O +Cough O +, O +No O +t O +Dyspnea O +Gastrointestinal O +No O +t O +Abdominal O +pain O +, O +No O +t O +Nausea O +, O +No O +t O +Emesis O +, O +No O +t O +Diarrhea O +, O +No O +t O +Constipation O +Since O +12 O +AM O +Tmax O +37 O +. O +3 O +C O +99 O +. O +2 O +Tcurrent O +37 O +. O +3 O +C O +99 O +. O +2 O +HR O +69 O +64 O +78 O +bpm O +BP O +150 O +73 O +91 O +128 O +39 O +65 O +150 O +99 O +103 O +mmHg O +RR O +16 O +16 O +24 O +insp O +min O +SpO2 O +100 O +Heart O +rhythm O +SR O +Sinus O +Rhythm O +O2 O +Delivery O +Device O +None O +SpO2 O +100 O +ABG O +Physical O +Examination O +General O +Appearance O +No O +acute O +distress O +, O +Thin O +Eyes O +Conjunctiva O +PERRL O +, O +No O +t O +Conjunctiva O +pale O +Head O +, O +Ears O +, O +Nose O +, O +Throat O +Normocephalic O +Lymphatic O +Cervical O +WNL O +, O +Supraclavicular O +WNL O +Cardiovascular O +S1 O +Normal O +, O +S2 O +Normal O +, O +RRR O +Peripheral O +Vascular O +Right O +radial O +pulse O +Present O +, O +Left O +radial O +pulse O +Present O +, O +Right O +DP O +pulse O +Present O +, O +Left O +DP O +pulse O +Present O +Respiratory O +Chest O +Expansion O +Symmetric O +, O +Breath O +Sounds O +Clear O +Abdominal O +Soft O +, O +Non O +tender O +, O +Bowel O +sounds O +present O +, O +No O +t O +Tender O +, O +healing O +colectomy O +scar O +, O +no O +erythema O +, O +tenderness O +, O +bleeding O +, O +oozing O +. O +Extremities O +Right O +Absent O +, O +Left O +Absent O +Skin O +Not O +assessed O +Neurologic O +Attentive O +, O +Follows O +simple O +commands O +, O +Responds O +to O +Verbal O +stimuli O +, O +Oriented O +to O +only O +new O +year O +and O +thought O +he O +was O +at O +Hospital1 O +947 O +, O +Alzheimer O +'s O +pt O +with O +baseline O +dementia O +. O +Pt O +oriented O +to O +self O +, O +but O +not O +time O +or O +place O +. O +Movement O +Purposeful O +, O +Tone O +Normal O +Labs O +Radiology O +WBC O +9 O +. O +7 O +Hct O +24 O +. O +0 O +Plt O +593 O +Other O +labs O +PT O +PTT O +INR O +14 O +. O +4 O +27 O +. O +2 O +1 O +. O +3 O +" O + +This O +is O +a O +51 O +year O +old O +M O +w O +a O +h O +o O +MS O +, O +quadraparesis O +, O +HTN O +, O +restrictive O +lung O +disease O +, O +chronic O +constipation O +and O +SBOs O +s O +p O +ileostomy B-PROCEDURE +, O +multiple O +UTIs O +also O +s O +p O +suprapubic O +tube O +presents O +with O +SBO O +and O +UTI O +. O +Of O +note O +he O +was O +just O +recently O +discharged O +from O +the O +Hospital1 O +52 O +on O +10 O +2 O +for O +an O +admission O +for O +a O +UTI O +negative O +cultures O +treated O +with O +cipro O +, O +shingles O +treated O +w O +acyclovir O +and O +SBO O +evaluated O +by O +surgery B-PROCEDURE +but O +managed O +conservatively O +. O +He O +returns O +today O +as O +his O +home O +health O +aide O +had O +noticed O +his O +Urine O +output O +was O +low O +, O +75cc O +overnight O +when O +he O +usually O +has O +about O +1 O +liter O +of O +UOP O +overnight O +. O +His O +ostomy O +output O +has O +been O +high O +. O +He O +has O +not O +noticed O +any O +symptoms O +. O +Over O +the O +past O +two O +weeks O +he O +has O +had O +mild O +earaches O +, O +a O +sorethroat O +as O +well O +as O +some O +rhinorrhea O +. O +He O +has O +not O +noticed O +any O +watery O +itchy O +eyes O +. O +He O +has O +not O +sure O +if O +he O +has O +had O +a O +change O +in O +his O +ostomy O +output O +or O +suprapubic O +output O +. O +He O +has O +not O +noticed O +any O +visual O +changes O +, O +he O +has O +not O +noticed O +any O +new O +neurologic O +si O +sx O +. O +He O +denies O +any O +abdominal O +pain O +, O +has O +not O +sujectively O +noticed O +any O +change O +in O +abdominal O +distention O +. O +He O +denies O +any O +pain O +in O +regards O +to O +his O +zoster O +now O +or O +when O +diagnosed O +. O +Denies O +CP O +, O +has O +an O +occasional O +cough O +that O +is O +not O +worsening O +. O +. O +In O +the O +ED O +, O +he O +was O +noted O +to O +be O +severely O +dehydrated O +on O +exam O +. O +His O +BP O +nadir O +was O +79 O +43 O +and O +HR O +peak O +was O +97 O +. O +T O +99 O +he O +usually O +" O +runs O +low O +" O +, O +new O +ARF O +1 O +. O +4 O +up O +from O +0 O +. O +6 O +. O + +A O +64 O +yo O +F O +w O +PMHx O +sx O +for O +AF O +, O +COPD O +, O +HTN O +, O +hyperlipidemia O +who O +initially O +had O +an O +open B-PROCEDURE +ASD I-PROCEDURE +repair I-PROCEDURE +c O +b O +sternal O +wound O +infection O +and O +post O +operative O +AF O +in O +11 O +15 O +treated O +with O +amiodarone O +. O +On O +2 O +20 O +, O +she O +was O +initially O +admitted O +through O +the O +ED O +with O +SOB O +and O +back O +pain O +, O +and O +was O +noted O +to O +have O +atrial O +fibrillation O +with O +RVR O +. O +A O +CTA B-PROCEDURE +demonstrating O +diffuse O +LAD O +and O +post O +obstructive O +PNA O +concerning O +for O +malignancy O +. O +For O +her O +atrial O +fibrillation O +, O +she O +was O +started O +on O +diltiazem O +gtt O +, O +for O +which O +she O +was O +transferred O +to O +the O +Hospital O +Unit O +Name O +42 O +for O +monitoring O +. O +The O +atrial O +fibrillation O +was O +thought O +to O +be O +in O +the O +setting O +of O +a O +post O +obstructive O +pneumonia O +, O +for O +which O +she O +was O +treated O +with O +antibiotics O +. O +She O +was O +then O +transferred O +to O +the O +floor O +later O +that O +same O +night O +on O +metoprolol O +50 O +mg O +tid O +. O +While O +on O +the O +floor O +, O +she O +had O +a O +bronchoscopy B-PROCEDURE +performed O +which O +showed O +external O +compression O +of O +her O +left O +mainstem O +bronchus O +, O +and O +she O +had O +a O +biopsy B-PROCEDURE +FNA I-PROCEDURE +performed O +, O +which O +showed O +large O +cell O +carcinoma O +. O +She O +was O +then O +readmitted O +to O +the O +Hospital O +Unit O +Name O +42 O +yesterday O +with O +atrial O +fibrillation O +with O +HR O +130s O +, O +and O +was O +started O +on O +a O +diltiazem O +gtt O +. O +. O +In O +the O +Hospital O +Unit O +Name O +42 O +, O +she O +was O +started O +on O +po O +diltiazem O +, O +which O +was O +rapidly O +uptitrated O +to O +60 O +mg O +qid O +. O +She O +was O +called O +out O +this O +morning O +. O +Tonight O +, O +at O +8 O +30 O +pm O +, O +she O +was O +noted O +to O +have O +HR O +160s O +, O +w O +EKG O +c O +w O +AF O +with O +RVR O +, O +for O +which O +she O +received O +metoprolol O +5 O +mg O +IV O +x2 O +, O +followed O +by O +diltiazem O +10 O +mg O +IV O +x2 O +without O +conversion O +. O +She O +denies O +chest O +pain O +, O +SOB O +, O +tachypnea O +. O +She O +does O +note O +some O +diaphoresis O +and O +occasional O +palpitations O +. O + +Briefly O +79 O +yo O +F O +w O +a O +h O +o O +CAD O +s O +p O +RCA O +stenting O +BMS O +to O +mRCA O +3421 O +and O +pLAD O +3423 O +, O +diastolic O +CHF O +2 O +pillow O +orthopnea O +, O +1 O +MR O +, O +HTN O +, O +Hyperlipidemia O +, O +previous O +smoking O +history O +, O +and O +atrial O +fibrillation O +initially O +p O +w O +cough O +, O +dyspnea O +. O +. O +Briefly O +, O +pt O +'s O +symptoms O +began O +Month O +only O +760 O +. O +At O +that O +time O +pt O +was O +admitted O +with O +GI O +bleed O +, O +transfused O +and O +discharged O +without O +resolution O +of O +symptoms O +. O +Furthur O +workup O +noted O +bilateral O +atrial O +thrombi O +and O +anticoagulation O +was O +reinitiated O +. O +CTA O +did O +not O +show O +PE O +but O +was O +concern O +for O +small O +peripheral O +emboli O +as O +cause O +of O +dyspnea O +. O +Pt O +was O +had O +multiple O +PFTs O +, O +echos O +, O +CT O +scans O +and O +CXRs O +without O +definitive O +cause O +of O +dyspnea O +. O +Most O +recent O +PFTs O +on O +3432 O +12 O +27 O +c O +w O +restrictive O +ventilatory O +defect O +and O +low O +DLCO O +suspicious O +for O +interstitial O +pulmonary O +process O +worsening O +. O +She O +has O +been O +followed O +by O +cardiology B-PROCEDURE +and O +pulmonology B-PROCEDURE +and O +is O +being O +treated O +for O +dCHF O +and O +reactive O +airway O +disease O +. O +. O +On O +current O +admission O +pt O +presented O +with O +cough O +, O +thought O +to O +be O +URI O +, O +rather O +than O +worsening O +of O +chronic O +dyspnea O +. O +Current O +etiology O +considerations O +include O +CHF O +vs O +intrinsic O +pulmonary O +disease O +infiltrative O +vs O +embolic O +disease O +. O +In O +order O +to O +optimize O +cardic O +function O +with O +atrial O +kick O +, O +pt O +was O +pretreated O +with O +Sotolol B-PROCEDURE +and O +underwent O +TEE B-PROCEDURE +and O +cardioversion B-PROCEDURE +of O +afib O +on O +3433 O +1 O +11 O +. O +After O +cardioversion B-PROCEDURE +, O +patient O +developed O +junctional O +HR O +to O +45bpm O +with O +SBPs O +in O +80s O +. O +She O +was O +placed O +on O +dobutamine O +and O +HR O +increased O +to O +80s O +sinus O +vs O +antrial O +escape O +rhythm O +. O +Off O +of O +dobutamine O +, O +HR O +and O +BP O +decreased O +with O +EKG O +demonstrated O +QTc O +of O +700 O +. O + + +84 O +year O +old O +man O +with O +CAD O +s O +p O +CABG B-PROCEDURE +, O +DM O +, O +HTN O +, O +presented O +with O +2 O +days O +of O +black O +stools O +and O +coffee O +ground O +emesis O +. O +Pt O +reports O +of O +woke O +up O +2am O +on O +10 O +19 O +and O +had O +black O +soft O +loose O +BM O +, O +followed O +by O +nausea O +and O +and O +vomiting O +blackish O +liquid O +. O +He O +felt O +better O +but O +continued O +to O +have O +three O +more O +black O +stools O +over O +the O +next O +two O +days O +. O +He O +vomited O +a O +total O +of O +1 O +20 O +times O +before O +presenting O +to O +the O +hospital O +. O +He O +has O +been O +feeling O +lethargic O +and O +lightheaded O +and O +called O +the O +ambulence O +at O +the O +advice O +of O +his O +son O +. O +His O +stools O +were O +lightening O +in O +color O +prior O +arriving O +. O +He O +has O +not O +been O +using O +any O +new O +medications O +and O +has O +not O +had O +a O +prior O +GIB O +. O +. O +In O +the O +ED O +, O +initial O +VS O +98 O +. O +7 O +88 O +65 O +47 O +98 O +RA O +. O +He O +was O +BIBEMS O +with O +SBPs O +110 O +120s O +and O +has O +had O +similarly O +stable O +blood O +pressures O +since O +arrival O +. O +He O +had O +an O +NG O +lavage O +with O +coffee O +ground O +emesis O +that O +cleared O +with O +600 O +cc O +of O +flushing O +. O +During O +the O +lavage O +he O +had O +chest O +pressure O +and O +an O +EKG O +showed O +STD O +in O +V2 O +4 O +. O +He O +did O +not O +have O +radiation O +, O +pain O +, O +or O +diaphoresis O +. O +Home O +medications O +ALLOPURINOL O +300 O +mg O +Tablet O +by O +mouth O +daily O +GLIPIZIDE O +5 O +mg O +Extended O +Rel O +by O +mouth O +daily O +LOSARTAN O +COZAAR O +100 O +mg O +by O +mouth O +daily O +METFORMIN O +500 O +mg O +by O +mouth O +daily O +METOPROLOL O +TARTRATE O +50 O +mg O +by O +mouth O +daily O +PIOGLITAZONE O +ACTOS O +15 O +mg O +by O +mouth O +daily O +SIMVASTATIN O +80 O +mg O +Tablet O +by O +mouth O +daily O +ASPIRIN O +81 O +mg O +Tablet O +by O +mouth O +daily O +Past O +medical O +history O +Coronary O +artery O +disease O +s O +p O +triple O +vessel O +coronary O +artery O +bypass O +in O +7 O +2899 O +Hypertension O +Peripheral O +arterial O +disease O +Hypercholesterolemia O +Diabetes O +Osteoarthritis O +Gout O +Anemia O +Baseline O +32 O +35 O +with O +unrevealing O +w O +u O +by O +heme O +Right O +hernia O +repair O +in O +2877 O +Appendectomy O +in O +2841 O +Prostate O +disease O +N O +C O +Occupation O +Retired O +trial O +lawyer O +Drugs O +Denies O +Tobacco O +Denies O +Alcohol O +Occasional O + + +85 O +y O +o O +F O +with O +PMHx O +of O +HTN O +, O +HL O +, O +h O +o O +breast O +CA O +and O +3cm O +renal O +pelvis O +transitional O +cell O +tumor O +who O +presented O +for O +nephrectomy B-PROCEDURE +on O +2575 O +8 O +15 O +. O +Her O +post O +op O +course O +was O +complicated O +by O +agitation O +thought O +due O +to O +narcotics O +. O +Today O +, O +she O +was O +restarted O +on O +her O +home O +meds O +and O +while O +on O +telemetry O +, O +pt O +was O +noted O +to O +be O +bradycardic O +to O +40s O +. O +Pt O +was O +triggered O +for O +SBP O +of O +70 O +and O +HR O +of O +40 O +during O +which O +she O +remained O +asymptomatic O +. O +She O +was O +given O +1L O +IVF O +and O +her O +HR O +BP O +trended O +back O +up O +to O +baseline O +. O +However O +, O +there O +was O +a O +second O +event O +an O +hour O +later O +when O +she O +sat O +up O +and O +became O +bradycardic O +in O +the O +30s O +with O +associated O +hypotension O +. O +Second O +episode O +occurred O +with O +position O +change O +and O +again O +, O +pt O +developped O +junctional O +rhythm O +in O +30s O +. O +home O +meds O +Verapamil O +240mg O +daily O +Lisinopril O +5mg O +Rosuvastatin O +10mg O +Meclizine O +25 O +TID O +PRN O +Imipramine O +25 O +QHS O +Colace O +100mg O +Loratidine O +10mg O +daily O +Physical O +Examination O +T O +98 O +BP O +111 O +47 O +P O +74 O +R O +16 O +O2 O +98 O +on O +2L O +NC O +General O +oriented O +to O +person O +only O +, O +NAD O +, O +comfortable O +HEENT O +Sclera O +anicteric O +, O +dry O +MM O +, O +oropharynx O +clear O +Neck O +supple O +, O +unable O +to O +appreciate O +JVP O +due O +to O +habitus O +Lungs O +poor O +effort O +but O +Month O +only O +199 O +BS O +at O +bases O +and O +some O +audible O +airway O +secretion O +in O +upper O +airways O +CV O +Regular O +rate O +and O +rhythm O +, O +no O +m O +r O +g O +, O +diff O +to O +auscult O +2 O +13 O +habitus O +Abdomen O +diffusely O +tender O +, O +bowel O +sounds O +present O +, O +multiple O +surgical O +incisions O +, O +clean O +dry O +and O +intact O +, O +abd O +binder O +in O +place O +GU O +foley O +in O +place O +Ext O +cool O +, O +no O +edema O +, O +1 O +pulses O +, O +pneumoboots O +in O +place O + + + + + +An O +82 O +man O +with O +multiple O +chronic O +conditions O +and O +previous O +surgeries B-PROCEDURE +presents O +with O +9 O +day O +history O +of O +productive O +cough O +, O +fever O +and O +dyspnea O +. O + + + + + + + + + + +67 O +y O +. O +o O +. O +male O +smoker O +with O +end O +stage O +COPD O +on O +home O +oxygen O +, O +tracheobronchomalacia O +, O +s O +p O +RUL B-PROCEDURE +resection I-PROCEDURE +for O +squamous O +cell O +carcinoma O +. O +Y O +stent O +placement O +was O +complicated O +by O +cough O +and O +copious O +secretions O +requiring O +multiple O +therapeutic O +aspirations O +. O +Patient O +reports O +decreased O +appetite O +, O +50 O +lb O +wt O +loss O +in O +6 O +months O +. O +Decreased O +activity O +tolerance O +. O +PET O +scan O +revealed O +some O +FDG O +avid O +nodes O +concerning O +for O +recurrence O +. O +Pt O +. O +presents O +with O +worsening O +SOB O +with O +R O +shoulder O +pain O +and O +weakness O +. O + + + + + + +94 O +M O +with O +CAD O +s O +p O +4v B-PROCEDURE +CABG I-PROCEDURE +, O +CHF O +, O +CRI O +presented O +with O +vfib O +arrest O +. O + + +85 O +yo O +M O +with O +PMH O +of O +colon O +CA O +s O +p O +resection B-PROCEDURE +now O +presenting O +with O +black O +stools O +and O +HCT O +drop O +. O + + +An O +elderly O +female O +with O +history O +of O +atrial O +fibrillation O +, O +Chronic O +Obstructive O +Pulmonary O +Disease O +, O +hypertension O +, O +hyperlipidemia O +and O +previous O +repair B-PROCEDURE +of I-PROCEDURE +atrial I-PROCEDURE +septum I-PROCEDURE +defect I-PROCEDURE +, O +presenting O +with O +shortness O +of O +breath O +and O +atrial O +fibrillation O +resistant O +to O +medication O +. O + +A O +79 O +year O +old O +female O +wit O +history O +of O +CAD O +, O +diastolic O +CHF O +, O +HTN O +, O +Hyperlipidemia O +, O +previous O +smoking O +history O +, O +and O +atrial O +fibrillation O +who O +presents O +for O +direct O +admission O +from O +home O +for O +progressive O +shortness O +of O +breath O +. O +Patient O +denies O +recent O +palpitations O +, O +and O +reports O +that O +she O +has O +been O +compliant O +with O +all O +medications O +. O +She O +admits O +to O +recent O +fatigue O +and O +2 O +pillow O +orthopnea B-PROCEDURE +which O +has O +been O +present O +for O +months O +. O +Patient O +underwent O +cardioversion B-PROCEDURE +and O +became O +hypotensive O +with O +a O +junctional O +rhythm O +requiring O +intubation O +. O +She O +was O +placed O +on O +dobutamine O +. O +Off O +of O +dobutamine O +, O +cardiac O +monitoring O +demonstrated O +a O +long O +QTc O +and O +an O +atrial O +escape O +rhythm O +. O + + + + + + +A O +40 O +year O +old O +woman O +comes O +to O +the O +clinic O +complaining O +of O +gritty O +sensation O +in O +her O +eyes O +. O +She O +also O +has O +difficulty O +swallowing O +dry O +foods O +with O +no O +pain O +or O +heartburn O +. O +The O +patient O +is O +a O +schoolteacher O +and O +must O +drink O +water O +frequently O +during O +lectures O +due O +to O +her O +mouth O +dryness O +. O +She O +also O +reports O +occasional O +joint O +pain O +. O +Medical O +history O +is O +not O +significant O +other O +than O +the O +confirmed O +Sjogren O +disease O +with O +no O +other O +rheumatologic O +disease O +. O +She O +is O +sexually O +active O +with O +her O +husband O +and O +has O +2 O +children O +both O +delivered O +by O +natural O +vaginal O +delivery O +. O +She O +has O +no O +history O +of O +any O +kind O +of O +surgery B-PROCEDURE +. O +Physical O +examination O +shows O +conjunctival O +erythema O +and O +cracking O +of O +the O +lips O +. O +The O +remainder O +of O +the O +examination O +and O +history O +is O +normal O +. O +Her O +lab O +result O +shows O +elevated O +ESR O +50 O +mm O +h O + +A O +50 O +year O +old O +woman O +comes O +to O +the O +clinic O +with O +intermittent O +ear O +discharge O +and O +sense O +of O +hearing O +loss O +on O +her O +left O +ear O +. O +Past O +medical O +history O +is O +significant O +for O +obesity O +, O +hyperlipidemia O +, O +and O +diabetes O +mellitus O +. O +Her O +medications O +include O +Metformin O +, O +Atorvastatin O +and O +Vit O +D O +supplement O +. O +Vital O +signs O +are O +normal O +. O +BMI O +is O +37 O +. O +Otoscopy B-PROCEDURE +shows O +a O +small O +perforation O +in O +the O +left O +tympanic O +membrane O +and O +a O +pearly O +mass O +behind O +the O +membrane O +. O +Conduction O +hearing O +loss O +is O +noted O +in O +the O +left O +ear O +. O +The O +remainder O +of O +the O +ear O +, O +nose O +, O +and O +throat O +examination O +is O +normal O +. O + + + +A O +30 O +year O +old O +man O +who O +is O +a O +computer O +scientist O +came O +to O +the O +clinic O +with O +the O +lab O +result O +stating O +azoospermia O +. O +The O +patient O +is O +sexually O +active O +with O +his O +wife O +and O +does O +not O +use O +any O +contraception O +methods O +. O +They O +have O +been O +trying O +to O +conceive O +for O +the O +past O +year O +with O +no O +success O +. O +The O +patient O +has O +a O +past O +medical O +history O +of O +recurrent O +pneumonia O +, O +shortness O +of O +breath O +, O +and O +persistent O +cough O +that O +produces O +large O +amounts O +of O +thick O +sputum O +. O +The O +patient O +had O +multiple O +lung O +infections O +during O +childhood O +. O +He O +does O +not O +smoke O +, O +use O +illicit O +drugs O +or O +alcohol O +. O +The O +patient O +has O +no O +history O +of O +other O +medical O +conditions O +including O +allergies O +or O +any O +kind O +of O +surgery B-PROCEDURE +. O +On O +physical O +examination O +, O +the O +digits O +show O +clubbing O +. O +An O +ultrasound O +shows O +bilateral O +absence O +of O +the O +vas O +deferens O +, O +and O +FEV1 O +was O +75 O +on O +the O +respiratory O +function O +test O +. O + + + + + + +A O +27 O +year O +old O +woman O +comes O +to O +the O +dermatology O +clinic O +with O +skin O +rash O +and O +oral O +ulcers O +. O +The O +rashes O +are O +mildly O +itchy O +. O +The O +patient O +has O +no O +other O +medical O +conditions O +and O +takes O +no O +medications O +. O +Vital O +signs O +are O +normal O +. O +On O +examination O +, O +there O +are O +pink O +papules O +symmetrically O +distributed O +over O +the O +anterior O +surfaces O +of O +the O +shins O +and O +ankles O +. O +There O +are O +some O +white O +ulcerated O +papules O +on O +her O +buccal O +mucosa O +. O +She O +is O +in O +relationship O +with O +her O +boyfriend O +and O +has O +only O +one O +sexual O +partner O +. O +Her O +boyfriend O +uses O +condoms O +. O +She O +smokes O +1 O +to O +2 O +cigarettes O +a O +day O +and O +drinks O +a O +beer O +daily O +. O +Biopsy B-PROCEDURE +reveals O +prominent O +hyperkeratosis O +with O +a O +thickened O +granular O +layer O +. O +There O +is O +an O +infiltration O +of O +mononuclear O +cells O +in O +the O +superficial O +dermis O +that O +involves O +the O +overlying O +epidermis O +. O +The O +rete O +ridges O +have O +a O +sawtooth O +appearance O +. O + + + +A O +50 O +year O +old O +woman O +comes O +to O +the O +clinic O +complaining O +of O +difficulty O +swallowing O +both O +liquids O +and O +solid O +foods O +, O +as O +well O +as O +occasional O +cough O +while O +eating O +. O +She O +also O +has O +difficulty O +lifting O +her O +arms O +above O +her O +head O +and O +getting O +up O +from O +a O +chair O +. O +The O +weakness O +seems O +to O +get O +worse O +gradually O +. O +The O +patient O +has O +no O +prior O +medical O +problems O +and O +takes O +no O +medications O +. O +Vital O +signs O +are O +normal O +. O +Physical O +examination O +shows O +an O +erythematous O +rash O +on O +the O +upper O +eyelids O +. O +There O +are O +some O +red O +papules O +over O +joints O +of O +her O +hands O +. O +The O +rest O +of O +the O +physical O +examination O +is O +unremarkable O +. O +Antinuclear O +antibodies O +, O +anti O +Jo O +1 O +antibodies O +and O +anti O +MDA5 O +antibody O +are O +positive O +. O +Muscle B-PROCEDURE +biopsy I-PROCEDURE +shows O +perifascicular O +inflammation O +and O +atrophy O +of O +the O +fascicle O +and O +surrounding O +blood O +vessels O +. O + + +A O +32 O +year O +old O +woman O +comes O +to O +the O +hospital O +with O +vaginal O +spotting O +. O +Her O +last O +menstrual O +period O +was O +10 O +weeks O +ago O +. O +She O +has O +regular O +menses O +lasting O +for O +6 O +days O +and O +repeating O +every O +29 O +days O +. O +Medical O +history O +is O +significant O +for O +appendectomy B-PROCEDURE +and O +several O +complicated O +UTIs O +. O +She O +has O +multiple O +male O +partners O +, O +and O +she O +is O +inconsistent O +with O +using O +barrier O +contraceptives O +. O +Vital O +signs O +are O +normal O +. O +Serum O +β O +hCG O +level O +is O +1800 O +mIU O +mL O +, O +and O +a O +repeat O +level O +after O +2 O +days O +shows O +an O +abnormal O +rise O +to O +2100 O +mIU O +mL O +. O +Pelvic O +ultrasound O +reveals O +a O +thin O +endometrium O +with O +no O +gestational O +sac O +in O +the O +uterus O +. O + + +A O +61 O +year O +old O +man O +comes O +to O +the O +clinic O +due O +to O +nonproductive O +cough O +and O +progressive O +dyspnea O +. O +The O +patient O +'s O +medical O +conditions O +include O +hypertension O +, O +hypercholesteremia O +and O +peptic O +ulcer O +disease O +. O +He O +smokes O +2 O +packs O +of O +cigarettes O +daily O +for O +the O +past O +30 O +years O +. O +On O +examination O +, O +there O +are O +decreased O +breath O +sounds O +and O +percussive O +dullness O +at O +the O +base O +of O +the O +left O +lung O +. O +Other O +vital O +signs O +are O +normal O +. O +Abdomen O +is O +soft O +without O +tenderness O +. O +CT O +scan O +shows O +a O +left O +sided O +pleural O +effusion O +and O +nodular O +thickening O +of O +the O +pleura O +. O +The O +plural O +fluid O +was O +bloody O +on O +thoracentesis O +. O +Biopsy B-PROCEDURE +shows O +proliferation O +of O +epithelioid O +type O +cells O +with O +very O +long O +microvilli O +. O + +A O +7 O +month O +old O +boy O +is O +brought O +to O +emergency O +by O +his O +parents O +due O +to O +irritability O +and O +inability O +to O +defecate O +for O +the O +past O +3 O +days O +. O +The O +patient O +has O +had O +constipation O +and O +discomfort O +with O +bowel O +movements O +since O +birth O +. O +His O +symptoms O +worsened O +after O +eating O +semi O +solid O +foods O +. O +Vital O +signs O +are O +normal O +. O +Abdominal O +examination O +shows O +distension O +and O +tenderness O +to O +palpation O +with O +presence O +of O +bowel O +sounds O +. O +Xray O +with O +barium O +shows O +a O +narrow O +rectum O +and O +rectosigmoid O +area O +. O +The O +rest O +of O +the O +colon O +proximal O +to O +this O +segment O +is O +dilated O +. O +Digital O +rectal O +exam O +revealed O +burst O +of O +feces O +out O +of O +the O +anus O +. O +The O +biopsy B-PROCEDURE +showed O +absence O +of O +submucosal O +ganglia O +in O +the O +last O +segment O +of O +the O +large O +intestine O +. O + + + + + + +A O +7 O +year O +old O +girl O +is O +brought O +to O +the O +emergency O +department O +by O +her O +parents O +for O +generalized O +rash O +. O +The O +mother O +reports O +that O +she O +was O +playing O +outside O +wearing O +a O +skirt O +and O +felt O +a O +sharp O +pain O +in O +her O +arm O +while O +seating O +on O +a O +mat O +, O +plying O +with O +her O +doll O +. O +Her O +mother O +suspects O +that O +something O +had O +stung O +her O +. O +The O +patient O +'s O +blood O +pressure O +is O +75 O +55 O +mm O +Hg O +and O +her O +heart O +rate O +is O +122 O +min O +. O +Physical O +examination O +shows O +erythematous O +, O +raised O +plaques O +over O +the O +trunk O +, O +extremities O +, O +and O +face O +. O +Lung B-PROCEDURE +auscultation I-PROCEDURE +reveals O +bilateral O +expiratory O +wheezes O +. O + +A O +15 O +year O +old O +boy O +with O +mild O +intellectual O +disability O +is O +brought O +to O +the O +office O +by O +his O +parents O +for O +a O +routine O +physical O +examination O +. O +The O +boy O +is O +going O +to O +a O +school O +for O +students O +with O +learning O +disabilities O +. O +The O +patient O +was O +adopted O +, O +and O +his O +immunizations O +are O +up O +to O +date O +. O +Review O +of O +the O +patient O +'s O +medical O +records O +is O +notable O +for O +cytogenetic B-PROCEDURE +studies I-PROCEDURE +that O +showed O +a O +small O +gap O +near O +the O +tip O +of O +the O +long O +arm O +of O +the O +X O +chromosome O +, O +which O +is O +consistent O +with O +fragile O +X O +syndrome O +, O +an O +X O +linked O +disorder O +. O +The O +defect O +is O +an O +unstable O +expansion O +of O +trinucleotide O +repeats O +CGG O +in O +the O +fragile O +X O +mental O +retardation O +1 O +FMR1 O +gene O +, O +located O +on O +the O +long O +arm O +of O +the O +X O +chromosome O +. O +He O +is O +not O +using O +any O +medications O +and O +vital O +signs O +are O +within O +normal O +levels O +. O +His O +blood O +chemistry O +analysis O +as O +bellow O +Blood O +Chemistry O +Value O +Normal O +Range O +Patient O +Value O +Glucose O +90 O +120 O +mg O +dl O +95 O +mg O +dl O +BUN O +Blood O +Urea O +Nitrogen O +7 O +24 O +mg O +dl O +10 O +mg O +dl O +Creatinine O +0 O +. O +7 O +1 O +. O +4 O +mg O +dl O +0 O +. O +8 O +mg O +dl O +Calcium O +8 O +. O +5 O +10 O +. O +5 O +mg O +dl O +9 O +mg O +dl O +Sodium O +134 O +143 O +mEq O +L O +135 O +mEq O +L O +Potassium O +3 O +. O +5 O +4 O +. O +5 O +mEq O +L O +3 O +. O +7 O +mEq O +L O +Chloride O +95 O +108 O +mEq O +L O +98 O +mEq O +L O +CO2 O +20 O +30 O +mEq O +L O +25 O +mEq O +L O +Blood O +pH O +7 O +. O +38 O +7 O +. O +42 O +7 O +. O +39 O + + +A O +23 O +year O +old O +man O +comes O +to O +the O +emergency O +department O +following O +an O +episode O +of O +syncope O +. O +He O +was O +working O +out O +when O +he O +felt O +dizzy O +and O +passed O +out O +without O +head O +injury O +. O +He O +has O +had O +3 O +other O +episodes O +of O +light O +headedness O +over O +the O +last O +year O +, O +all O +happening O +during O +physical O +activity O +. O +He O +never O +had O +this O +experience O +while O +resting O +. O +He O +has O +no O +other O +medical O +conditions O +. O +The O +patient O +does O +not O +use O +tobacco O +, O +alcohol O +, O +or O +illicit O +drugs O +. O +His O +father O +died O +suddenly O +at O +age O +35 O +. O +Vital O +signs O +are O +within O +normal O +limits O +. O +On O +physical O +examination O +, O +the O +patient O +has O +a O +harsh O +systolic O +murmur O +. O +The O +lungs O +are O +clear O +with O +no O +peripheral O +edema O +. O +Echocardiography B-PROCEDURE +shows O +asymmetric O +interventricular O +septal O +hypertrophy O +. O + + + +A O +63 O +year O +old O +man O +comes O +to O +the O +clinic O +for O +recent O +unintentional O +weight O +loss O +. O +The O +patient O +also O +has O +epigastric O +discomfort O +after O +meals O +. O +He O +has O +no O +known O +medical O +problems O +and O +takes O +no O +medications O +. O +His O +blood O +pressure O +is O +130 O +75 O +and O +pulse O +rate O +is O +88 O +min O +. O +He O +is O +not O +febrile O +. O +Upper O +endoscopy B-PROCEDURE +shows O +a O +lesion O +in O +the O +stomach O +that O +shows O +typical O +features O +of O +diffuse O +type O +adenocarcinoma O +presenting O +with O +signet O +ring O +cells O +that O +do O +not O +form O +glands O +. O + + +An O +8 O +year O +old O +boy O +is O +brought O +to O +the O +clinic O +by O +his O +parents O +because O +of O +weakness O +and O +difficulty O +of O +standing O +up O +from O +a O +sitting O +position O +. O +The O +mother O +is O +healthy O +but O +had O +a O +brother O +who O +died O +in O +his O +20th O +after O +being O +disabled O +and O +using O +wheelchairs O +in O +the O +last O +few O +years O +of O +his O +life O +. O +Physical O +examination O +shows O +3 O +5 O +lower O +extremity O +muscle O +strength O +and O +enlarged O +calf O +muscles O +. O +The O +other O +physical O +examination O +and O +vital O +signs O +are O +unremarkable O +. O +Muscle B-PROCEDURE +biopsy I-PROCEDURE +showed O +absence O +of O +dystrophin O +protein O +. O +The O +patient O +is O +diagnosed O +with O +DMD O +. O + + +A O +49 O +year O +old O +man O +comes O +to O +the O +office O +because O +of O +the O +bulging O +in O +his O +groin O +. O +Physical O +examination O +shows O +a O +swelling O +above O +the O +inguinal O +ligament O +. O +When O +the O +patient O +is O +asked O +to O +cough O +, O +the O +size O +of O +the O +bulge O +increases O +. O +His O +medical O +history O +is O +significant O +for O +mild O +dyslipidemia O +, O +which O +is O +under O +control O +by O +lifestyle O +modifications O +. O +He O +does O +not O +smoke O +, O +but O +drinks O +alcohol O +occasionally O +. O +His O +vital O +signs O +and O +other O +physical O +examinations O +are O +unremarkable O +. O +He O +is O +referred O +to O +a O +surgeon O +and O +scheduled O +to O +undergo O +elective B-PROCEDURE +laparoscopic I-PROCEDURE +hernia I-PROCEDURE +repair I-PROCEDURE +. O + + + +A O +23 O +year O +old O +woman O +comes O +to O +the O +emergency O +department O +with O +a O +history O +of O +nosebleeds O +lasting O +for O +1 O +hour O +. O +She O +has O +a O +history O +of O +heavy O +menses O +as O +well O +as O +occasional O +gum O +bleeding O +following O +dental B-PROCEDURE +procedures I-PROCEDURE +. O +Her O +mother O +also O +has O +a O +history O +of O +menorrhagia O +. O +Laboratory O +tests O +reveal O +increased O +bleeding O +time O +and O +slightly O +increased O +partial O +thromboplastin O +time O +. O +She O +has O +no O +other O +medical O +conditions O +and O +is O +otherwise O +healthy O +. O +Her O +coagulation O +study O +shows O +CB O +0 O +. O +30 O +IU O +mL O +and O +FVIII O +C O +0 O +. O +37 O +IU O +mL O +. O +She O +is O +not O +smoking O +or O +using O +any O +kind O +of O +illicit O +drugs O +. O +She O +uses O +alcohol O +occasionally O +and O +is O +in O +ra O +elationship O +with O +her O +boyfriend O +for O +the O +past O +2 O +years O +. O + + + + + +A O +60 O +year O +old O +man O +comes O +to O +the O +clinic O +complaining O +of O +hand O +tremor O +that O +started O +few O +months O +ago O +. O +It O +is O +most O +bothering O +when O +he O +wants O +to O +drink O +from O +a O +glass O +or O +pour O +from O +a O +bottle O +. O +He O +does O +not O +smoke O +, O +but O +drinks O +occasionally O +. O +He O +recently O +started O +consuming O +more O +alcohol O +as O +his O +tremor O +subsides O +somewhat O +when O +he O +drinks O +small O +amounts O +of O +alcohol O +. O +Family O +history O +is O +significant O +for O +similar O +problems O +in O +his O +mother O +. O +Vital O +signs O +are O +normal O +and O +the O +patient O +has O +no O +other O +medical O +conditions O +. O +Neurologic B-PROCEDURE +examination I-PROCEDURE +shows O +bilateral O +tremor O +in O +the O +upper O +extremities O +. O +The O +diagnosis O +of O +essential O +tremor O +is O +confirmed O +. O + + + +A O +48 O +year O +old O +man O +comes O +to O +the O +office O +complaining O +of O +heartburn O +and O +acid O +reflux O +. O +He O +has O +taken O +over O +the O +counter O +antacids O +but O +sees O +no O +relief O +. O +Other O +medical O +history O +is O +unremarkable O +. O +The O +patient O +does O +not O +use O +tobacco O +, O +alcohol O +, O +or O +illicit O +drugs O +. O +Vital O +signs O +are O +within O +normal O +limits O +. O +BMI O +is O +31 O +kg O +m2 O +. O +Physical O +examination O +is O +positive O +for O +mild O +tenderness O +in O +upper O +stomach O +. O +Chest O +x O +ray O +shows O +an O +air O +fluid O +opacity O +behind O +the O +heart O +. O +A O +barium B-PROCEDURE +swallow I-PROCEDURE +study I-PROCEDURE +reveals O +approximately O +1 O +3 O +of O +the O +stomach O +herniating O +through O +the O +esophageal O +hiatus O +. O + + +A O +20 O +year O +old O +man O +comes O +to O +the O +emergency O +due O +to O +bleeding O +after O +a O +tooth B-PROCEDURE +extraction I-PROCEDURE +. O +The O +bleeding O +has O +persisted O +for O +approximately O +30 O +minutes O +despite O +constant O +direct O +pressure O +. O +He O +is O +a O +known O +case O +of O +Hemophilia O +type O +A O +treated O +with O +FVIII O +. O +Blood O +pressure O +is O +95 O +60 O +mm O +Hg O +and O +pulse O +is O +105 O +min O +. O +His O +weight O +is O +70 O +Kg O +. O +Family O +history O +is O +positive O +for O +Hemophilia O +type O +A O +in O +his O +maternal O +uncle O +. O +He O +also O +has O +a O +lipoma O +on O +his O +left O +arm O +which O +he O +plans O +to O +remove O +surgically O +. O +His O +FVIII O +activity O +is O +40 O +. O + + +Patient O +is O +a O +45 O +year O +old O +man O +with O +a O +history O +of O +anaplastic O +astrocytoma O +of O +the O +spine O +complicated O +by O +severe O +lower O +extremity O +weakness O +and O +urinary O +retention O +s O +p O +Foley B-PROCEDURE +catheter I-PROCEDURE +, O +high O +dose O +steroids O +, O +hypertension O +, O +and O +chronic O +pain O +. O +The O +tumor O +is O +located O +in O +the O +T O +L O +spine O +, O +unresectable O +anaplastic O +astrocytoma O +s O +p O +radiation B-PROCEDURE +. O +Complicated O +by O +progressive O +lower O +extremity O +weakness O +and O +urinary O +retention O +. O +Patient O +initially O +presented O +with O +RLE O +weakness O +where O +his O +right O +knee O +gave O +out O +with O +difficulty O +walking O +and O +right O +anterior O +thigh O +numbness O +. O +MRI O +showed O +a O +spinal O +cord O +conus O +mass O +which O +was O +biopsied O +and O +found O +to O +be O +anaplastic O +astrocytoma O +. O +Therapy O +included O +field O +radiation O +t10 O +l1 O +followed O +by O +11 O +cycles O +of O +temozolomide O +7 O +days O +on O +and O +7 O +days O +off O +. O +This O +was O +followed O +by O +CPT O +11 O +Weekly O +x4 O +with O +Avastin O +Q2 O +weeks O +2 O +weeks O +rest O +and O +repeat O +cycle O +. O + +48 O +M O +with O +a O +h O +o O +HTN O +hyperlipidemia O +, O +bicuspid O +aortic O +valve O +, O +and O +tobacco O +abuse O +who O +presented O +to O +his O +cardiologist O +on O +2148 O +10 O +1 O +with O +progressive O +SOB O +and O +LE O +edema O +. O +TTE B-PROCEDURE +revealed O +severe O +aortic O +stenosis O +with O +worsening O +LV O +function O +. O +EF O +was O +25 O +. O +RV O +pressure O +was O +41 O +and O +had O +biatrial O +enlargement O +. O +Noted O +to O +have O +2 O +aortic O +insufficiency O +with O +mild O +MR O +. O +He O +was O +sent O +home O +from O +cardiology O +clinic O +with O +Lasix O +and O +BB O +which O +he O +did O +not O +tolerate O +, O +continued O +to O +have O +worsening O +SOB O +and O +LE O +edema O +and O +finally O +presented O +here O +for O +evaluation O +. O +During O +this O +admission O +repeat O +echo O +confirmed O +critical O +aortic O +stenosis O +showing O +left O +ventricular O +hypertrophy O +with O +cavity O +dilation O +and O +severe O +global O +hypokinesis O +, O +severe O +aortic O +valve O +stenosis O +with O +underlying O +bicuspid O +aortic O +valve O +, O +dilated O +ascending O +aorta O +, O +mild O +pulmonary O +artery O +systolic O +hypertension O +. O +The O +patient O +underwent O +a O +preop O +workup O +for O +valvular O +replacement O +with O +preop O +chest O +CT O +scan O +and O +carotid O +US O +showing O +moderate O +heterogeneous O +plaque O +with O +bilateral O +1 O +39 O +ICA O +stenosis O +. O +He O +also O +underwent O +a O +cardiac O +cath O +with O +right O +heart O +cath O +to O +evaluate O +his O +pulm O +art O +pressures O +which O +showed O +no O +angiographically O +apparent O +flow O +limiting O +coronary O +artery O +disease O +. O + +A O +32 O +yo O +woman O +who O +presents O +following O +a O +severe O +' O +exploding O +' O +headache O +. O +She O +and O +her O +husband O +report O +that O +yesterday O +she O +was O +in O +the O +kitchen O +and O +stood O +up O +and O +hit O +her O +head O +on O +the O +corner O +of O +a O +cabinet O +. O +The O +next O +morning O +she O +developed O +a O +sudden O +' O +exploding O +' O +headache O +. O +She O +came O +to O +the O +hospital O +where O +head O +CT B-PROCEDURE +showed O +a O +significant O +amount O +of O +blood O +in O +her O +right O +ventricle O +. O +NSGY B-PROCEDURE +evaluated O +her O +for O +spontaneous O +intraventricular O +hemorrhage O +with O +a O +concern O +for O +an O +underlying O +vascular O +malformation O +. O +Cerebral B-PROCEDURE +angiogram I-PROCEDURE +was O +done O +which O +showed O +abnormal O +vasculature O +with O +a O +draining O +vein O +from O +L O +temporal O +lobe O +penetrating O +deep O +white O +matter O +consistent O +with O +AVM O +. O +The O +patient O +did O +continue O +to O +have O +a O +headaches O +but O +they O +were O +improving O +with O +pain O +medication O +. O +The O +patient O +refused O +PT O +evaluation O +but O +was O +ambulating O +independently O +without O +difficulty O +. O +She O +was O +discharged O +to O +home O +with O +her O +husband O +on O +2155 O +12 O +6 O +. O + +This O +is O +a O +44 O +year O +old O +female O +with O +PMH O +of O +PCOS O +, O +Obesity O +, O +HTN O +who O +presented O +with O +symptoms O +of O +cholecystitis O +and O +was O +found O +incidentally O +to O +have O +a O +large O +pericardial O +effusion O +. O +A O +pericardiocentesis B-PROCEDURE +was O +performed O +and O +the O +fluid B-PROCEDURE +analysis I-PROCEDURE +was O +consistent O +with O +Burkitt O +'s O +lymphoma O +. O +Pericardial O +fluid O +was O +kappa O +light O +chain O +restricted O +CD10 O +positive O +monotypic O +B O +cells O +expressing O +FMC O +7 O +, O +CD19 O +, O +CD20 O +, O +and O +myc O +rearrangement O +consistent O +with O +Burkitt O +'s O +Lymphoma O +. O +A O +subsequent O +lumbar O +puncture O +and O +bone O +marrow O +biopsy B-PROCEDURE +were O +negative O +for O +any O +involvement O +which O +made O +this O +a O +primary O +cardiac O +lymphoma O +. O +A O +cardiac O +MRI B-PROCEDURE +showed O +a O +mass O +that O +was O +3cm O +x O +1cm O +on O +the O +lateral O +wall O +of O +the O +right O +atrium O +adjacent O +to O +the O +AV O +junction O +. O +Past O +Medical O +History O +1 O +. O +Rare O +migraines O +2 O +. O +HTN O +3 O +. O +Obesity O +4 O +. O +PCOS O +infertility O +5 O +. O +Viral O +encephalitis O +meningitis O +ICH O +seizure O +stroke O +2137 O +from O +severe O +sinus O +infxn O +, O +caused O +mild O +non O +focal O +residual O +deficits O +6 O +. O +CSF O +leak O +w O +meningitis O +s O +p O +lumbar O +drain O +placement O +7 O +. O +R O +LE O +DVT O +s O +p O +IVC B-PROCEDURE +filter I-PROCEDURE +placement I-PROCEDURE +8 O +. O +Knee B-PROCEDURE +surgery I-PROCEDURE + +74M O +hx O +of O +CAD O +s O +p O +CABG O +, O +EF O +60 O +prior O +CVA O +no O +residual O +deficits O +, O +HTN O +, O +HL O +, O +DMII O +, O +Moderate O +to O +Severe O +PVD O +was O +referred O +to O +cardiology O +for O +evaluation O +of O +PVD O +, O +and O +on O +examination O +patient O +was O +found O +to O +have O +carotid O +bruits O +. O +Upon O +further O +review O +of O +symptoms O +the O +pt O +reports O +Occasional O +dizziness O +, O +no O +prior O +syncope O +occasional O +HA O +, O +Denies O +CP O +SOB O +. O +No O +sensory O +or O +motor O +defects O +. O +He O +recalls O +that O +he O +might O +have O +had O +a O +stroke O +10 O +15 O +years O +ago O +without O +any O +residual O +deficit O +. O +Prior O +to O +CABG B-PROCEDURE +he O +only O +had O +diaphoresis O +. O +Further O +review O +of O +systems O +is O +notable O +for O +absence O +of O +chest O +pain O +, O +dyspnea O +on O +exertion O +, O +paroxysmal O +nocturnal O +dyspnea O +, O +orthopnea O +, O +palpitations O +, O +syncope O +or O +presyncope O +. O +He O +underwent O +Carotid B-PROCEDURE +U O +S O +that O +showed O +significant O +bilateral O +carotid O +stenosis O +, O +L O +R O +. O +Angiography B-PROCEDURE +revealed O +an O +80 O +stenosis O +of O +the O +R O +ICA O +and O +a O +90 O +L O +ICA O +stenosis O +. O +Cerebral B-PROCEDURE +angiography I-PROCEDURE +further O +revealed O +patent O +right O +ACA O +and O +MCA O +and O +patent O +left O +ACA O +and O +left O +MCA O +. O +Past O +Medical O +History O +CAD O +s O +p O +CABG B-PROCEDURE +in O +2154 O +Hospital1 O +112 O +Prior O +CVA O +Bilateral O +carotid O +artery O +disease O +Anemia O +PVD O +Hypertension O +Diabetes O +c O +b O +retinopathy B-PROCEDURE +and O +peripheral B-PROCEDURE +neuropathy I-PROCEDURE +Cataracts O +s O +p O +surgery B-PROCEDURE +Thyroid O +nodule O +Colon O +polyps O +s O +p O +resection B-PROCEDURE +Intermittent O +Lower O +back O +pain O +Proteinuria O +s O +p O +right O +elbow O +fracture O +as O +a O +child O +Arthritis O + + +60 O +yo O +M O +with O +Hep O +C O +cirrhosis O +, O +grade O +II O +esophageal O +varices O +, O +recent O +admission O +for O +UGIB O +2 O +9 O +NSAID O +gastritis O +, O +referred O +for O +admission O +throught O +the O +ED O +by O +hepatology O +clinic O +for O +new O +slurred O +speech O +and O +tangential O +thought O +process O +. O +Patient O +also O +describes O +new O +imbalance O +leading O +to O +a O +fall O +during O +which O +he O +may O +have O +hit O +his O +head O +on O +. O +Per O +last O +liver O +clinic O +note O +has O +been O +off O +ETOH O +for O +a O +year O +corroborated O +with O +pt O +, O +utox O +was O +negative O +for O +alocohol O +. O +CT B-PROCEDURE +was O +within O +normal O +limits O +, O +and O +neuro O +evaluation O +determined O +this O +was O +not O +ischemic O +infart O +. O +Patient O +was O +given O +a O +presumptive O +diagnosis O +of O +hepatic O +encephalopathy O +and O +started O +on O +lactulose O +. O +Liver B-PROCEDURE +function I-PROCEDURE +tests I-PROCEDURE +showed O +a O +striking O +increase O +in O +his O +total O +and O +direct O +bilirubin O +since O +last O +visit O +. O +Another O +worrisome O +feature O +was O +the O +increase O +in O +the O +patient O +'s O +AFP O +. O +This O +could O +be O +progression O +of O +cirrhosis O +as O +he O +failed O +interferon O +twice O +. O +He O +is O +to O +follow O +up O +as O +an O +outpatient O +to O +work O +this O +up O +. O +Past O +Medical O +History O +HCV O +Cirrhosis O +tx O +with O +interferon O +x2 O +with O +no O +response O +Portal O +Gastropathy O +Grade O +II O +Esophageal O +varices O +HTN O +Recent O +admission O +4 O +2150 O +UGIB O +2 O +9 O +non O +steroidal O +induced O +gastritis O + + +41 O +year O +old O +man O +with O +history O +of O +severe O +intellectual O +disability O +, O +CHF O +, O +epilepsy O +presenting O +with O +facial O +twitching O +on O +the O +right O +and O +generalized O +shaking O +in O +at O +his O +NH O +which O +required O +20 O +mg O +valium O +to O +cease O +seizure O +activity O +. O +Per O +outside O +medical O +patient O +was O +felt O +to O +have O +focal O +epilepsy O +with O +secondary O +generalization O +, O +likely O +due O +to O +anoxic O +brain O +injury O +at O +birth O +, O +and O +probably O +related O +to O +the O +atrophic O +changes O +seen O +on O +MRI B-PROCEDURE +, O +particularly O +in O +the O +left O +temporal O +lobe O +. O +The O +patient O +first O +developed O +seizures O +at O +age O +13 O +found O +by O +family O +to O +have O +a O +generalized O +convulsion O +. O +He O +had O +a O +second O +seizure O +two O +years O +after O +his O +first O +episode O +. O +He O +was O +maintained O +on O +Dilantin O +and O +phenobarbital O +. O +The O +patient O +went O +20 O +years O +without O +another O +seizure O +. O +He O +was O +recently O +tapered O +off O +Dilantin O +, O +and O +it O +was O +felt O +that O +perhaps O +this O +medication O +was O +necessary O +to O +maintain O +him O +seizure O +free O +. O +The O +patient O +had O +no O +further O +events O +during O +the O +hospital O +course O +and O +was O +back O +at O +his O +baseline O +at O +the O +time O +of O +discharge O +. O +Full O +EEG B-PROCEDURE +reports O +are O +pending O +at O +the O +time O +of O +dictation O +. O +Past O +Medical O +History O +Epilepsy O +as O +above O +, O +CHF O +, O +depression O + + +A O +75 O +yo O +M O +w O +metastatic O +papillary O +thyroid O +cancer O +s O +p O +XRT B-PROCEDURE +19 O +sessions O +who O +presented O +with O +2 O +days O +of O +worsening O +dysphagia O +for O +solids O +, O +poor O +oral O +intake O +, O +weight O +loss O +20 O +pounds O +over O +last O +several O +weeks O +and O +some O +lethargy O +. O +Papillary O +thyroid O +cancer O +dx O +w O +right O +neck O +mass O +s O +p O +neck O +mass O +resection O +; O +unable O +to O +perform O +thyroidectomy O +high O +bleed O +risk O +, O +proximity O +to O +trachea O +and O +recurrent O +laryngeal O +nerve O +and O +large O +tumor O +size O +s O +p O +XRT B-PROCEDURE +to O +neck O +s O +p O +RAI B-PROCEDURE +ablation I-PROCEDURE +Metastatic O +to O +lymph O +nodes O +and O +adrenal O +glands O +s O +p O +hernia B-PROCEDURE +repair I-PROCEDURE +s O +p O +tonsillectomy B-PROCEDURE + +34 O +year O +old O +woman O +with O +Marfan O +'s O +syndrome O +and O +known O +severe O +mitral O +valve O +prolapse O +with O +regurgitation O +, O +who O +was O +planned O +for O +a O +MV B-PROCEDURE +repair I-PROCEDURE +but O +was O +lost O +to O +follow O +up O +. O +She O +remains O +symptomatic O +and O +is O +now O +prepared O +to O +undergo O +mitral B-PROCEDURE +valve I-PROCEDURE +repair I-PROCEDURE +replacement B-PROCEDURE +surgery I-PROCEDURE +. O +EF O +of O +65 O +on O +TTE O +. O +Past O +Medical O +History O +Marfans O +Syndrome O +MVP O +with O +severe O +mitral O +regurgitation O +Gastric O +reflux O +disease O +History O +of O +gestational O +diabetes O +mellitus O +Hypertension O +with O +pregnancy O +Obesity O +c B-PROCEDURE +section I-PROCEDURE +x O +2 O +laser B-PROCEDURE +eye I-PROCEDURE +surgery I-PROCEDURE +cataract B-PROCEDURE +surgery I-PROCEDURE +foot B-PROCEDURE +surgery I-PROCEDURE +shorten O +bone O +length O + +70 O +y O +o O +with O +COPD O +on O +2 O +. O +5 O +3 O +. O +5L O +O2 O +at O +baseline O +, O +OSA O +and O +obesity O +hypoventilation O +syndrome O +, O +dCHF O +, O +discharged O +2132 O +8 O +24 O +now O +presents O +with O +agitation O +and O +altered O +mental O +status O +with O +hypoxia O +and O +O2 O +sats O +70s O +on O +BipAp O +with O +5L O +. O +Pt O +agitated O +then O +somnolent O +at O +initial O +presentation O +. O +Daughter O +reported O +increased O +agitation O +and O +altered O +mental O +status O +x O +2 O +3 O +days O +with O +O2 O +sats O +60s O +70s O +at O +home O +. O +Daughter O +has O +also O +noted O +increased O +LE O +edema O +and O +weight O +gain O +which O +prompted O +a O +phone O +call O +to O +her O +PCP O +and O +increased O +lasix O +dose O +from O +80daily O +to O +100mg O +daily O +with O +some O +mild O +improvement O +in O +edema O +. O +She O +has O +had O +decreased O +appetite O +, O +PO O +intake O +, O +energy O +level O +at O +home O +with O +difficulty O +with O +ADLs O +. O +No O +recent O +history O +of O +fever O +, O +cough O +, O +chills O +, O +sputum O +production O +, O +CP O +, O +abd O +pain O +, O +or O +other O +complaints O +other O +than O +chronic O +right O +thigh O +pain O +last O +1 O +2 O +months O +. O +Daughter O +also O +reports O +med O +compliance O +and O +compliance O +with O +BiPap O +at O +night O +. O +Past O +Medical O +History O +CAD O +; O +s O +p O +4 O +vessel O +CABG B-PROCEDURE +in O +2119 O +CHF O +; O +EF O +55 O +, O +mild O +AS O +obesity O +hypoventilation O +syndrome O +obstructive O +sleep O +apnea O +DM2 O +ventricular O +tachycardia O +; O +s O +p O +ICD B-PROCEDURE +in O +2127 O +hypothyroidism O +schizophrenia O +COPD O +Pneumona O +treated O +in O +4 O +7 O +at O +Hospital1 O + +62 O +yo O +male O +with O +hx O +of O +CVA O +, O +neurogenic O +bladder O +with O +indwelling O +suprapubic B-PROCEDURE +catheter I-PROCEDURE +with O +multiple O +prior O +admissions O +for O +UTIs O +, O +altered O +mental O +status O +, O +and O +urosepsis O +presents O +to O +the O +hospital O +in O +urosepsis O +now O +resolved O +after O +treatment O +with O +vanc O +meropenem O +. O +Per O +CT B-PROCEDURE +there O +is O +a O +non O +obstructing O +stone O +in O +the O +L O +ureter O +, O +no O +evidence O +of O +urethral O +strictures O +. O +Significant O +leaking O +around O +suprapubic O +cath O +site O +. O +Started O +on O +ditropan O +changed O +over O +to O +detrol O +. O +Urologist O +not O +concerned O +with O +leaking O +and O +will O +f O +u O +with O +pt O +next O +week O +. O +s O +p O +CVA B-PROCEDURE +Neurogenic O +bladder O +s O +p O +suprapubic B-PROCEDURE +cath I-PROCEDURE +Recurrent O +UTIs O +with O +Klebsiella O +Pseudomonas O +Non O +hodgkins O +Marginal O +Zone O +Lymphoma O +of O +the O +left O +orbit O +Dx O +in O +03 O +s O +p O +R O +CHOP O +x O +6 O +cycles O +Bells O +Palsy O +BPH O +Hypertension O +Partial O +Bowel O +obstruction O +s O +p O +colostomy B-PROCEDURE +Hepatitis O +C O +Cryoglobulinemia O +SLE O +with O +transverse O +myelitis O +, O +anti O +dsDNA O +Ab O +Insulin O +Dependant O +Diabetic O +Fungal O +Esophagitis O +Stage O +IV O +? O +Urinary O +Tract O +Infections O +pseudomonas O +enterococcus O + +70 O +year O +old O +woman O +with O +a O +history O +of O +CAD O +recently O +noted O +abdominal O +mass O +who O +presents O +with O +fevers O +rigors O +and O +bandemia O +. O +Over O +the O +last O +few O +weeks O +leading O +up O +to O +admission O +, O +she O +has O +been O +experiencing O +mid O +abdominal O +pain O +, O +radiating O +to O +the O +left O +flank O +. O +It O +lasts O +throughout O +the O +day O +is O +not O +increased O +by O +eating O +though O +there O +is O +associated O +vomiting O +and O +is O +worsened O +with O +coughing O +. O +CT O +abdomen O +without O +contrast O +was O +then O +performed O +on O +4 O +20 O +showing O +a O +large O +9 O +. O +5 O +x O +7 O +. O +5 O +x O +6 O +. O +0 O +cm O +heterogeneous O +left O +upper O +abdominal O +mass O +. O +Patient O +underwent O +a O +EUS O +with O +biopsy B-PROCEDURE +. O +The O +results O +of O +the O +biopsy B-PROCEDURE +were O +consistent O +with O +pancreatic O +adenocarcinoma O +at O +the O +head O +of O +pancreas O +. O +Splenic O +flecture O +pancreatic O +tail O +mass O +was O +also O +seen O +on O +CT O +, B-PROCEDURE +likely O +diverticular O +abscess O +given O +the O +patients O +recent O +likely O +history O +of O +diverticulitis O +this O +was O +thought O +to O +be O +an O +infected O +fluid O +collection O +or O +abscess O +. O +She O +was O +treated O +with O +IV O +antibiotics O +Zosyn O +, O +then O +ceftriaxone O +and O +flagyl O +and O +will O +continue O +on O +them O +until O +seen O +by O +ID O +as O +an O +outpatient O +. O +Past O +Medical O +History O +1 O +. O +Coronary O +artery O +disease O +with O +history O +of O +angioplasty O +in O +State O +108 O +one O +year O +ago O +2 O +. O +Mitral O +valve O +prolapse O +3 O +. O +Atrial O +fibrillation O +4 O +. O +Hyperlipemia O +5 O +. O +Hypertension O +6 O +. O +Chronic O +kidney O +disease O +SCr O +2 O +. O +1 O +in O +3 O +17 O +7 O +. O +Hypothyroidism O +? O +TSH O +10 O +in O +3 O +17 O +8 O +. O +Anemia O +HCT O +30 O +. O +7 O +in O +3 O +17 O + +79 O +yo O +F O +with O +multifactorial O +chronic O +hypoxemia O +and O +dyspnea O +thought O +due O +to O +diastolic O +CHF O +, O +pulmonary O +hypertension O +thought O +secondary O +to O +a O +chronic O +ASD O +and O +COPD O +on O +5L O +home O +oxygen O +admitted O +with O +complaints O +of O +worsening O +shortness O +of O +breath O +. O +Cardiology O +consult O +recommended O +a O +right O +heart O +cath O +for O +evaluation O +of O +response O +to O +sildenafil O +but O +the O +patient O +refused O +. O +Pulmonary O +consult O +recommended O +an O +empiric O +, O +compassionate O +sildenafil O +trial O +due O +to O +severe O +dyspneic O +symptomology O +preventing O +outpatient O +living O +, O +and O +the O +patient O +tolerated O +an O +inpatient O +trial O +without O +hypotension O +. O +Patient O +to O +f O +u O +with O +pulmonology O +to O +start O +sildenifil O +chronically O +as O +outpatient O +as O +prior O +authorization O +is O +obtained O +. O +Past O +Medical O +History O +Atrial O +septal O +defect O +repair O +6 O +17 O +complicated O +by O +sinus O +arrest O +with O +PPM B-PROCEDURE +placement I-PROCEDURE +. O +Diastolic O +CHF O +, O +estimated O +dry O +weight O +of O +94kg O +Pulm O +HTN O +RSVP O +75 O +in O +11 O +24 O +thought O +secondary O +to O +longstanding O +ASD O +COPD O +on O +home O +O2 O +5L O +NC O +with O +baseline O +saturation O +high O +80 O +'s O +to O +low O +90 O +'s O +on O +this O +therapy O +. O +OSA O +, O +not O +CPAP O +compliant O +Mild O +mitral O +regurgitation O +Microcytic O +anemia O +Hypothyroidism O +S O +p O +APPY O +, O +s O +p O +CCY O +' O +33 O +Gallstone O +pancreatitis O +s O +p O +ERCP B-PROCEDURE +, O +sphincterotomy B-PROCEDURE +Elevated O +alk O +phos O +secondary O +to O +amiodarone O + +64yo O +woman O +with O +multiple O +myeloma O +, O +s O +p O +allogeneic B-PROCEDURE +transplant I-PROCEDURE +with O +recurrent O +disease O +and O +with O +systemic O +amyloidosis O +involvement O +of O +lungs O +, O +tongue O +, O +bladder O +, O +heart O +, O +on O +hemodialysis B-PROCEDURE +for O +ESRD O +who O +represents O +for O +malaise O +, O +weakness O +, O +and O +generalized O +body O +aching O +x O +2 O +days O +. O +She O +was O +admitted O +last O +week O +with O +hypercalcemia O +and O +treated O +with O +pamidronate O +30mg O +, O +calcitonin O +, O +and O +dialysis O +. O +Patient O +was O +Initially O +treated O +with O +melphalan O +and O +prednisone O +, O +followed O +by O +VAD O +regimen O +, O +and O +autologous B-PROCEDURE +stem I-PROCEDURE +cell I-PROCEDURE +transplant I-PROCEDURE +. O +With O +relapse O +of O +her O +myeloma O +, O +she O +received O +thalidomide O +velcade O +and O +thalidomide O +, O +which O +were O +eventually O +also O +held O +due O +to O +worsening O +edema O +and O +kidney O +function O +. O + +This O +is O +a O +78 O +year O +old O +male O +with O +h O +o O +BPH O +s O +p O +multiple O +urological B-PROCEDURE +procedures I-PROCEDURE +, O +including O +s O +p O +Suprapubic B-PROCEDURE +prostatectomy I-PROCEDURE +. O +He O +was O +noted O +to O +have O +low O +urine O +output O +and O +bladder O +scan O +showed O +360cc O +residual O +. O +It O +was O +impossible O +for O +staff O +to O +pass O +a O +foley O +. O +Urology O +was O +consulted O +, O +performed O +a O +flexible O +cystoscopy B-PROCEDURE +in O +the O +ICU O +and O +found O +severe O +2cm O +bulbar O +urethral O +stricture O +. O +They O +were O +able O +to O +pass O +small O +catheter O +through O +and O +left O +in O +place O +. O +The O +patient O +leaked O +around O +the O +catheter O +, O +the O +catheter O +eventually O +came O +out O +but O +he O +continued O +to O +have O +good O +urine O +output O +and O +post O +void O +bladder O +scans O +were O +performed O +q4h O +to O +ensure O +he O +did O +not O +have O +high O +residual O +volume O +. O +Urology O +suggested O +that O +when O +patient O +is O +stable O +he O +will O +have O +to O +be O +taken O +to O +the O +OR O +to O +have O +the O +stricture O +surgically O +fixed O +. O + +65 O +yo O +man O +with O +history O +of O +CAD O +and O +prior O +MI O +, O +HLD O +, O +HTN O +, O +ventricular O +tachycardia O +, O +and O +syncope O +was O +admitted O +earlier O +today O +evaluation O +of O +syncope O +and O +ventricular O +arrhythmias O +. O +He O +was O +recently O +discharged O +after O +a O +negative O +work O +up O +for O +syncope O +which O +included O +the O +implantation B-PROCEDURE +of I-PROCEDURE +a I-PROCEDURE +cardiac I-PROCEDURE +monitoring I-PROCEDURE +device I-PROCEDURE +. O +It O +was O +interrogated O +at O +the O +OSH O +and O +per O +report O +the O +monitor O +read O +from O +yesterday O +40 O +seconds O +of O +VT O +and O +then O +bradycardia O +with O +a O +rate O +of O +39 O +shortly O +thereafter O +corresponding O +with O +his O +symptoms O +. O +Overnight O +, O +the O +patient O +went O +into O +monomorphic O +VT O +on O +telemetry O +. O +The O +patient O +was O +found O +to O +be O +unresponsive O +. O +CPR B-PROCEDURE +was O +initiated O +, O +unclear O +if O +the O +patient O +had O +a O +pulse O +. O +Within O +one O +minute O +the O +patient O +returned O +to O +sinus O +rhythm O +. O +The O +patient O +does O +not O +report O +any O +symptoms O +prior O +to O +this O +episode O +. O +Currently O +, O +the O +patient O +feels O +presyncope O +and O +nausea O +, O +but O +denies O +chest O +pain O +. O +Patient O +is O +to O +be O +transferred O +to O +the O +CCU O +for O +catheterization B-PROCEDURE +and O +EPS B-PROCEDURE +. O + + + +The O +patient O +is O +a O +31 O +year O +old O +woman O +complaining O +of O +abdominal O +pain O +. O +The O +pain O +started O +last O +night O +as O +diffuse O +abdominal O +discomfort O +. O +She O +had O +poor O +appetite O +as O +well O +as O +malaise O +. O +The O +pain O +worsened O +in O +intensity O +and O +became O +sharp O +in O +the O +morning O +. O +The O +pain O +became O +localized O +to O +the O +right O +lower O +quadrant O +in O +the O +morning O +. O +The O +temperature O +is O +within O +the O +normal O +limits O +with O +normal O +vital O +signs O +. O +Focal O +tenderness O +and O +guarding O +were O +observed O +during O +palpation O +of O +the O +right O +lower O +quadrant O +. O +Palpation O +of O +the O +left O +lower O +quadrant O +causes O +pain O +on O +the O +right O +. O +Her O +lab O +work O +is O +remarkable O +for O +leukocytosis O +. O +Computed O +Tomography O +of O +the O +abdomen O +with O +contrast O +shows O +the O +presence O +of O +a O +distended O +appendix O +with O +thickened O +appendiceal O +wall O +without O +perforation O +, O +abscess O +or O +gangrene O +. O +She O +is O +a O +candidate O +for O +laparoscopic B-PROCEDURE +appendectomy I-PROCEDURE +under O +general O +anesthesia O +. O + +A O +39 O +year O +old O +man O +came O +to O +the O +clinic O +with O +cough O +and O +shortness O +of O +breath O +that O +was O +not O +relieved O +by O +his O +inhaler O +. O +He O +had O +these O +symptoms O +for O +5 O +days O +during O +the O +past O +2 O +weeks O +. O +He O +doubled O +his O +oral O +corticosteroids O +in O +the O +past O +week O +. O +He O +is O +a O +chef O +with O +a O +history O +of O +asthma O +for O +3 O +years O +, O +suffering O +from O +frequent O +cough O +, O +wheezing O +, O +and O +shortness O +of O +breath O +and O +chest O +tightness O +. O +The O +symptoms O +become O +more O +bothersome O +within O +1 O +2 O +hours O +of O +starting O +work O +every O +day O +and O +worsen O +throughout O +the O +work O +week O +. O +His O +symptoms O +improve O +within O +1 O +2 O +hours O +outside O +the O +workplace O +. O +Spirometry B-PROCEDURE +was O +performed O +revealing O +a O +forced O +expiratory O +volume O +in O +the O +first O +second O +FEV1 O +of O +63 O +of O +the O +predicted O +. O +His O +past O +medical O +history O +is O +significant O +for O +seasonal O +allergic O +rhinitis O +in O +the O +summer O +. O +He O +doesn O +' O +t O +smoke O +or O +use O +illicit O +drugs O +. O +His O +family O +history O +is O +significant O +for O +asthma O +in O +his O +father O +and O +sister O +. O +He O +currently O +uses O +inhaled O +corticosteroid O +ICS O +and O +fluticasone O +500 O +mcg O +salmeterol O +50 O +mcg O +, O +one O +puff O +twice O +daily O +. O + + +The O +patient O +is O +a O +42 O +year O +old O +postmenopausal O +woman O +who O +had O +a O +screening O +sonogram B-PROCEDURE +which O +revealed O +an O +abnormality O +in O +the O +right O +breast O +. O +She O +had O +no O +palpable O +masses O +on O +breast O +exam O +. O +Core B-PROCEDURE +biopsy I-PROCEDURE +was O +done O +and O +revealed O +a O +1 O +. O +8 O +cm O +infiltrating O +ductal O +breast O +carcinoma O +in O +the O +left O +upper O +outer O +quadrant O +. O +Lumpectomy B-PROCEDURE +was O +done O +and O +the O +surgical O +margins O +were O +clear O +. O +The O +tumor O +was O +HER2 O +positive O +and O +ER O +PR O +negative O +. O +Axillary O +sampling O +revealed O +1 O +positive O +lymph O +node O +out O +of O +12 O +sampled O +. O +CXR O +was O +unremarkable O +. O +She O +is O +using O +well O +women O +multivitamins O +daily O +and O +no O +other O +medication O +. O +She O +smokes O +frequently O +and O +consumes O +alcohol O +occasionally O +. O +She O +is O +in O +a O +relation O +with O +only O +one O +partner O +and O +has O +a O +history O +of O +3 O +pregnancies O +and O +live O +births O +. O +She O +breastfed O +all O +three O +children O +. O + +A O +45 O +year O +old O +woman O +was O +referred O +to O +the O +emergency O +department O +with O +abdominal O +pain O +lasting O +about O +4 O +days O +accompanied O +by O +nausea O +and O +2 O +episodes O +of O +vomiting O +. O +The O +pain O +is O +localized O +to O +the O +epigastric O +region O +and O +radiates O +to O +the O +right O +upper O +quadrant O +. O +The O +pain O +is O +worsening O +after O +eating O +fatty O +food O +. O +The O +patient O +experienced O +similar O +pain O +twice O +in O +the O +past O +year O +. O +Her O +past O +medical O +history O +is O +remarkable O +for O +hypercholesterolemia O +and O +two O +C B-PROCEDURE +sections I-PROCEDURE +. O +She O +has O +2 O +children O +, O +and O +she O +is O +menopausal O +. O +She O +doesn O +' O +t O +smoke O +, O +drink O +alcohol O +, O +or O +use O +illicit O +drugs O +. O +She O +is O +mildly O +febrile O +. O +Her O +BP O +is O +150 O +85 O +, O +HR O +115 O +, O +RR O +15 O +, O +T O +38 O +. O +2 O +, O +SpO2 O +98 O +on O +RA O +. O +On O +palpation O +, O +she O +experiences O +epigastric O +tenderness O +and O +tenderness O +in O +the O +right O +upper O +quadrant O +without O +rebound O +. O +Bowel O +sounds O +are O +normal O +. O +Laboratory O +analysis O +is O +remarkable O +for O +elevated O +ESR O +and O +leukocytosis O +with O +a O +left O +shift O +. O +The O +ultrasound B-PROCEDURE +revealed O +several O +gallstones O +and O +biliary O +sludge O +. O +The O +largest O +gallstone O +is O +0 O +. O +7cm O +. O +Surgery O +consultation O +recommends O +elective O +cholecystectomy O +. O + +A O +53 O +year O +old O +man O +presents O +with O +chronic O +HCV O +infection O +for O +the O +past O +2 O +years O +. O +His O +past O +medical O +history O +is O +only O +significant O +for O +inguinal B-PROCEDURE +hernia I-PROCEDURE +surgery I-PROCEDURE +when O +he O +was O +20 O +years O +old O +. O +He O +is O +on O +IFN O +100 O +mg O +week O +plus O +RBV O +400 O +mg O +day O +combination O +therapy O +for O +the O +past O +9 O +months O +. O +Direct O +antiviral O +drugs O +were O +added O +to O +his O +treatment O +6 O +months O +ago O +. O +His O +medical O +record O +shows O +previous O +positive O +HCV O +RNA O +tests O +as O +well O +as O +positive O +enzyme O +immunoassay O +for O +anti O +HCV O +antibodies O +. O +The O +recent O +biopsy B-PROCEDURE +was O +negative O +for O +hepatocellular O +carcinoma O +and O +was O +only O +remarkable O +for O +chronic O +inflammation O +compatible O +with O +a O +chronic O +viral O +hepatitis O +. O +There O +is O +no O +evidence O +of O +alcoholic O +liver O +disease O +, O +bleeding O +from O +esophageal O +varices O +, O +hemochromatosis O +, O +autoimmune O +hepatitis O +or O +metabolic O +liver O +disease O +. O +He O +is O +an O +alert O +male O +with O +no O +acute O +distress O +. O +His O +BP O +130 O +75 O +, O +HR O +90 O +min O +and O +BMI O +27 O +. O +His O +abdomen O +is O +soft O +with O +no O +ascites O +or O +tenderness O +. O +The O +lower O +extremities O +are O +normal O +with O +no O +edema O +. O + + + + +The O +patient O +is O +a O +37 O +year O +old O +woman O +who O +came O +to O +the O +clinic O +for O +a O +routine O +Pap O +smear O +. O +The O +test O +revealed O +stage O +1B O +of O +cervical O +cancer O +. O +The O +patient O +tested O +positive O +for O +HPV O +16 O +. O +She O +has O +three O +sexual O +partners O +and O +four O +children O +. O +She O +underwent O +tubal O +ligation O +. O +She O +smokes O +30 O +packs O +year O +and O +drinks O +alcohol O +frequently O +. O +She O +is O +otherwise O +healthy O +. O +She O +was O +offered O +a O +radical O +hysterectomy B-PROCEDURE +. O + +The O +patient O +is O +a O +47 O +year O +old O +Asian O +woman O +complaining O +of O +persistent O +feelings O +of O +sadness O +. O +She O +lost O +interest O +in O +activities O +she O +used O +to O +enjoy O +. O +She O +states O +that O +her O +mood O +is O +mostly O +depressed O +for O +the O +past O +3 O +weeks O +. O +She O +also O +lost O +her O +appetite O +, O +which O +led O +to O +about O +5kg O +weight O +loss O +. O +She O +complains O +of O +loss O +of O +energy O +and O +feelings O +of O +worthlessness O +nearly O +every O +day O +. O +She O +is O +not O +using O +any O +drugs O +and O +she O +does O +not O +smoke O +. O +She O +doesn O +' O +t O +drink O +alcohol O +. O +She O +used O +to O +exercise O +every O +day O +for O +at O +least O +30 O +min O +. O +But O +she O +doesn O +' O +t O +have O +enough O +energy O +to O +do O +so O +for O +the O +past O +3 O +weeks O +. O +She O +also O +has O +some O +digestive O +issues O +recently O +. O +She O +is O +married O +and O +has O +4 O +children O +. O +She O +is O +menopausal O +. O +Her O +husband O +was O +recently O +diagnosed O +with O +colon O +cancer O +and O +he O +is O +starting O +his O +chemotherapy B-PROCEDURE +. O +There O +is O +nothing O +remarkable O +in O +her O +past O +medical O +history O +and O +her O +drug O +history O +is O +only O +positive O +for O +Vit O +D3 O +1000 O +units O +daily O +. O +Her O +family O +history O +is O +negative O +for O +any O +psychologic O +problems O +. O +Her O +HAM O +D O +score O +is O +20 O +. O + + +The O +patient O +is O +a O +35 O +year O +old O +woman O +with O +myasthenia O +gravis O +, O +class O +IIa O +. O +She O +complains O +of O +diplopia O +and O +fatigue O +and O +weakness O +that O +affects O +mainly O +her O +upper O +limbs O +. O +She O +had O +a O +positive O +anti O +AChR O +antibody O +test O +, O +and O +her O +single B-PROCEDURE +fiber I-PROCEDURE +electromyography I-PROCEDURE +SFEMG B-PROCEDURE +was O +positive O +. O +She O +takes O +pyridostigmine O +60 O +mg O +three O +times O +a O +day O +. O +But O +she O +still O +has O +some O +symptoms O +that O +interfere O +with O +her O +job O +. O +She O +is O +a O +research O +coordinator O +and O +has O +3 O +children O +. O +Her O +70 O +year O +old O +father O +has O +hypertension O +. O +She O +does O +not O +smoke O +or O +use O +illicit O +drugs O +. O +She O +drinks O +alcohol O +occasionally O +at O +social O +events O +. O +Her O +physical O +exam O +and O +lab O +studies O +were O +not O +remarkable O +for O +any O +other O +abnormalities O +. O +BP O +110 O +75 O +Hgb O +11 O +g O +dl O +WBC O +8000 O +mm3 O +Plt O +300000 O +ml O +Creatinine O +0 O +. O +5 O +mg O +dl O +BUN O +10 O +mg O +dl O +Beta O +hcg O +negative O +for O +pregnancy O + +A O +3 O +day O +old O +Asian O +female O +infant O +presents O +with O +jaundice O +that O +started O +a O +day O +ago O +. O +She O +was O +born O +at O +38w3d O +of O +gestation O +, O +after O +an O +uncomplicated O +pregnancy O +. O +The O +family O +history O +is O +unremarkable O +. O +The O +baby O +is O +breastfed O +. O +Vital O +signs O +are O +reported O +as O +axillary O +temperature O +36 O +. O +3 O +C O +, O +heart O +rate O +154 O +beats O +min O +, O +respiratory O +rate O +37 O +breaths O +min O +, O +and O +blood O +pressure O +65 O +33 O +mm O +Hg O +. O +Her O +weight O +is O +3 O +. O +2 O +kg O +, O +length O +is O +53 O +cm O +, O +and O +head O +circumference O +36 O +cm O +. O +Her O +sclera O +are O +yellow O +and O +her O +body O +is O +icteric O +. O +No O +murmurs O +or O +any O +other O +abnormalities O +are O +detected O +in O +the O +heart O +and O +lung O +auscultation O +. O +Her O +liver O +and O +spleen O +are O +normal O +on O +palpation O +. O +Laboratory O +results O +are O +as O +follows O +Serum O +total O +bilirubin O +21 O +. O +02 O +mg O +dL O +Direct O +bilirubin O +of O +2 O +. O +04 O +mg O +dL O +AST O +37 O +U O +L O +ALT O +20 O +U O +L O +GGT O +745 O +U O +L O +Alkaline O +phosphatase O +531 O +U O +L O +Creatinine O +0 O +. O +3 O +mg O +dL O +Urea O +29 O +mg O +dL O +Na O +147 O +mEq O +L O +K O +4 O +. O +5 O +mEq O +L O +CRP O +3 O +mg O +L O +Complete O +blood O +cell O +count O +within O +the O +normal O +range O +. O +She O +is O +diagnosed O +with O +uncomplicated O +neonatal O +jaundice O +that O +may O +require O +phototherapy B-PROCEDURE +. O + + +The O +patient O +is O +a O +14 O +year O +old O +boy O +complaining O +of O +scoliosis O +and O +back O +pain O +. O +He O +has O +no O +other O +medical O +condition O +. O +He O +used O +to O +be O +able O +to O +play O +routine O +activities O +such O +as O +basketball O +and O +soccer O +, O +however O +, O +he O +recently O +has O +problem O +doing O +them O +. O +The O +pain O +is O +in O +his O +leg O +and O +back O +and O +aggravated O +by O +physical O +activities O +. O +He O +prefer O +lying O +down O +most O +of O +the O +time O +. O +He O +is O +not O +happy O +with O +his O +body O +gesture O +and O +complaints O +of O +shoulder O +imbalance O +and O +shifting O +his O +head O +to O +right O +. O +Patient O +is O +a O +well O +dressed O +and O +well O +nourished O +adolescent O +who O +is O +alert O +and O +cooperative O +. O +The O +left O +shoulder O +is O +slightly O +higher O +than O +the O +right O +shoulder O +. O +The O +scoliotic O +curve O +is O +measured O +as O +45 O +degree O +. O +The O +patients O +is O +candidate O +for O +scoliosis B-PROCEDURE +surgery I-PROCEDURE +according O +to O +perioperative O +MEP O +monitoring O + + +A O +62 O +year O +old O +African O +American O +man O +presented O +with O +left O +upper O +and O +lower O +extremity O +weakness O +, O +associated O +with O +dark O +visual O +spot O +in O +right O +eye O +, O +right O +facial O +numbness O +, O +facial O +drop O +and O +slurred O +speech O +. O +He O +denied O +dyspnea O +, O +headache O +, O +palpitations O +, O +chest O +pain O +, O +fever O +, O +dizziness O +, O +bowel O +or O +urinary O +incontinence O +, O +loss O +of O +consciousness O +. O +His O +medical O +history O +was O +significant O +for O +hypertension O +, O +hyperlipidemia O +and O +hypothyroidism O +. O +He O +smokes O +cigarette O +1 O +pack O +per O +day O +for O +40 O +years O +and O +alcohol O +consumption O +of O +5 O +to O +6 O +beers O +per O +week O +. O +He O +is O +not O +aware O +about O +his O +family O +history O +. O +He O +is O +using O +Levothyroxine O +, O +Atorvastatin O +and O +HTCZ O +. O +His O +vital O +signs O +were O +stable O +in O +the O +primary O +evaluation O +. O +Left O +sided O +facial O +droop O +, O +dysarthria O +, O +and O +left O +sided O +hemiplegia O +were O +seen O +in O +the O +physical O +exam O +. O +His O +National O +Institutes O +of O +Health O +Stroke O +Scale O +NIHSS O +score O +was O +calculated O +as O +7 O +. O +Initial O +CT B-PROCEDURE +angiogram I-PROCEDURE +of O +head O +and O +neck O +reported O +no O +acute O +intracranial O +findings O +. O +Intravenous O +recombinant O +tissue O +plasminogen O +activator O +t O +PA O +was O +administered O +as O +well O +as O +high O +dose O +statin O +therapy O +. O +The O +patient O +was O +admitted O +to O +the O +intensive O +care O +unit O +to O +be O +monitored O +for O +24 O +hours O +. O +MRI B-PROCEDURE +of O +the O +head O +revealed O +an O +acute O +1 O +. O +7 O +cm O +infarct O +of O +the O +right O +periventricular O +white O +matter O +and O +posterior O +right O +basal O +ganglia O +. O + + + +A O +57 O +year O +old O +man O +was O +admitted O +to O +the O +clinic O +because O +of O +weight O +loss O +and O +persistent O +dry O +cough O +4 O +months O +ago O +. O +Chest B-PROCEDURE +computed I-PROCEDURE +topography I-PROCEDURE +showed O +bilateral O +multiple O +infiltrates O +in O +the O +upper O +lobes O +and O +thickened O +bronchial O +walls O +. O +There O +is O +a O +documented O +positive O +serum O +MPO O +ANCA O +in O +his O +medical O +record O +. O +Transbronchial B-PROCEDURE +biopsy I-PROCEDURE +revealed O +necrotic O +granulomas O +with O +multinucleated O +giant O +cells O +and O +the O +Wegener O +'s O +granulomatosis O +was O +diagnosed O +for O +him O +. O +He O +is O +treating O +with O +corticosteroid O +and O +cyclophosphamides O +since O +4 O +months O +ago O +. O +His O +Birmingham O +Vasculitis O +Activity O +Score O +BVAS O +is O +above O +4 O +since O +the O +beginning O +of O +his O +disease O +. O +His O +last O +physical O +exam O +and O +lab O +study O +was O +performed O +yesterday O +and O +showed O +the O +results O +bellow O +A O +wellbeing O +, O +well O +nourished O +man O +, O +non O +icteric O +, O +cooperative O +and O +alert O +Weight O +73 O +kg O +Height O +177 O +BP O +120 O +80 O +HR O +90 O +min O +RR O +22 O +min O +Hgb O +13 O +g O +dl O +WBC O +8000 O +mm3 O +Neutrophil O +2700 O +mm3 O +Plt O +300000 O +ml O +AST O +40 O +U O +L O +ALT O +56 O +U O +L O +Alk O +P O +147 O +U O +L O +Bill O +total O +1 O +. O +2 O +mg O +dl O +ESR O +120 O +mm O +hr O +MPO O +ANCA O +153 O +EU O + +The O +patient O +is O +a O +41 O +year O +old O +man O +and O +a O +known O +case O +of O +Acromegaly O +who O +underwent O +transsphenoidal O +surgery O +4 O +months O +ago O +. O +He O +came O +to O +the O +clinic O +for O +the O +follow O +up O +lab O +studies O +after O +his O +primary O +resection O +surgery O +. O +His O +lab O +study O +shows O +the O +IGF O +1 O +level O +of O +4 O +. O +5 O +ULN O +adjusted O +by O +sex O +and O +age O +. O +His O +random O +GH O +level O +is O +4 O +ug O +L O +. O +The O +recent O +brain O +MRI B-PROCEDURE +confirmed O +the O +residual O +pituitary O +tumor O +. O +His O +past O +medical O +history O +is O +only O +significant O +for O +acromegaly O +due O +to O +pituitary O +adenoma O +and O +the O +recent O +surgery O +. O +After O +his O +surgery O +he O +takes O +only O +vitamin O +D O +and O +multivitamins O +. O + +The O +patient O +is O +a O +17 O +year O +old O +boy O +complaining O +of O +severe O +migratory O +pain O +in O +the O +right O +lower O +quadrant O +of O +his O +abdomen O +that O +started O +four O +days O +ago O +. O +The O +pain O +is O +accompanied O +by O +nausea O +and O +vomiting O +. O +He O +was O +febrile O +with O +tenderness O +, O +rebound O +tenderness O +and O +guarding O +on O +palpation O +. O +His O +WBC O +was O +elevated O +with O +dominant O +neutrophils O +. O +CT B-PROCEDURE +scan O +showed O +evidence O +of O +acute O +perforated O +appendicitis O +with O +free O +fluid O +in O +the O +pelvis O +. O +Diagnostic B-PROCEDURE +laparoscopy I-PROCEDURE +revealed O +phlegmon O +with O +no O +other O +abdominal O +abnormalities O +. O +He O +is O +now O +a O +candidate O +for O +emergent B-PROCEDURE +laparoscopic I-PROCEDURE +appendectomy I-PROCEDURE +under O +general O +anesthesia O +. O + + +A O +42 O +year O +old O +healthy O +woman O +came O +to O +the O +clinic O +to O +have O +her O +flu O +shot O +in O +early O +October O +. O +She O +works O +in O +a O +rehab O +center O +and O +has O +no O +underlying O +disease O +. O +It O +'s O +her O +first O +time O +getting O +the O +vaccine O +this O +year O +. O +She O +is O +married O +for O +5 O +years O +and O +uses O +barrier O +methods O +of O +contraception O +. O +Her O +menstrual O +cycle O +is O +irregular O +. O +She O +does O +not O +smoke O +. O +She O +is O +not O +on O +any O +medications O +. O +She O +exercises O +regularly O +for O +30 O +minutes O +a O +day O +at O +least O +5 O +days O +a O +week O +. O +She O +has O +no O +history O +of O +allergies O +to O +any O +food O +or O +drugs O +. O +Her O +past O +surgical O +history O +is O +significant O +for O +tonsillectomy B-PROCEDURE +and O +she O +is O +otherwise O +healthy O +. O + + +The O +patient O +is O +a O +20 O +year O +old O +Caucasian O +female O +presents O +to O +the O +clinic O +with O +one O +sided O +vision O +lost O +and O +facial O +weakness O +, O +dysarthria O +and O +numbness O +lasting O +for O +1 O +day O +. O +She O +visited O +her O +PCP O +and O +underwent O +brain B-PROCEDURE +MRI I-PROCEDURE +which O +revealed O +a O +single O +plaque O +in O +the O +brainstem O +. O +After O +few O +months O +, O +she O +experienced O +lower O +extremities O +weakness O +led O +to O +balance O +problem O +. O +The O +second O +MRI B-PROCEDURE +revealed O +another O +lesion O +in O +the O +left O +cerebral O +hemisphere O +. O +The O +diagnosis O +of O +Relapsing O +Remitting O +Multiple O +Sclerosis O +RRMS O +is O +confirmed O +after O +the O +second O +MRI O +. O +Her O +past O +surgical O +history O +is O +significant O +for O +a O +C B-PROCEDURE +section I-PROCEDURE +2 O +years O +ago O +and O +she O +has O +a O +one O +child O +. O +She O +is O +divorced O +and O +is O +not O +currently O +in O +any O +sexual O +relationship O +. O +She O +smokes O +10 O +cigarettes O +per O +day O +and O +drinks O +alcohol O +occasionally O +. O +She O +is O +working O +as O +an O +editor O +in O +a O +publisher O +company O +and O +she O +is O +happy O +that O +she O +can O +keep O +working O +from O +home O +most O +of O +the O +time O +. O +She O +is O +under O +the O +treatment O +of O +RRMS O +from O +7 O +months O +ago O +. O + + + + + + + + + +A O +22 O +year O +old O +Caucasian O +man O +came O +to O +the O +Clinic O +with O +a O +history O +of O +tremors O +since O +a O +year O +ago O +. O +The O +tremor O +was O +first O +in O +his O +right O +hand O +while O +holding O +something O +. O +Later O +the O +tremor O +became O +continuous O +and O +extended O +to O +both O +hands O +and O +legs O +and O +even O +at O +rest O +. O +The O +Kayser O +Fleischer O +' O +ring O +was O +detected O +in O +the O +ophthalmologic B-PROCEDURE +exam I-PROCEDURE +. O +The O +physical O +exam O +revealed O +jaundice O +, O +hepatosplenomegaly O +and O +hypotonia O +of O +the O +upper O +limbs O +. O +He O +had O +a O +constant O +smile O +on O +his O +face O +, O +however O +, O +he O +has O +aggressive O +behavior O +according O +to O +his O +parents O +' O +explanation O +. O +His O +laboratory O +study O +was O +significant O +for O +a O +low O +serum O +caeruloplasmin O +0 O +. O +05 O +g O +l O +, O +and O +a O +raised O +24 O +hour O +urine O +copper O +excretion O +120 O +μg O +24 O +h O +. O +Wilson O +disease O +was O +confirmed O +by O +high O +liver O +copper O +concentration O +305 O +μg O +g O +dry O +weight O +of O +liver O +. O + + +The O +patient O +is O +a O +15 O +year O +old O +boy O +with O +asthma O +diagnosed O +a O +year O +ago O +. O +He O +presents O +with O +shortness O +of O +breath O +, O +chest O +tightening O +and O +cough O +. O +According O +to O +his O +mother O +, O +he O +didn O +' O +t O +respond O +to O +the O +usual O +corticosteroid O +inhaler O +. O +He O +was O +admitted O +to O +the O +emergency O +department O +with O +diagnosis O +of O +severe O +asthma O +exacerbation O +. O +He O +is O +a O +candidate O +for O +general O +corticosteroid O +therapy O +. O +Spirometry B-PROCEDURE +revealed O +a O +forced O +expiratory O +volume O +in O +the O +first O +second O +FEV1 O +of O +60 O +of O +the O +predicted O +. O +His O +past O +medical O +history O +is O +non O +significant O +. O +His O +family O +history O +is O +significant O +for O +asthma O +in O +his O +mother O +and O +his O +uncle O +. O +He O +used O +to O +be O +treated O +with O +combination O +of O +inhaled O +corticosteroids O +and O +Zafirlukast O +. O + +The O +patient O +is O +a O +63 O +year O +old O +man O +presenting O +to O +the O +Emergency O +Department O +with O +a O +history O +of O +acute O +urinary O +retention O +in O +the O +past O +2 O +days O +. O +Abdominopelvic B-PROCEDURE +CT I-PROCEDURE +scan O +revealed O +a O +large O +prostate O +and O +a O +bladder O +filled O +with O +urine O +. O +He O +is O +a O +candidate O +for O +urethral B-PROCEDURE +catheterization I-PROCEDURE +and O +TURP B-PROCEDURE +. O +Further O +evaluation O +revealed O +Post O +void O +residual O +71 O +mL O +Prostate O +volume O +TRUS O +63 O +mL O +Prostate O +specific O +antigen O +PSA O +level O +3 O +. O +5 O +ng O +mL O +His O +recent O +blood O +chemistry O +3 O +days O +ago O +was O +normal O +Hgb O +13 O +. O +6 O +g O +dl O +WBC O +133000 O +mm3 O +Plt O +370000 O +ml O +PT O +12 O +second O +PTT O +34 O +second O +INR O +0 O +. O +9 O +Creatinine O +0 O +. O +5 O +mg O +dl O +BUN O +10 O +mg O +dl O +U O +A O +Color O +yellow O +Appearance O +cloudy O +PH O +5 O +. O +3 O +Specific O +gravity O +1 O +. O +010 O +Glc O +100 O +Nitrite O +negative O +Ketone O +none O +Leukocyte O +esterase O +negative O +RBC O +negative O +WBC O +2 O +WBCs O +hpf O +U O +C O +negative O + +The O +patient O +is O +a O +45 O +year O +old O +postmenopausal O +woman O +with O +cytologically O +confirmed O +breast O +cancer O +. O +A O +core O +biopsy B-PROCEDURE +revealed O +a O +3 O +cm O +invasive O +ductal O +breast O +carcinoma O +in O +the O +left O +upper O +outer O +quadrant O +. O +The O +tumor O +is O +HER2 O +positive O +and O +ER O +PR O +negative O +. O +Axillary O +sampling O +revealed O +5 O +positive O +lymph O +nodes O +. O +CXR O +was O +remarkable O +for O +metastatic O +lesions O +. O +The O +patient O +is O +using O +multivitamins O +and O +iron O +supplements O +. O +She O +does O +not O +smoke O +or O +consume O +alcohol O +. O +She O +is O +not O +sexually O +active O +and O +has O +no O +children O +. O +She O +is O +a O +candidate O +for O +tumor B-PROCEDURE +resection I-PROCEDURE +and O +agrees O +to O +do O +so O +prior O +to O +chemotherapy B-PROCEDURE +. O + +A O +46 O +year O +old O +man O +presents O +with O +dizziness O +and O +frequent O +headaches O +. O +He O +has O +a O +family O +history O +of O +CAD O +, O +but O +no O +other O +cardiovascular O +risk O +factors O +such O +as O +smoking O +, O +high O +blood O +pressure O +, O +and O +diabetes O +mellitus O +and O +is O +physically O +active O +. O +The O +patient O +'s O +LDL O +C O +and O +HDL O +C O +levels O +were O +545 O +and O +53 O +mg O +dL O +, O +respectively O +. O +His O +fasting O +glucose O +and O +triglyceride O +levels O +85 O +and O +158 O +mg O +dL O +, O +resp O +. O +were O +within O +normal O +limits O +. O +The O +patient O +reported O +no O +use O +of O +lipid O +lowering O +medications O +. O +Neck B-PROCEDURE +auscultation I-PROCEDURE +revealed O +a O +systolic O +murmur O +3 O +6 O +in O +the O +neck O +, O +radiating O +to O +the O +skull O +. O +Ultrasonography B-PROCEDURE +of O +the O +carotid O +arteries O +, O +revealed O +severe O +stenosis O +in O +the O +left O +internal O +carotid O +artery O +LICA O +, O +as O +well O +as O +moderate O +stenosis O +in O +the O +right O +internal O +carotid O +artery O +RICA O +estimated O +between O +40 O +and O +50 O +. O +For O +the O +LICA O +, O +the O +peak O +systolic O +PSV O +and O +end O +diastolic O +velocity O +EDV O +cutoff O +values O +were O +208 O +. O +5 O +cm O +s O +and O +54 O +. O +5 O +cm O +s O +, O +respectively O +; O +RICA O +PSV O +was O +91 O +. O +72 O +cm O +s O +and O +RICA O +EDV O +was O +37 O +. O +37 O +cm O +s O +. O +Plaque O +was O +observed O +in O +the O +anterior O +and O +posterior O +walls O +of O +the O +internal O +carotid O +artery O +and O +common O +carotid O +artery O +, O +which O +were O +characterized O +as O +bulky O +plates O +extending O +to O +the O +middle O +third O +of O +the O +internal O +coronary O +arteries O +ICAs O +and O +as O +predominantly O +echogenic O +and O +hyperechoic O +, O +with O +less O +than O +50 O +of O +the O +area O +being O +echolucent O +with O +uneven O +surfaces O +. O + + +The O +patient O +is O +a O +55 O +year O +old O +man O +diagnosed O +with O +HCV O +2 O +years O +ago O +and O +the O +recent O +coinfection O +with O +HBV O +. O +His O +past O +medical O +history O +is O +non O +significant O +. O +He O +is O +on O +IFN O +, O +RBV O +and O +direct O +antiviral O +drugs O +for O +the O +past O +6 O +months O +. O +The O +patient O +takes O +no O +other O +medications O +. O +His O +medical O +records O +show O +previous O +positive O +HCV O +RNA O +tests O +and O +a O +positive O +enzyme O +immunoassay O +for O +anti O +HCV O +antibodies O +. O +The O +recent O +biopsy B-PROCEDURE +was O +negative O +for O +hepatocellular O +carcinoma O +and O +was O +only O +remarkable O +for O +chronic O +inflammation O +compatible O +with O +a O +chronic O +viral O +hepatitis O +. O +There O +is O +no O +evidence O +of O +alcoholic O +liver O +disease O +, O +bleeding O +from O +esophageal O +varices O +, O +hemochromatosis O +, O +autoimmune O +hepatitis O +, O +or O +metabolic O +liver O +disease O +. O +He O +is O +an O +alert O +male O +with O +no O +acute O +distress O +. O +His O +BP O +130 O +75 O +, O +HR O +90 O +min O +and O +BMI O +27 O +. O +His O +abdomen O +is O +soft O +with O +no O +ascites O +or O +tenderness O +. O +The O +lower O +extremities O +are O +normal O +with O +no O +edema O +. O + +The O +patient O +is O +a O +25 O +year O +old O +man O +with O +type O +1 O +diabetes O +confirmed O +with O +molecular B-PROCEDURE +analysis I-PROCEDURE +7 O +years O +ago O +. O +He O +presents O +to O +the O +clinic O +with O +shortness O +of O +breath O +and O +fatigue O +during O +activities O +. O +He O +claims O +mild O +dyspnea O +after O +climbing O +3 O +floors O +, O +no O +dyspnea O +at O +rest O +and O +no O +angina O +New O +York O +Heart O +Association O +class O +2 O +. O +He O +is O +diagnosed O +with O +cardiomyopathy O +that O +will O +be O +treated O +with O +ACE O +inhibitors O +and O +Beta O +blockers O +. O +His O +takes O +70 O +30 O +Insulin O +and O +vitamin O +D O +supplements O +. O +His O +past O +medical O +history O +is O +not O +significant O +for O +any O +other O +medical O +issues O +. O +His O +family O +history O +is O +positive O +for O +DM O +type O +1 O +in O +his O +uncle O +and O +his O +grandfather O +. O +His O +lab O +study O +is O +as O +bellow O +FBS O +100 O +mg O +dl O +HbA1c O +6 O +. O +5 O +Cholesterol O +190 O +mg O +dl O +TG O +140 O +mg O +dl O +LDL O +125 O +mg O +dl O +HDL O +40 O +mg O +dl O + + +A O +Pap O +smear O +in O +a O +54 O +year O +old O +woman O +revealed O +abnormal O +cervical O +squamous O +intraepithelial O +glandular O +lesion O +. O +She O +tested O +positive O +for O +HPV O +16 O +. O +She O +is O +sexually O +active O +with O +her O +husband O +and O +has O +4 O +children O +. O +She O +is O +menopausal O +and O +uses O +no O +contraception O +. O +She O +smokes O +and O +drinks O +alcohol O +frequently O +. O +She O +is O +otherwise O +healthy O +. O +She O +was O +offered O +conization B-PROCEDURE +. O + +The O +patient O +is O +a O +23 O +year O +old O +man O +who O +came O +to O +the O +hospital O +with O +high O +blood O +pressure O +175 O +95 O +mmHg O +and O +signs O +of O +septicemia O +. O +He O +developed O +respiratory O +failure O +requiring O +mechanical O +ventilation O +and O +renal O +failure O +requiring O +hemodialysis B-PROCEDURE +. O +His O +blood O +smear O +showed O +microangiopathic O +hemolytic O +anemia O +and O +thrombocytopenia O +. O +His O +blood O +tests O +revealed O +elevated O +lactate O +dehydrogenase O +and O +reduced O +human O +complement O +C3 O +levels O +with O +a O +normal O +coagulation O +profile O +. O +He O +was O +diagnosed O +with O +atypical O +hemolytic O +uremic O +syndrome O +. O +He O +was O +treated O +with O +plasma O +exchange O +and O +corticosteroids O +. O +He O +has O +been O +previously O +vaccinated O +with O +meningococcal O +group O +ACWY O +conjugate O +vaccine O +and O +meningococcal O +group O +B O +vaccine O +. O +The O +genetic O +survey O +revealed O +ADAMTS13 O +10 O +. O + + +A O +46 O +year O +old O +Asian O +woman O +with O +MDD O +complains O +of O +persistent O +feelings O +of O +sadness O +and O +loss O +of O +interest O +in O +daily O +activities O +. O +She O +states O +that O +her O +mood O +is O +still O +depressed O +most O +of O +the O +days O +. O +She O +complains O +of O +loss O +of O +energy O +and O +feelings O +of O +worthlessness O +nearly O +every O +day O +. O +She O +is O +on O +anti O +depressants O +for O +the O +past O +6 O +months O +, O +but O +the O +symptoms O +are O +still O +present O +. O +She O +does O +not O +drink O +alcohol O +or O +smoke O +. O +She O +used O +to O +exercise O +every O +day O +for O +at O +least O +30 O +min O +. O +, O +but O +she O +doesn O +' O +t O +have O +enough O +energy O +to O +do O +so O +for O +the O +past O +3 O +weeks O +. O +She O +also O +has O +some O +digestive O +issues O +recently O +. O +She O +is O +married O +and O +has O +4 O +children O +. O +She O +is O +menopausal O +. O +Her O +husband O +was O +diagnosed O +with O +colon O +cancer O +a O +year O +ago O +and O +is O +undergoing O +chemotherapy B-PROCEDURE +. O +Her O +past O +medical O +history O +is O +unremarkable O +. O +Her O +family O +history O +is O +negative O +for O +any O +psychologic O +problems O +. O +Her O +HAM O +D O +score O +is O +20 O +. O + + + + +The O +patient O +is O +a O +3 O +day O +old O +female O +infant O +with O +jaundice O +that O +started O +one O +day O +ago O +. O +She O +was O +born O +at O +34w O +of O +gestation O +and O +kept O +in O +an O +incubator O +due O +to O +her O +gestational O +age O +. O +Vital O +signs O +were O +reported O +as O +axillary O +temperature O +36 O +. O +3 O +C O +, O +heart O +rate O +154 O +beats O +min O +, O +respiratory O +rate O +37 O +breaths O +min O +, O +and O +blood O +pressure O +65 O +33 O +mm O +Hg O +. O +Her O +weight O +is O +2 O +. O +1 O +kg O +, O +length O +is O +45 O +cm O +, O +and O +head O +circumference O +32 O +cm O +. O +She O +presents O +with O +yellow O +sclera O +and O +icteric O +body O +. O +Her O +liver O +and O +spleen O +are O +normal O +to O +palpation O +. O +Laboratory O +results O +are O +as O +follows O +Serum O +total O +bilirubin O +21 O +. O +02 O +mg O +dL O +Direct O +bilirubin O +of O +2 O +. O +04 O +mg O +dL O +AST O +37 O +U O +L O +ALT O +20 O +U O +L O +GGT O +745 O +U O +L O +Alkaline O +phosphatase O +531 O +U O +L O +Creatinine O +0 O +. O +3 O +mg O +dL O +Urea O +29 O +mg O +dL O +Na O +147 O +mEq O +L O +K O +4 O +. O +5 O +mEq O +L O +CRP O +3 O +mg O +L O +Complete O +blood O +cell O +count O +within O +the O +normal O +range O +. O +She O +is O +diagnosed O +with O +neonatal O +jaundice O +that O +may O +require O +phototherapy B-PROCEDURE +. O + +