28492 lines (28236 with data), 218.8 kB

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 B-SYMPTOM
pressure I-SYMPTOM
within I-SYMPTOM
the I-SYMPTOM
eye I-SYMPTOM
. 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 O
surgery O
. O
However O
, O
they O
have O
not O
had O
LASIK O
surgery O
. 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 B-SYMPTOM
field I-SYMPTOM
damage I-SYMPTOM
. 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 O
surgery O
or O
LASIK O
surgery O
. 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
individual O
, O
aged O
39 O
, O
has O
been O
definitively O
diagnosed O
with O
anxiety O
. O
They O
are O
proficient O
in O
English O
and O
have O
reported O
experiencing O
significant O
anxiety B-SYMPTOM
symptoms I-SYMPTOM
. O
Their O
SSASI O
score O
is O
6 O
, O
HAM O
A O
score O
is O
20 O
, O
PHQ O
9 O
score O
is O
7 O
, O
and O
HAM O
D O
score O
is O
23 O
, O
indicating O
varying O
levels O
of O
anxiety O
and O
depressive B-SYMPTOM
symptoms I-SYMPTOM
. O
They O
have O
also O
expressed O
experiencing O
suicidal O
ideation O
. O
There O
is O
no O
history O
of O
dementia O
. O
Additional O
assessment O
using O
the O
GAD O
7 O
and O
Beck O
Depression O
Inventory O
is O
ongoing O
to O
further O
understand O
their O
condition O
. O
















The O
patient O
's O
definitive O
diagnosis O
is O
confirmed O
through O
PCR O
testing O
. O
They O
have O
shown O
symptoms O
such O
as O
fever B-SYMPTOM
, O
muscle B-SYMPTOM
pain I-SYMPTOM
, O
and O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. O
The O
patient O
was O
hospitalized O
for O
5 O
days O
, O
with O
2 O
of O
those O
days O
requiring O
ventilation O
. O
Their O
vaccination O
status O
indicates O
they O
have O
received O
1 O
shot O
of O
an O
mRNA O
vaccine O
. O
The O
patient O
's O
oxygen O
saturation O
level O
is O
at O
95 O
. O
They O
have O
a O
history O
of O
asthma O
, O
a O
comorbid O
respiratory O
disease O
. O

The O
patient O
has O
been O
diagnosed O
with O
COVID O
19 O
. O
The O
definitive O
diagnosis O
was O
confirmed O
through O
PCR O
testing O
. O
The O
patient O
exhibited O
symptoms O
including O
fever B-SYMPTOM
, O
headache B-SYMPTOM
, O
and O
body B-SYMPTOM
pains I-SYMPTOM
. O
Due O
to O
the O
severity O
of O
the O
condition O
, O
the O
patient O
required O
hospitalization O
and O
ventilation O
support O
. O
At O
the O
time O
of O
assessment O
, O
the O
patient O
's O
oxygen O
saturation O
level O
was O
96 O
. O
The O
patient O
had O
not O
received O
any O
vaccination O
against O
COVID O
19 O
prior O
to O
this O
illness O
. O
Additionally O
, O
the O
patient O
had O
a O
history O
of O
bronchiectasis O
, O
a O
comorbid O
respiratory O
disease O
. O

The O
patient O
has O
received O
a O
definitive O
diagnosis O
of O
COVID O
19 O
through O
a O
PCR O
test O
. O
Their O
reported O
symptoms O
include O
fever B-SYMPTOM
and O
muscle B-SYMPTOM
pain I-SYMPTOM
. O
They O
have O
not O
required O
hospitalization O
or O
ventilation O
for O
their O
condition O
. O
The O
patient O
's O
vaccination O
status O
indicates O
that O
they O
have O
received O
a O
2 O
shot O
COVID O
19 O
vaccine O
series O
along O
with O
a O
booster O
dose O
. O
Their O
oxygen O
saturation O
level O
is O
at O
97 O
. O
There O
are O
no O
comorbid O
respiratory O
diseases O
reported O
in O
their O
medical O
history O
. O

The O
patient O
's O
definitive O
diagnosis O
of O
COVID O
19 O
is O
based O
solely O
on O
a O
positive O
result O
from O
a O
rapid O
test O
. O
Their O
reported O
symptoms O
include O
headache B-SYMPTOM
and O
fatigue B-SYMPTOM
. O
They O
have O
not O
required O
hospitalization O
or O
ventilation O
support O
. O
The O
patient O
is O
unvaccinated O
against O
COVID O
19 O
. O
Their O
oxygen O
saturation O
level O
is O
at O
98 O
. O
They O
have O
a O
history O
of O
asthma O
as O
a O
comorbid O
respiratory O
disease O
. O

The O
individual O
under O
consideration O
has O
not O
received O
a O
definitive O
diagnosis O
for O
COVID O
19 O
. O
They O
have O
experienced O
symptoms O
such O
as O
headache B-SYMPTOM
but O
have O
not O
required O
hospitalization O
or O
ventilation O
. O
Their O
vaccination O
status O
indicates O
that O
they O
are O
unvaccinated O
. O
Information O
regarding O
their O
oxygen O
saturation O
is O
not O
provided O
. O
Additionally O
, O
there O
are O
no O
reported O
comorbid O
respiratory O
diseases O
in O
this O
case O
. O


The O
patient O
's O
definitive O
diagnosis O
is O
rheumatoid O
arthritis O
. O
Currently O
, O
there O
is O
no O
active O
DMARD O
treatment O
, O
but O
there O
was O
prior O
treatment O
with O
hydroxychloroquine O
. O
Prednisone O
is O
being O
used O
along O
with O
other O
RA O
medications O
. O
The O
patient O
has O
3 O
swollen O
and O
2 O
tender B-SYMPTOM
joints I-SYMPTOM
. O
There O
is O
no O
history O
of O
tuberculosis O
. O
The O
DAS O
28 O
CRP O
score O
is O
4 O
. O
Comorbidities O
are O
absent O
. O

The O
patient O
has O
a O
definitive O
diagnosis O
of O
rheumatoid O
arthritis O
. O
They O
are O
currently O
undergoing O
active O
anti O
TNF O
therapy O
as O
their O
DMARD O
treatment O
. O
Prior O
to O
this O
, O
they O
were O
treated O
with O
methotrexate O
. O
Naproxen O
is O
being O
used O
as O
another O
medication O
for O
their O
rheumatoid O
arthritis O
. O
The O
patient O
has O
5 O
swollen B-SYMPTOM
joints I-SYMPTOM
and O
2 O
tender B-SYMPTOM
joints I-SYMPTOM
. O
They O
have O
a O
history O
of O
past O
tuberculosis O
. O
There O
are O
no O
comorbidities O
reported O
for O
the O
patient O
. O

The O
patient O
has O
a O
definitive O
diagnosis O
of O
rheumatoid O
arthritis O
and O
is O
currently O
undergoing O
active O
treatment O
with O
hydroxychloroquine O
, O
without O
prior O
DMARD O
treatment O
. O
Additionally O
, O
the O
patient O
is O
taking O
ibuprofen O
for O
their O
condition O
. O
They O
are O
experiencing O
symptoms O
in O
6 O
tender B-SYMPTOM
joints I-SYMPTOM
and O
have O
a O
DAS O
28 O
CRP O
score O
of O
5 O
. O
5 O
. O
The O
patient O
has O
comorbid O
diabetes O
but O
no O
history O
of O
tuberculosis O
. O












An O
elderly O
female O
with O
past O
medical O
history O
of O
hypertension O
, O
severe O
aortic O
stenosis O
, O
hyperlipidemia O
, O
and O
right O
hip O
arthroplasty O
. O
Presents O
after O
feeling O
a O
snap O
of O
her O
right O
leg O
and O
falling O
to O
the O
ground O
. O
No O
head B-SYMPTOM
trauma I-SYMPTOM
or O
loss B-SYMPTOM
of I-SYMPTOM
consciousness I-SYMPTOM
. O

78 O
M O
transferred O
to O
nursing O
home O
for O
rehab O
after O
CABG O
. 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 B-SYMPTOM
stool I-SYMPTOM
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 B-SYMPTOM
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA O
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 B-SYMPTOM
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 B-SYMPTOM
. O
On O
ROS O
, O
pt O
denies O
pain B-SYMPTOM
, O
lightheadedness B-SYMPTOM
, O
headache B-SYMPTOM
, O
neck B-SYMPTOM
pain I-SYMPTOM
, O
sore B-SYMPTOM
throat I-SYMPTOM
, O
recent O
illness O
or O
sick O
contacts O
, O
cough B-SYMPTOM
, O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
chest B-SYMPTOM
discomfort I-SYMPTOM
, O
heartburn B-SYMPTOM
, O
abd I-SYMPTOM
pain I-SYMPTOM
, O
n O
v O
, O
diarrhea O
, O
constipation B-SYMPTOM
, O
dysuria B-SYMPTOM
. 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 B-SYMPTOM
fracture I-SYMPTOM
. 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 B-SYMPTOM
. 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 B-SYMPTOM
of I-SYMPTOM
C2 I-SYMPTOM
. 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 O
which O
showed O
sinus O
tachycardia O
and O
ST O
depressions O
in O
V3 O
and O
V4 O
. O
CT O
head O
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 O
post O
bioprosthetic O
atrial O
valve O
replacement O
for O
atrial O
stenosis O
, O
atrial O
fibrillation O
with O
cardioversion O
, O
right O
nephrectomy O
for O
renal O
cell O
carcinoma O
, O
colon O
cancer O
status O
post O
colectomy O
, O
presents O
with O
9 O
day O
history O
of O
productive O
cough B-SYMPTOM
, O
fever B-SYMPTOM
and O
dyspnea B-SYMPTOM
. 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 B-SYMPTOM
and O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
Earlier O
, O
she O
presented O
with O
back B-SYMPTOM
pain I-SYMPTOM
and O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. 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 B-SYMPTOM
positive I-SYMPTOM
stools I-SYMPTOM
. O
She O
was O
discharged O
and O
returned O
with O
abdominal B-SYMPTOM
cramping I-SYMPTOM
and O
black B-SYMPTOM
stools I-SYMPTOM
. O
EGD O
showed O
a O
small O
gastric B-SYMPTOM
and I-SYMPTOM
duodenal I-SYMPTOM
ulcer I-SYMPTOM
healing O
, O
esophageal B-SYMPTOM
stricture I-SYMPTOM
, O
no O
active O
bleeding B-SYMPTOM
. O
She O
also O
had O
an O
abdominal O
CT O
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 B-SYMPTOM
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 O
gtt O
and O
octreotide O
gtt O
given O
his O
elevated B-SYMPTOM
liver I-SYMPTOM
function I-SYMPTOM
tests O
. O
Lab O
tests O
show O
elevated B-SYMPTOM
lipase I-SYMPTOM
, O
pancytopenia O
and O
coagulopathy O
. O
He O
had O
a O
right O
upper O
abdominal O
quadrant O
ultrasound O
which O
demonstrated O
gallstones B-SYMPTOM
and O
sludge B-SYMPTOM
and O
ascites B-SYMPTOM
. O
As O
such O
given O
new O
ascites B-SYMPTOM
and O
abdominal B-SYMPTOM
pain I-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
positive I-SYMPTOM
. O
He O
has O
right O
upper O
abdominal O
quadrant O
pain B-SYMPTOM
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 B-SYMPTOM
over O
the O
two O
days O
prior O
to O
admission O
. O
The O
patient O
denies O
fever B-SYMPTOM
, O
chills B-SYMPTOM
, O
night B-SYMPTOM
sweats I-SYMPTOM
, O
headache B-SYMPTOM
, O
sinus B-SYMPTOM
tenderness I-SYMPTOM
, O
rhinorrhea B-SYMPTOM
or O
congestion B-SYMPTOM
. O
Denied O
cough B-SYMPTOM
, O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. O
He O
also O
denied O
chest B-SYMPTOM
pain I-SYMPTOM
or O
tightness B-SYMPTOM
. 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 B-SYMPTOM
and O
congested B-SYMPTOM
. 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
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 B-SYMPTOM
in I-SYMPTOM
her I-SYMPTOM
urine I-SYMPTOM
. O
Her O
family O
noted O
that O
she O
was O
breathing O
rapidly O
and O
was O
quite O
somnolent B-SYMPTOM
. O
She O
appears O
to O
be O
in O
respiratory B-SYMPTOM
distress I-SYMPTOM
. 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 B-SYMPTOM
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 B-SYMPTOM
of I-SYMPTOM
membranes I-SYMPTOM
. 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 B-SYMPTOM
and O
chills B-SYMPTOM
. 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 O
section O
. 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 O
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 B-SYMPTOM
. 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 B-SYMPTOM
and O
then O
unresponsive B-SYMPTOM
. 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 B-SYMPTOM
but O
able O
to O
protect O
her O
airway O
and O
so O
not O
intubated O
. O
She O
vomited B-SYMPTOM
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 O
revealed O
hepatosplenomegaly O
but O
no O
intraperitoneal B-SYMPTOM
fluid I-SYMPTOM
. O

A O
80yo O
male O
with O
dementia O
and O
past O
history O
of O
CABG O
, O
two O
caths O
this O
year 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
, O
presents O
with O
increasing O
chest B-SYMPTOM
pain I-SYMPTOM
and O
nausea B-SYMPTOM
over O
the O
past O
few O
days O
. O
The O
patient O
has O
history O
of O
repeated O
episodes O
of O
recurrent O
chest B-SYMPTOM
pain I-SYMPTOM
with O
relief O
with O
morphine O
. O
Pt O
is O
on O
ASA O
, O
Statins O
, O
Imdur O
, O
and O
Heparin O
. O
Last O
month O
s O
cath O
showed O
patent O
BMS O
in O
LCX O
and O
no O
new O
lesions B-SYMPTOM
. O
According O
to O
the O
family O
, O
the O
patient O
has O
increasing O
episodes O
of O
chest B-SYMPTOM
pain I-SYMPTOM
with O
minimal O
exertion O
in O
the O
last O
two O
weeks O
. O

66 O
yo O
female O
pedestrian O
struck O
by O
auto O
. O
Unconscious B-SYMPTOM
and O
unresponsive B-SYMPTOM
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 B-SYMPTOM
p I-SYMPTOM
embolization I-SYMPTOM
of I-SYMPTOM
the I-SYMPTOM
avulsed I-SYMPTOM
second I-SYMPTOM
branch I-SYMPTOM
of I-SYMPTOM
brachial I-SYMPTOM
artery I-SYMPTOM
, O
complicated O
by O
exp B-SYMPTOM
lap I-SYMPTOM
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 O
of O
the O
head O
showing O
extensive O
interparenchymal O
hemorrhages O
throughout O
. O

A O
43 O
year O
old O
woman O
with O
history O
of O
transverse O
myelitis O
leading O
to O
paraplegia O
, O
depression O
, O
frequent O
pressure O
ulcers O
, O
presenting O
with O
chills B-SYMPTOM
and O
reporting O
she O
felt O
" O
as O
if O
dying O
" O
. O
Upon O
presentation O
, O
she O
denied O
any O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
, O
but O
did O
report O
diarrhea B-SYMPTOM
with O
two O
loose O
bowel O
movements O
per O
day O
. O
Patient O
reported O
that O
she O
had O
a O
fallout O
with O
her O
VNA O
and O
has O
not O
had O
any O
professional O
wound O
care O
. O
Patient O
is O
agitated B-SYMPTOM
, O
with O
rigors O
, O
complaining O
of O
feeling O
cold B-SYMPTOM
and O
back B-SYMPTOM
pain I-SYMPTOM
. O
Patient O
rolled O
and O
found O
to O
have O
a O
stage O
IV O
decubitus O
ulcer O
on O
coccyx O
and O
buttocks O
, O
heels O
. O
Admission O
labs O
significant O
for O
thrombocytosis O
, O
elevated B-SYMPTOM
lactate I-SYMPTOM
, O
and O
prolonged B-SYMPTOM
PT I-SYMPTOM
. 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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
and O
back B-SYMPTOM
pain I-SYMPTOM
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 B-SYMPTOM
pain I-SYMPTOM
and O
treated O
with O
pain O
medications O
. O
Subsequently O
developed O
rash B-SYMPTOM
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 B-SYMPTOM
, O
fevers B-SYMPTOM
and O
sore B-SYMPTOM
throat I-SYMPTOM
. 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 O
scan O
, O
contrast O
infiltrated O
her O
arm O
with O
skin O
blistering B-SYMPTOM
and O
swelling B-SYMPTOM
. 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 O
resection O
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 B-SYMPTOM
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy O
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 B-SYMPTOM
appetitie I-SYMPTOM
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased B-SYMPTOM
activity I-SYMPTOM
tolerance I-SYMPTOM
. O
Smokes O
5 O
cig O
day O
. O
PET O
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 B-SYMPTOM
pain I-SYMPTOM
, O
palpitations B-SYMPTOM
, O
trauma B-SYMPTOM
, O
F B-SYMPTOM
C I-SYMPTOM
, O
N B-SYMPTOM
V I-SYMPTOM
D I-SYMPTOM
. O
Pt O
. O
presents O
with O
worsening O
SOB B-SYMPTOM
with O
R O
shoulder O
pain B-SYMPTOM
and O
weakness B-SYMPTOM
. O

A O
90 O
year O
old O
woman O
who O
was O
recently O
hospitalized O
for O
legionella O
PNA O
, O
and O
has O
been O
continuing O
her O
recovery O
at O
home O
with O
her O
son O
. O
She O
had O
been O
doing O
fairly O
well O
for O
the O
last O
few O
days O
except O
for O
some O
waxing O
and O
waning O
confusion B-SYMPTOM
, O
and O
perhaps O
intermittent O
dysarthria B-SYMPTOM
. O
The O
son O
was O
getting O
ready O
for O
work O
at O
1 O
15am O
today O
, O
as O
per O
his O
usual O
routine O
. O
He O
looked O
in O
on O
the O
patient O
at O
that O
time O
; O
she O
appeared O
to O
be O
sleeping O
comfortably O
in O
bed O
, O
on O
her O
back O
. O
Soon O
thereafter O
, O
he O
heard O
her O
walking O
to O
the O
bathroom O
. O
At O
1 O
40am O
, O
he O
heard O
a O
loud O
crash O
coming O
from O
the O
bathroom O
. O
He O
found O
the O
patient O
on O
the O
floor O
of O
the O
bathroom O
, O
making O
non O
verbal O
utterances O
and O
with O
minimal O
movement O
of O
the O
right O
side O
. O

This O
is O
a O
76 O
year O
old O
female O
with O
personal O
history O
of O
diastolic O
congestive O
heart O
failure O
, O
atrial O
fibrillation O
on O
Coumadin O
, O
presenting O
with O
low B-SYMPTOM
hematocrit I-SYMPTOM
and O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. O
Her O
hematocrit O
dropped O
from O
28 O
to O
16 O
. O
9 O
over O
the O
past O
6 O
weeks O
with O
progressive O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
worse O
with O
exertion O
over O
the O
past O
two O
weeks O
. O
She O
reports O
orthopnea O
. O
She O
denies O
fevers B-SYMPTOM
, O
chills B-SYMPTOM
, O
chest B-SYMPTOM
pain I-SYMPTOM
, O
palpitaitons B-SYMPTOM
, O
cough B-SYMPTOM
, O
abdominal B-SYMPTOM
pain I-SYMPTOM
, O
constipation B-SYMPTOM
or O
diahrrea B-SYMPTOM
, O
melena B-SYMPTOM
, O
blood B-SYMPTOM
in O
her O
stool O
, O
dysuria B-SYMPTOM
or O
rash B-SYMPTOM
. O
Her O
electrocardiogram O
present O
no O
significant O
change O
from O
previous O
. O
Her O
Guaiac O
was O
reported O
as O
being O
positive 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 O
. O
The O
patient O
would O
like O
to O
undergo O
detoxification O
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 B-SYMPTOM
pain I-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
, O
vomitting B-SYMPTOM
bilious O
but O
nonbloody O
, O
and O
diarrhea B-SYMPTOM
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 B-SYMPTOM
on O
exertion O
, O
orthopnea B-SYMPTOM
. O
Also O
describes O
weight B-SYMPTOM
gain I-SYMPTOM
. O
Labs O
are O
significant O
for O
elevated B-SYMPTOM
lipase I-SYMPTOM
. O

78 O
year O
old O
female O
with O
PMHx O
HTN O
, O
dCHF O
, O
Diabetes O
, O
CKD O
, O
Atrial O
fibrillation O
on O
coumadin O
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
to O
cardiology O
clinic O
today O
with O
confusion B-SYMPTOM
and O
Somnolence B-SYMPTOM
. O
Of O
note O
, O
she O
was O
recently O
discharged O
after O
presyncope O
falls O
. O
At O
that O
time O
, O
lasix O
was O
stopped O
and O
atenolol O
was O
switched O
to O
metoprolol O
as O
there O
was O
concern O
that O
blunting O
of O
tachycardia O
could O
be O
contributing O
to O
falls O
. O
She O
was O
discharged O
to O
rehab O
previously O
living O
at O
home O
. O
Per O
report O
from O
the O
ER O
, O
patient O
has O
had O
confusion B-SYMPTOM
at O
home O
for O
3 O
weeks O
, O
though O
no O
family O
accompanies O
her O
to O
corroborate O
this O
story O
, O
and O
patient O
denies O
this O
. O
The O
patient O
is O
not O
sure O
why O
she O
is O
in O
the O
hospital O
. O
She O
saw O
her O
cardiologist O
today O
, O
who O
referred O
her O
to O
the O
ER O
after O
she O
appeared O
to O
be O
dehydrated B-SYMPTOM
, O
somnolent B-SYMPTOM
, O
and O
confused B-SYMPTOM
. O
The O
patient O
denies O
headache B-SYMPTOM
, O
blurry B-SYMPTOM
vision I-SYMPTOM
, O
numbness B-SYMPTOM
, O
tingling B-SYMPTOM
or O
weakness B-SYMPTOM
. O
No O
CP B-SYMPTOM
. O
SOB B-SYMPTOM
, O
worsening O
DOE B-SYMPTOM
. O
No O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
. O

A O
87 O
year O
old O
female O
NH O
resident O
with O
a O
history O
of O
chronic O
atrial O
fibrillation O
, O
hypertension O
and O
hypothyroidism O
who O
presents O
wit O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
She O
had O
been O
in O
her O
usual O
state O
of O
health O
until O
5 O
days O
ago O
when O
she O
suddenly O
began O
to O
have O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
Her O
abdominal B-SYMPTOM
pain I-SYMPTOM
was O
initially O
intermittent O
lasting O
for O
a O
few O
hours O
at O
at O
time O
. O
No O
clear O
correlation O
with O
food O
. O
Yesterday O
, O
she O
noticed O
that O
her O
pain B-SYMPTOM
was O
much O
more O
severe O
and O
more O
localized O
to O
the O
right O
. O
This O
was O
accompanied O
by O
nausea B-SYMPTOM
and O
vomitting B-SYMPTOM
. O
She O
vomitted O
twice O
, O
with O
clear O
liquid O
emesis O
and O
was O
sent O
to O
a O
hospital O
. O
At O
the O
hospital O
, O
she O
was O
noted O
to O
have O
elevated B-SYMPTOM
amylase I-SYMPTOM
lipase I-SYMPTOM
to O
538 O
and O
516 O
with O
elevated O
bili O
to O
4 O
. O
1 O
and O
AST O
ALT O
to O
198 O
115 O
and O
was O
given O
ciprofloxacin O
, O
flagyl O
and O
500cc O
NS O
and O
was O
transferred O
to O
the O
emergency O
department O
. O
At O
the O
emergency O
department O
her O
vital O
signs O
were O
TM O
97 O
. O
9 O
HR O
83 O
BP O
157 O
92 O
RR O
18 O
sat O
97 O
RA 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 O
showed O
sinus B-SYMPTOM
rhythm I-SYMPTOM
, O
HR O
80 O
with O
LAD B-SYMPTOM
, O
prolonged B-SYMPTOM
PR I-SYMPTOM
, 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 B-SYMPTOM
global I-SYMPTOM
left I-SYMPTOM
ventricular I-SYMPTOM
function I-SYMPTOM
, O
mild O
to O
moderate O
aortic B-SYMPTOM
regurgitation I-SYMPTOM
and O
mild O
mitral B-SYMPTOM
regurgitation I-SYMPTOM
. 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 O
SCT O
, O
who O
presents O
with O
one O
week O
of O
worsening O
SOB B-SYMPTOM
and O
two O
days O
of O
a O
clear O
productive O
cough B-SYMPTOM
. O
The O
patient O
states O
his O
SOB B-SYMPTOM
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 B-SYMPTOM
pressure I-SYMPTOM
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 B-SYMPTOM
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND B-SYMPTOM
; 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 B-SYMPTOM
to O
the O
99 O
's O
and O
crampy O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
Denies O
chills B-SYMPTOM
, O
night B-SYMPTOM
sweats I-SYMPTOM
, O
vomiting B-SYMPTOM
, O
or O
diarrhea B-SYMPTOM
. 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 B-SYMPTOM
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 B-SYMPTOM
. O

85M O
dementia O
, O
colon O
cancer O
and O
recent O
colectomy O
with O
primary O
reanastomosis O
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 B-SYMPTOM
abdomen I-SYMPTOM
, O
well O
healed O
surgical O
scar O
. O
No O
edema B-SYMPTOM
or O
cord B-SYMPTOM
. 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 O
, 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 B-SYMPTOM
, O
a O
sorethroat B-SYMPTOM
as O
well O
as O
some O
rhinorrhea B-SYMPTOM
. O
He O
denies O
any O
abdominal B-SYMPTOM
pain I-SYMPTOM
, 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 B-SYMPTOM
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 O
stenting O
, 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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. O
According O
to O
Pt O
, O
her O
primary O
complaint O
is O
not O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
but O
cough B-SYMPTOM
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 B-SYMPTOM
, O
chills B-SYMPTOM
, O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
, O
pleuritic B-SYMPTOM
pain I-SYMPTOM
, O
weight B-SYMPTOM
gain I-SYMPTOM
, O
or O
dietary B-SYMPTOM
indiscretion I-SYMPTOM
. O
She O
also O
reports O
a O
sore B-SYMPTOM
throat I-SYMPTOM
over O
the O
past O
3 O
days O
. O
She O
recently O
underwent O
thoracentesis O
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 B-SYMPTOM
, 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 B-SYMPTOM
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 O
and O
became O
hypotensive B-SYMPTOM
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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
and O
back B-SYMPTOM
pain I-SYMPTOM
, 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 O
tomography O
angiography O
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 O
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 O
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 B-SYMPTOM
pain I-SYMPTOM
, O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
and O
tachypnea B-SYMPTOM
. O
She O
does O
note O
some O
diaphoresis B-SYMPTOM
and O
occasional O
palpitations B-SYMPTOM
. O

This O
84 O
year O
old O
man O
with O
a O
history O
of O
coronary O
artery O
disease O
presents O
with O
2 O
days O
of O
melena O
and O
black O
colored O
emesis B-SYMPTOM
. O
Stools O
becoming O
less O
dark O
, O
but O
he O
had O
increased O
lethargy B-SYMPTOM
and O
presented O
to O
the O
emergency O
department O
today O
. O
Initial O
systolic O
blood O
pressure O
recorded O
in O
the O
60s O
, O
but O
all O
in O
110 O
120s O
after O
that O
. O
In O
the O
ED O
, O
he O
had O
gastric 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
with O
mild O
ST O
depression O
V3 O
V5 O
that O
resolved O
spontaneously O
. O
Patient O
is O
on O
ASPIRIN O
81 O
mg O
Tablet O
by O
mouth O
daily O
. O

A O
96 O
y O
o O
female O
found O
unresponsive B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
and O
some O
neck O
shoulder O
discomfort B-SYMPTOM
. O
NCHCT O
showed O
9mm O
L O
parietal O
SDH O
. O
C O
spine O
negative O
. O
Imaging O
CT O
head O
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 O
. O
Her O
post O
op O
course O
was O
complicated O
by O
agitation B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
in O
the O
30s O
with O
associated O
hypotension B-SYMPTOM
. 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 B-SYMPTOM
, O
chills B-SYMPTOM
, O
rhinorrhea B-SYMPTOM
. 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 B-SYMPTOM
on O
exertion O
. O
The O
computed O
tomography O
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 B-SYMPTOM
eosinophils I-SYMPTOM
peripherally I-SYMPTOM
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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
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

78 O
M O
w O
pmh O
of O
CABG O
in O
early O
Month O
only O
3 O
at O
Hospital6 O
4406 O
transferred O
to O
nursing O
home O
for O
rehab O
on O
12 O
8 O
after O
several O
falls O
out O
of O
bed O
. O
He O
was O
then O
readmitted O
to O
Hospital6 O
1749 O
on O
3120 O
12 O
11 O
after O
developing O
acute O
pulmonary O
edema O
CHF O
unresponsiveness O
? O
. O
There O
was O
a O
question O
whether O
he O
had O
a O
small O
MI O
; O
he O
reportedly O
had O
a O
small O
NQWMI O
. O
He O
improved O
with O
diuresis B-SYMPTOM
and O
was O
not O
intubated O
. O
. O
Yesterday O
, O
he O
was O
noted O
to O
have O
a O
melanotic B-SYMPTOM
stool I-SYMPTOM
earlier O
this O
evening O
and O
then 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

Ms O
Known O
patient O
lastname O
241 O
is O
a O
Age O
over O
90 O
2398 O
year O
old O
woman O
with O
past O
medical O
history O
significant O
for O
hypertension O
, O
severe O
aortic O
stenosis O
, O
hyperlipidemia O
, O
arthroplasty O
. O
. O
Per O
the O
patient O
, O
she O
was O
standing O
and O
felt O
a O
snap O
of O
her O
right O
leg O
and O
fell O
to O
the O
ground O
. O
No O
head B-SYMPTOM
trauma I-SYMPTOM
or O
LOC B-SYMPTOM
. O
She O
was O
evaluated O
by O
orthopedics O
and O
transferred O
to O
medicine O
for O
optimization O
of O
her O
cardiac O
status O
. O
Review O
of O
systems O
Ear O
, O
Nose O
, O
Throat O
Dry B-SYMPTOM
mouth I-SYMPTOM
Cardiovascular O
Edema O
, O
Orthopnea O
Respiratory O
Dyspnea B-SYMPTOM
Flowsheet O
Data O
as O
of O
3294 O
3 O
6 O
10 O
33 O
PM O
Vital O
Signs O
Hemodynamic O
monitoring O
Fluid O
Balance O
24 O
hours O
Since O
96 O
AM O
Tmax O
37 O
. O
5 O
C O
99 O
. O
5 O
Tcurrent O
37 O
. O
5 O
C O
99 O
. O
5 O
HR O
102 O
93 O
102 O
bpm O
BP O
117 O
54 O
70 O
117 O
54 O
70 O
117 O
54 O
70 O
mmHg O
RR O
24 O
15 O
24 O
insp O
min O
SpO2 O
100 O
Heart O
rhythm O
ST O
Sinus O
Tachycardia O
. O
Clarify O
She O
appears O
comfortable O
with O
adequate O
pain O
control O
with O
prn O
morphine O
. O
Given O
her O
tight O
valvular O
stenosis O
, O
she O
is O
high O
risk O
for O
general O
anesthesia O
. O
would O
start O
standing O
tylenol O
1g O
q8 O
continue O
morphine O
IV O
prn O
for O
breakthrough O
plan O
for O
OR O
tomorrow O
am O
per O
ortho O
pending O
optimization O
of O
her O
cardiac O
function O
, O
and O
improvement O
in O
renal O
function O
. O
CAD O
No O
clear O
documentation O
, O
however O
given O
age O
calcific O
atherosclerosis O
is O
highly O
likely O
continue O
statin O
Hold O
beta O
blocker O
for O
now O
hold O
aspirin O
in O
perioperative O
period O
. O
ATRIAL O
FIBRILLATION O
In O
setting O
of O
acute B-SYMPTOM
pain I-SYMPTOM
and O
peri O
op O
. O
Will O
need O
to O
monitor O
as O
pt O
with O
high O
CHADS O
score O
, O
however O
in O
periop O
period O
would O
not O
be O
able O
to O
have O
systemic O
anticoagulation O
Rate O
control O
with O
beta O
blocker O
once O
stable O
If O
unstable O
, O
would O
use O
esmolol O
first O
, O
cardiovert O
last O
option O
. O
. O
HTN O
Better O
controlled O
on O
floor O
. O
Good O
BP O
control O
essential O
for O
preventing O
flash O
pulmonary O
edema O
in O
setting O
of O
AS O
. O
continue O
metoprolol O
, O
as O
above O
continue O
to O
monitor O
BP O
and O
consider O
adding O
another O
Doctor O
Last O
Name O
such O
as O
amlodipine O
5mg O
daily O
if O
BP O
sustains O
above O
SBP O
150s O
. O
Hyperlipidemia O
continue O
simvastatin O
40mg O
PO O
daily O
. O
FEN O
GI O
Low O
sodium O
diet O
, O
replete O
lytes O
PRN O
. O
CODE O
Confirmed O
DNR O
DNI O

Pt O
is 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
who O
presented O
to O
Hospital1 O
Location O
un O
1375 O
on O
6 O
25 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 B-SYMPTOM
to O
29 O
with O
hypotension B-SYMPTOM
and O
bradycardia B-SYMPTOM
. O
Her O
hypotension B-SYMPTOM
and O
confusion B-SYMPTOM
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA O
which O
eventually O
grew O
klebsiella O
, O
treated O
initially O
with O
levofloxacin O
. O
She O
had O
a O
leukocytosis O
to O
18 O
and O
a O
creatinine O
of O
6 O
up O
from O
presumed O
prior O
baseline O
of O
2 O
. O
On O
morning O
of O
transfer O
, O
pt O
had O
blood O
cultures O
result O
3 O
3 O
bottles O
positive O
for O
GAS O
, O
her O
antibiotics O
were O
switched O
to O
vancomycin O
which O
was O
then O
changed O
to O
ceftriaxone O
. O
Her O
blood O
pressure O
dropped O
to O
the O
60s O
. O
She O
was O
given O
a O
bolus O
of O
bicarb O
and O
transfered O
to O
their O
ICU O
. O
After O
an O
additional O
bolus O
of O
500cc O
she O
was O
started O
on O
levophed O
. O
She O
was O
anuric B-SYMPTOM
throughout O
the O
day O
. O
She O
had O
a O
midline O
placed O
on O
right O
side 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 B-SYMPTOM
. O
She O
was O
receiving O
levophed O
throughout O
her O
transfer O
. O
Arrival O
VS O
96 O
. O
3 O
68 O
102 O
26 O
22 O
97 O
2L O
NC O
on O
0 O
. O
04mcg O
kg O
min O
levophed O
. O
On O
ROS O
, O
pt O
denies O
pain B-SYMPTOM
, O
lightheadedness B-SYMPTOM
, O
headache B-SYMPTOM
, O
neck B-SYMPTOM
pain I-SYMPTOM
, O
sore B-SYMPTOM
throat I-SYMPTOM
, O
recent O
illness O
or O
sick O
contacts O
, O
cough B-SYMPTOM
, O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
chest B-SYMPTOM
discomfort I-SYMPTOM
, O
heartburn B-SYMPTOM
, O
abd B-SYMPTOM
pain I-SYMPTOM
, O
n O
v O
, O
diarrhea B-SYMPTOM
, O
constipation B-SYMPTOM
, O
dysuria B-SYMPTOM
. O
Is O
a O
poor O
historian O
regarding O
how O
long O
she O
has O
had O
a O
rash B-SYMPTOM
on O
her O
legs O
. O
States O
she O
has O
not O
felt O
ill O
and O
she O
was O
brought O
to O
the O
hospital O
because O
her O
daughter O
came O
home O
and O
found O
her O
sleeping O
. O
Does O
complain O
of O
feeling O
very O
thirsty O
. O
" O


An O
82 O
M O
with O
COPD O
, O
s O
p O
bioprosthetic O
AVR O
for O
AS O
, O
afib O
s O
p O
CV O
, O
right O
nephrectomy O
for O
RCC O
, O
colon O
ca O
s O
p O
colectomy O
who O
presents O
with O
9 O
day O
hostory O
of O
productive O
cough B-SYMPTOM
and O
fevers B-SYMPTOM
. O
light O
of O
stairs O
baseline O
. O
dyspnea B-SYMPTOM
and O
productive O
cough B-SYMPTOM
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 B-SYMPTOM
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 O
. 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 B-SYMPTOM
and O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. 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 B-SYMPTOM
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 O
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 B-SYMPTOM
and O
congested B-SYMPTOM
. 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 B-SYMPTOM
. 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 B-SYMPTOM
distress I-SYMPTOM
. O
. O
The O
falling O
beta O
HCG O
and O
trans O
abdominal O
ultrasound O
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 B-SYMPTOM
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 B-SYMPTOM
around O
the O
tube O
. O
He O
was O
given O
4mg O
IV O
morphine O
for O
abdominal B-SYMPTOM
pain I-SYMPTOM
, O
ativan O
2mg O
IV O
for O
withdrawal B-SYMPTOM
, 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 O
ultrasound O
which O
demonstrated O
gallstones B-SYMPTOM
and O
sludge B-SYMPTOM
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 B-SYMPTOM
pain I-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
extremity I-SYMPTOM
swelling I-SYMPTOM
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 B-SYMPTOM
, O
no O
asterixis B-SYMPTOM
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 B-SYMPTOM
tenderness I-SYMPTOM
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 B-SYMPTOM
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 O
section O
. 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


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 O
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 O
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 B-SYMPTOM
pain I-SYMPTOM
and O
nausea B-SYMPTOM
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 B-SYMPTOM
pain I-SYMPTOM
. O
Ruled O
out O
for O
MI O
. O
Last O
episode O
of O
chest B-SYMPTOM
pressure I-SYMPTOM
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


A O
52 O
year O
old O
woman O
with O
COPD O
and O
breast O
cancer O
who O
presented O
to O
an O
OSH O
with O
SOB B-SYMPTOM
and O
back B-SYMPTOM
pain I-SYMPTOM
for O
several O
weeks O
. O
Had O
been O
seen O
by O
PCP O
for O
the O
back B-SYMPTOM
pain I-SYMPTOM
and O
treated O
with O
pain O
meds O
. O
Subsequently O
developed O
rash B-SYMPTOM
that O
was O
thought O
to O
be O
zoster B-SYMPTOM
. O
In O
the O
last O
few O
days O
, O
increased O
O2 O
requirement O
2 O
liters O
at O
baseline O
4 O
liters O
, O
cough B-SYMPTOM
, O
fevers B-SYMPTOM
and O
sore O
throat O
. O
Noted O
sat O
of O
79 O
with O
ambulation O
at O
home O
. O
At O
OSH O
, 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
CT O
scan O
, O
had O
contrast O
infiltrate O
her O
arm O
with O
skin O
blistering O
and O
swelling O
. O
Treated O
with O
ceftriaxone O
and O
transferred O
to O
Hospital1 O
1 O
. O
Patient O
admitted O
from O
Transfer O
from O
other O
hospital O
History O
obtained O
from O
Patient O
, O
Medical O
records O
Physical O
Examination O
General O
Appearance O
Well O
nourished O
, O
No O
t O
Anxious B-SYMPTOM
, O
sleepy B-SYMPTOM
Eyes O
Conjunctiva O
PERRL O
, O
No O
t O
Sclera O
edema O
Head O
, O
Ears O
, O
Nose O
, O
Throat O
Normocephalic O
Cardiovascular O
S1 O
Normal O
, O
S2 O
Normal O
, O
No O
t O
S3 O
, O
No O
t O
S4 O
, O
Murmur O
No O
t 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
Not O
assessed O
, O
Left O
DP O
pulse O
Not O
assessed O
Respiratory O
Chest O
Expansion O
No O
t O
Symmetric O
, O
Breath O
Sounds O
Wheezes O
expiratory O
, O
Diminished O
, O
scoliotic O
, O
can O
feel O
ribs O
on O
the O
back O
on O
the O
right O
move O
with O
breathing O
Abdominal O
Soft O
, O
Non O
tender O
, O
Bowel O
sounds O
present O
Extremities O
Right O
Trace O
, O
Left O
Trace O
, O
No O
t O
Cyanosis O
, O
Clubbing O
Musculoskeletal O
No O
t O
Unable O
to O
stand O
Skin O
Not O
assessed O
, O
No O
t O
Jaundice O
, O
resolving O
zoster O
rash O
on O
right O
lateral O
chest O
, O
right O
arm O
is O
wrapped 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
person O
place O
time O
but O
sleepy O
, O
Movement O
Not O
assessed O
, O
Tone O
Not O
assessed O

Ms O
Known O
patient O
lastname O
21112 O
is O
a O
43 O
year O
old O
woman O
with O
history O
of O
transverse O
myelitis O
leading O
to O
paraplegia O
, O
depression O
, O
frequent O
pressure O
ulcers O
, O
presenting O
with O
chills O
and O
reporting O
she O
felt O
" O
as O
if O
dying O
" O
. O
Upon O
presentation O
, O
she O
denied O
any O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
, O
but O
did O
report O
diarrhea B-SYMPTOM
with O
two O
loose O
bowel O
movements O
per O
day O
. O
Patient O
reported O
that O
she O
had O
a O
fallout O
with O
her O
VNA O
and O
has O
not O
had O
any O
professional O
wound O
care O
since O
early O
Month O
only O
51 O
. O
Patient O
has O
a O
long O
history O
of O
psychiatric O
and O
behavioral O
problems O
. O
Name O
NI O
Name2 O
NI O
review O
, O
patient O
was O
dismissed O
from O
the O
Company O
110 O
practice O
due O
to O
abusive O
behavior O
against O
staff O
. O
She O
does O
not O
have O
a O
primary O
care O
provider O
at O
this O
time O
. O
In O
the O
ED O
Temp O
98 O
. O
9 O
HR O
90 O
BP O
109 O
62 O
RR O
16 O
O2 O
Sat O
97 O
RA O
. O
Patient O
initially O
thought O
to O
be O
agitated O
yelling O
her O
EMS O
transporters O
were O
" O
white O
devils O
" O
. O
Patient O
kept O
in O
observation O
area O
, O
although O
with O
rigors O
, O
complaining O
of O
feeling O
cold O
and O
back O
pain O
. O
Patient O
rolled O
and O
found O
to O
have O
a O
stage O
IV O
decubitus O
ulcer O
on O
coccyx O
and O
buttocks O
, O
heels O
. O
ADMISSION O
LABS O
3266 O
8 O
26 O
01 O
50PM O
BLOOD O
WBC O
10 O
. O
3 O
RBC O
4 O
. O
98 O
Hgb O
8 O
. O
1 O
Hct O
30 O
. O
7 O
MCV O
62 O
MCH O
16 O
. O
2 O
MCHC O
26 O
. O
3 O
RDW O
17 O
. O
5 O
Plt O
Ct O
914 O
3266 O
8 O
26 O
01 O
50PM O
BLOOD O
Neuts O
89 O
. O
0 O
Bands O
0 O
Lymphs O
9 O
. O
9 O
Monos O
0 O
. O
8 O
Eos O
0 O
. O
3 O
Baso O
0 O
. O
1 O
3266 O
8 O
26 O
01 O
50PM O
BLOOD O
PT O
15 O
. O
6 O
PTT O
32 O
. O
8 O
INR O
PT O
1 O
. O
4 O
3266 O
8 O
26 O
01 O
50PM O
BLOOD O
Glucose O
99 O
UreaN O
10 O
Creat O
0 O
. O
6 O
Na O
135 O
K O
4 O
. O
9 O
Cl O
102 O
HCO3 O
18 O
AnGap O
20 O
3266 O
8 O
26 O
01 O
50PM O
BLOOD O
Calcium O
8 O
. O
5 O
Phos O
3 O
. O
2 O
Mg O
2 O
. O
3 O
3266 O
8 O
26 O
04 O
00PM O
BLOOD O
Lipase O
17 O
3266 O
8 O
26 O
01 O
56PM O
BLOOD O
Lactate O
6 O
. O
3 O
3266 O
8 O
26 O
04 O
12PM O
BLOOD O
Lactate O
2 O
. O
9 O
3266 O
8 O
26 O
06 O
17PM O
BLOOD O
Lactate O
1 O
. O
6 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 O
stent O
, O
s O
p O
RUL O
resection O
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 B-SYMPTOM
and O
copious B-SYMPTOM
secretions I-SYMPTOM
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy O
was O
5 O
2769 O
at O
OSH O
, O
where O
patient O
had O
copious B-SYMPTOM
secretions I-SYMPTOM
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 B-SYMPTOM
appetitie I-SYMPTOM
, 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 B-SYMPTOM
pain I-SYMPTOM
, O
palpitations B-SYMPTOM
, O
trauma B-SYMPTOM
, 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


This O
is O
a O
76 O
year O
old O
female O
with O
pmh O
of O
diastolic O
CHF O
, O
atrial O
fibrillation O
on O
coumadin O
, O
presenting O
with O
Hct O
16 O
. O
9 O
and O
shortness O
of O
breath O
. O
She O
had O
routine O
labs O
drawn O
yesterday O
at O
her O
PCP O
's O
office O
. O
Once O
her O
hematocrit O
came O
she O
was O
called O
and O
instructed O
to O
come O
to O
the O
ED O
. O
She O
is O
also O
reporting O
progressive O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
worse O
with O
exertion O
over O
the O
past O
two O
weeks O
. O
She O
denies O
fevers B-SYMPTOM
, O
chills B-SYMPTOM
, O
chest B-SYMPTOM
pain I-SYMPTOM
, O
palpitaitons B-SYMPTOM
, O
cough B-SYMPTOM
, O
abdominal B-SYMPTOM
pain I-SYMPTOM
, O
constipation B-SYMPTOM
or O
diahrrea B-SYMPTOM
, O
melena B-SYMPTOM
, O
blood O
in O
her O
stool O
, O
dysuria B-SYMPTOM
, O
rash B-SYMPTOM
. O
She O
reports O
orthopnea O
. O
In O
the O
ED O
vitals O
were O
98 O
. O
4 O
131 O
49 O
, O
60 O
24 O
100 O
2L O
. O
ekg O
with O
NSR O
, O
twi O
in O
V1 O
, O
no O
significant O
change O
from O
previous O
. O
Repeat O
CBC O
showed O
Hct O
16 O
. O
1 O
with O
haptoglobin O
20 O
, O
and O
elevated O
LDH O
to O
315 O
. O
In O
addition O
, O
her O
guaiac O
was O
reported O
as O
being O
positive O
. O
Past O
medical O
history O
Hypertension O
Atrial O
flutter O
fibrillation O
, O
s O
p O
cardioversion O
2797 O
1 O
27 O
Diastolic O
heart O
failure O
Hysterectomy O
Bilateral O
hip O
replacements O
Social O
History O
Married O
for O
53 O
years O
with O
four O
children O
. O
She O
is O
retired O
from O
the O
airport O
. O
She O
does O
not O
smoke O
or O
drink O
. O
Occupation O
retired O
from O
airport O
Drugs O
denies O
Tobacco O
denies O
any O
history O
Alcohol O
denies O

40 O
year O
old O
woman O
with O
a O
h O
o O
alcoholism O
c O
b O
DTs O
seizures O
2 O
years O
ago O
, O
polysubstance O
abuse O
including 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 O
. O
The O
patient O
would O
like O
to O
undergo O
detoxification O
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 B-SYMPTOM
pain I-SYMPTOM
, O
12 O
24 O
, O
lower O
quadrants O
, O
radiating O
to O
the O
back O
since O
yesterday O
. O
She O
cannot O
describe O
any O
relationship O
with O
food O
as O
she O
has O
not O
eaten O
anything O
. O
She O
says O
the O
pain B-SYMPTOM
has O
worsened O
since O
yesterday O
. O
She O
also O
complains O
of O
nausea B-SYMPTOM
, O
vomitting B-SYMPTOM
bilious O
but O
nonbloody O
, O
and O
diarrhea B-SYMPTOM
no O
black O
or O
red O
stools O
. O
Her O
last O
drink O
was O
9am O
on O
3154 O
2 O
15 O
. O
Recently 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
. O
In O
the O
ED O
she O
was O
98 O
. O
6 O
101 O
149 O
96 O
20 O
96 O
. O
She O
was O
Doctor O
Last O
Name O
2062 O
16 O
25 O
on O
CIWA O
. O
ROS O
Reports O
DOE B-SYMPTOM
, O
orthopnea O
. O
Also O
describes O
weight B-SYMPTOM
gain I-SYMPTOM
since O
given O
birth O
to O
her O
child O
17 O
months O
ago O
, O
she O
attributes O
this O
to O
her O
recent O
pregnancy O
. O
She O
complains O
of O
tremors B-SYMPTOM
and O
also O
complains O
of O
a O
moderate O
headache B-SYMPTOM
that O
's O
been O
stable O
. O
. O
Denies O
CP O
, O
fevers B-SYMPTOM
, O
chills B-SYMPTOM
, O
or O
cough B-SYMPTOM
, O
palpitations B-SYMPTOM
, O
edema O
, O
joint B-SYMPTOM
pains I-SYMPTOM
, O
rashes B-SYMPTOM
, O
AVH O
, O
SI O
, O
or O
HI O
. O
Past O
Medical O
History O
Alcoholism O
drinks O
baseline O
1 O
pint O
of O
liquor O
day O
, O
past O
week O
drinking O
1 O
liter O
of O
vodka O
day O
Polysubstance O
abuse O
including O
cocaine O
, O
IV O
heroin O
, O
and O
crack O
2 O
years O
ago O
, O
snorting O
heroin O
2 O
days O
ago O
. O
Hep O
C O
, O
never O
treated O
, O
unknown O
severity O
, O
genotype O
, O
etc O
Infectious O
endocarditis O
in O
her O
20s O
, O
6 O
wks O
of O
abx O
no O
surgeries O
No O
h O
o O
STDs O
, O
HIV O
neg O
3 O
weeks O
ago O
Hep O
B O
immunized O
Family O
History O
Alcoholism O
in O
mother O
, O
father O
, O
and O
sister O
. O
Father O
also O
used O
cocaine O
and O
sister O
also O
used O
ecstasy O
. O
Occupation O
Formerly O
worked O
at O
Investment O
Firm O
Quality O
Control O
Dept O
Physical O
Examination O
Vitals O
T O
99 O
. O
6 O
BP O
152 O
96 O
P O
99 O
R O
27 O
O2 O
99 O
RA O
General O
Alert O
, O
oriented O
x3 O
, O
anxious O
, O
labile O
with O
at O
times O
inappropriate O
laughter O
mixed O
with O
anxiety O
, O
obese O
woman O
. O
HEENT O
Sclera O
anicteric O
, O
MMM O
, O
oropharynx O
clear O
Neck O
supple O
, O
JVP O
difficult O
to O
assess O
given O
habitus O
Lungs O
Clear O
to O
auscultation O
bilaterally O
, O
no O
wheezes O
, O
rales O
, O
ronchi O
CV O
Tachycardic O
, O
regular O
rhythm O
, O
normal O
S1 O
S2 O
, O
no O
murmurs O
, O
rubs O
, O
gallops O
Abdomen O
soft O
, O
diffuse O
tenderness O
to O
palpation O
, O
obese O
, O
non O
distended O
, O
bowel O
sounds O
present O
, O
no O
rebound O
tenderness O
or O
guarding O
, O
no O
organomegaly O
. O
During O
the O
exam O
she O
complains O
of O
severe O
tenderness O
but O
a O
few O
minutes O
later O
is O
laughing O
and O
sitting O
comfortably O
in O
bed O
. O
Ext O
warm O
, O
well O
perfused O
, O
2 O
pulses O
, O
no O
clubbing O
, O
cyanosis O
or O
edema O
Labs O
PT O
PTT O
INR O
13 O
. O
7 O
29 O
. O
4 O
1 O
. O
2 O
, O
ALT O
AST O
106 O
249 O
, O
Alk O
Phos O
T O
Bili O
145 O
3 O
. O
0 O
, O
Amylase O
Lipase O
135 O
221 O
, O
Differential O
Neuts O
57 O
. O
3 O
, O
Lymph O
34 O
. O
1 O
, O
Mono O
7 O
. O
0 O
, O
Eos O
0 O
. O
8 O
, O
Lactic O
Acid O
1 O
. O
8 O
mmol O
L O
, O
Albumin O
4 O
. O
1 O
g O
dL O
, O
LDH O
329 O
IU O
L O
, O
Ca O
8 O
. O
2 O
mg O
dL O
, O
Mg O
1 O
. O
7 O
mg O
dL O
, O
PO4 O
2 O
. O
5 O
mg O
dL O

78 O
year O
old O
female O
with O
PMHx O
HTN O
, O
dCHF O
, O
Diabetes O
, O
CKD O
, O
Atrial O
fibrillation O
on O
coumadin O
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
to O
cardiology O
clinic O
today O
with O
confusion O
and O
Somnolence O
. O
Of O
note O
, O
she O
was O
recently O
discharged O
at O
the O
beginning O
of O
2876 O
4 O
14 O
after O
presyncope O
falls O
. O
At O
that O
time O
, O
lasix O
was O
stopped O
and O
atenolol O
was O
switched O
to O
metoprolol O
as O
there O
was O
concern O
that O
blunting O
of O
tachycardia O
could O
be O
contributing O
to O
falls O
. O
She O
was O
discharged O
to O
rehab O
previously O
living O
at O
home O
. O
Per O
report O
from O
the O
ER O
, O
patient O
has O
had O
confusion O
at O
home O
x O
3 O
weeks O
, O
though O
no O
family O
accompanies O
her O
to O
corroborate O
this O
story O
, O
and O
patient O
denies O
this O
. O
The O
patient O
is O
not O
sure O
why O
she O
is O
in O
the O
hospital O
. O
She O
saw O
her O
cardiologist O
today O
, O
who O
referred O
her O
to O
the O
ER O
after O
she O
appeared O
to O
be O
dehydrated B-SYMPTOM
, O
somnolent B-SYMPTOM
, O
and O
confused O
. O
The O
patient O
denies O
headache B-SYMPTOM
, O
blurry B-SYMPTOM
Vision I-SYMPTOM
, O
numbness B-SYMPTOM
, O
tingling B-SYMPTOM
or O
weakness B-SYMPTOM
. O
No O
CP O
. O
SOB O
, O
worsening O
DOE O
. O
No O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
. O
Physical O
Exam O
GENERAL O
Intubated O
, O
NAD O
HEENT O
Normocephalic O
, O
atraumatic O
. O
No O
scleral O
icterus O
. O
MMM O
, O
OP O
clear O
. O
CARDIAC O
irregularly O
irregular O
. O
Normal O
S1 O
, O
S2 O
. O
No O
murmurs B-SYMPTOM
, O
rubs O
or O
Last O
Name O
un O
597 O
. O
LUNGS O
CTAB O
ABDOMEN O
Soft O
, O
NT O
, O
ND O
. O
BS O
EXTREMITIES O
1 O
edema O
NEUROLOGIC O
Mental O
status O
Intubated O
, O
off O
sedation O
, O
minimal O
arousal O
to O
voice O
stimulation O
. O
Not O
following O
commands O
. O
Cranial O
nerves O
Pupils O
sluggishly O
reactive O
, O
both O
post O
surgical O
, O
R O
4 O
3 O
, O
L O
3 O
. O
5 O
3 O
. O
Gaze O
midline O
and O
conjugate O
, O
face O
appears O
symmetric O
. O
Motor O
Withdraws O
LUE O
and O
LLE O
weakly O
, O
no O
response O
RUE O
, O
triple O
flexion O
RLE O
. O
Sensory O
withdraws O
to O
noxious O
stimulation O
weakly O
as O
above O
, O
L O
R O
Coordination O
unable O
to O
assess O
Gait O
unable O
to O
assess O

This O
is O
a O
87 O
year O
old O
female O
NH O
resident O
with O
a O
history O
of O
chronic O
atrial O
fibrillation O
, O
hypertension O
and O
hypothyroidism O
who O
presents O
to O
the O
Hospital O
Unit O
Name O
10 O
. O
She O
had O
been O
in O
her O
usual O
state O
of O
health O
until O
5 O
days O
ago O
when O
she O
suddenly O
began O
to O
have O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
Her O
abdominal O
pain B-SYMPTOM
was O
initially O
intermittent O
lasting O
for O
a O
few O
hours O
at O
at O
time O
. O
No O
clear O
correlation O
with O
food O
. O
Yesterday O
, O
she O
noticed O
that O
her O
pain B-SYMPTOM
was O
much O
more O
severe O
, O
3301 O
9 O
5 O
in O
severity O
and O
more O
localized O
to O
the O
right O
. O
This O
was O
accompanied O
by O
nausea B-SYMPTOM
and O
vomitting B-SYMPTOM
. O
She O
vomitted O
twice O
, O
with O
clear O
liquid O
emesis O
and O
was O
sent O
to O
Hospital3 O
. O
At O
Hospital1 O
, O
she O
was O
noted O
to O
have O
elevated O
amylase O
lipase O
to O
538 O
and O
516 O
with O
elevated O
bili O
to O
4 O
. O
1 O
and O
AST O
ALT O
to O
198 O
115 O
and O
was O
given O
ciprofloxacin O
, O
flagyl O
and O
500cc O
NS O
and O
was O
transferred O
to O
the O
Hospital1 O
1 O
emergency O
department O
. O
. O
At O
Hospital1 O
1 O
EDVS O
97 O
. O
9 O
HR O
83 O
157 O
92 O
RR O
18 O
97 O
RA O
. O
Elderly O
F O
, O
oriented O
X O
2 O
, O
NAD O
, O
flat O
jvp O
, O
CTA O
decreased O
b O
b O
, O
s1 O
s2 O
Last O
Name O
un O
, O
decreased O
BS O
, O
t O
at O
ruq O
, O
no O
edema 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 O
SCT O
, O
who O
presents O
to O
clinc O
with O
one O
week O
of O
worsening O
SOB B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
pressure I-SYMPTOM
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 B-SYMPTOM
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND B-SYMPTOM
; 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 B-SYMPTOM
to O
the O
99 O
's O
and O
crampy O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
Denies O
chills B-SYMPTOM
, O
night B-SYMPTOM
sweats I-SYMPTOM
, O
vomiting B-SYMPTOM
, O
or O
diarrhea B-SYMPTOM
. 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 O
SCT O
, O
who O
presents O
with O
hypoxia O
, O
one O
week O
of O
worsening O
SOB B-SYMPTOM
, O
and O
two O
days O
of O
productive B-SYMPTOM
cough I-SYMPTOM
. O
Plan O
Hypoxia O
The O
patient O
developed O
acute O
onset O
of O
hypoxia O
accompanied O
by O
fever B-SYMPTOM
and O
a O
one O
day O
cough B-SYMPTOM
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 O
SCT O
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


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 O
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 O
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 B-SYMPTOM
Cardiovascular O
No O
t O
Chest B-SYMPTOM
pain I-SYMPTOM
, O
No O
t O
Palpitations B-SYMPTOM
Respiratory O
No O
t O
Cough B-SYMPTOM
, O
No O
t O
Dyspnea B-SYMPTOM
Gastrointestinal O
No O
t O
Abdominal B-SYMPTOM
pain I-SYMPTOM
, O
No O
t O
Nausea B-SYMPTOM
, O
No O
t O
Emesis B-SYMPTOM
, O
No O
t O
Diarrhea B-SYMPTOM
, O
No O
t O
Constipation B-SYMPTOM
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 O
, 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 B-SYMPTOM
evaluated O
by O
surgery O
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 B-SYMPTOM
earaches I-SYMPTOM
, O
a O
sorethroat B-SYMPTOM
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 B-SYMPTOM
, 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 B-SYMPTOM
in O
regards O
to O
his O
zoster O
now O
or O
when O
diagnosed O
. O
Denies O
CP B-SYMPTOM
, O
has O
an O
occasional O
cough B-SYMPTOM
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 B-SYMPTOM
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 O
ASD O
repair O
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 B-SYMPTOM
and O
back B-SYMPTOM
pain I-SYMPTOM
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
RVR O
. O
A O
CTA O
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 O
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 O
FNA O
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 B-SYMPTOM
pain I-SYMPTOM
, O
SOB B-SYMPTOM
, O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations B-SYMPTOM
. 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 B-SYMPTOM
, 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 O
and O
pulmonology O
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 B-SYMPTOM
, 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 O
and O
underwent O
TEE O
and O
cardioversion O
of O
afib O
on O
3433 O
1 O
11 O
. O
After O
cardioversion O
, 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 O
, 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 B-SYMPTOM
and O
and O
vomiting B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
and O
lightheaded B-SYMPTOM
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 B-SYMPTOM
, O
pain B-SYMPTOM
, 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

54 O
y O
o O
M O
w O
IPF O
, O
called O
today O
with O
worsening O
dyspnea O
x O
3 O
days O
. O
He O
had O
been O
in O
unusal O
state O
of O
health O
at O
baseline O
resp O
status O
using O
4L O
NC O
at O
rest O
and O
6L O
NC O
with O
exertion O
when O
3 O
days O
PTA 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
he O
breathing O
became O
acutely O
worse O
and O
is O
concerned O
for O
allergen O
exposure O
. O
He O
denies O
any O
sick O
contacts O
, O
fevers B-SYMPTOM
, O
chills B-SYMPTOM
, O
worsening O
2169 O
productive O
2169 O
, O
rhinorrhea O
. O
He O
did O
receive O
flu O
and O
pneumovax O
. O
. O
He O
has O
had O
a O
recent O
admissions O
in O
11 O
26 O
with O
progressive O
DOE B-SYMPTOM
. O
CT O
revealed O
increased O
ground O
glass O
opacity O
in O
LL O
superimposed O
on O
pulmonary O
fibrosis O
with O
elevated O
eosinophils O
peripherally O
12 O
. O
A O
BAL 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
2739 O
2 O
16 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
20 O
on O
2 O
3L O
NC O
. O
He O
then O
represented O
to O
Hospital1 O
1 O
on O
12 O
12 O
for O
spontaneous O
pneumomediastinum O
of O
unclear O
etiology O
. O
. O
On O
day O
of O
admission O
, O
Pt O
called O
pulmonologist O
Dr O
. O
First O
Name O
STitle O
c O
o O
worsening O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
since O
Saturday O
3 O
23 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
NC O
at O
rest O
. O
No O
sick O
contacts O
recently O
and O
Name2 O
NI O
2169 O
has O
not O
changed O
. O
He O
was O
asked O
to O
go O
to O
ED O
given O
concern O
for O
either O
acute O
exacerbation O
of O
underlying O
IPF O
vs O
superimposed O
infection O
vs O
pneumothorax O
. 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

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 O
on O
2575 O
8 O
15 O
. O
Her O
post O
op O
course O
was O
complicated O
by O
agitation B-SYMPTOM
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 B-SYMPTOM
. 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
87 O
yo O
woman O
with O
h O
o O
osteoporosis O
, O
DM2 O
, O
dementia O
, O
depression O
, O
and O
anxiety B-SYMPTOM
presents O
s O
p O
fall O
with O
evidence O
of O
C2 O
fracture O
, O
chest B-SYMPTOM
pain I-SYMPTOM
, O
tachycardia O
, O
tachypnea O
, O
and O
low B-SYMPTOM
blood I-SYMPTOM
pressure I-SYMPTOM
. O

A O
75F O
found O
to O
be O
hypoglycemic O
with O
hypotension B-SYMPTOM
and O
bradycardia O
. O
She O
had O
UA O
positive O
for O
klebsiella O
. O
She O
had O
a O
leukocytosis O
to O
18 O
and O
a O
creatinine O
of O
6 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
awake O
but O
drowsy O
. O
This O
morning 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

An O
82 O
man O
with O
multiple O
chronic O
conditions O
and O
previous O
surgeries O
presents O
with O
9 O
day O
history O
of O
productive B-SYMPTOM
cough I-SYMPTOM
, O
fever B-SYMPTOM
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 B-SYMPTOM
and O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
An O
abdominal O
CT O
demonstrates 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


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
abdominal B-SYMPTOM
pain I-SYMPTOM
radiating O
to O
the O
back O
and O
elevated B-SYMPTOM
lipase I-SYMPTOM
. O
Signs O
of O
ascites O
, O
pancytopenia O
and O
coagulopathy O
. O



66 O
yo O
female O
pedestrian O
struck O
by O
auto O
. O
Unconscious B-SYMPTOM
and O
unresponsive B-SYMPTOM
at O
scene O
. O
Multiple O
fractures O
and O
head O
CT O
showing O
extensive O
interparenchymal B-SYMPTOM
hemorrhages I-SYMPTOM
. O

80 O
yo O
male O
with O
demantia O
and O
past O
medical O
history O
of O
CABG O
with O
repeated O
episodes O
of O
chest B-SYMPTOM
pain I-SYMPTOM
. O
Admitted O
for O
severe O
chest B-SYMPTOM
pain I-SYMPTOM
episode O
. O

A O
43 O
year O
old O
woman O
with O
history O
of O
transverse O
myelitis O
leading O
to O
paraplegia O
, O
depression O
, O
frequent O
pressure O
ulcers O
, O
presenting O
with O
chills B-SYMPTOM
, O
agitation B-SYMPTOM
, O
rigors B-SYMPTOM
, O
and O
back B-SYMPTOM
pain I-SYMPTOM
. O
Patient O
has O
stage O
IV O
decubitus O
ulcers O
on O
coccyx O
and O
buttocks O
, O
heels O
. O
Admission O
labs O
significant O
for O
thrombocytosis O
, O
elevated B-SYMPTOM
lactate I-SYMPTOM
, O
and O
prolonged O
PT O
. O

A O
52 O
year O
old O
woman O
with O
history O
of O
COPD O
and O
breast O
cancer O
who O
presents O
with O
SOB B-SYMPTOM
, O
hypoxia O
, O
cough B-SYMPTOM
, O
fevers B-SYMPTOM
and O
sore B-SYMPTOM
throat I-SYMPTOM
for O
several O
weeks 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 O
resection O
for O
squamous O
cell O
carcinoma O
. O
Y O
stent O
placement O
was O
complicated O
by O
cough B-SYMPTOM
and O
copious B-SYMPTOM
secretions I-SYMPTOM
requiring O
multiple O
therapeutic O
aspirations O
. O
Patient O
reports O
decreased B-SYMPTOM
appetite I-SYMPTOM
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased B-SYMPTOM
activity I-SYMPTOM
tolerance I-SYMPTOM
. 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 B-SYMPTOM
with O
R O
shoulder B-SYMPTOM
pain I-SYMPTOM
and O
weakness B-SYMPTOM
. O

A O
90 O
year O
old O
woman O
who O
was O
recently O
hospitalized O
for O
legionella O
PNA O
, O
with O
confusion B-SYMPTOM
and O
dysarthria O
the O
last O
few O
days O
. O
Found O
down O
in O
the O
bathroom O
this O
morning O
, O
making O
non O
verbal O
utterances O
and O
with O
minimal O
movement O
of O
the O
right O
side O
. O

76 O
year O
old O
female O
with O
personal O
history O
of O
diastolic O
congestive O
heart O
failure O
, O
atrial O
fibrillation O
on O
Coumadin O
, O
presenting O
with O
low B-SYMPTOM
hematocrit I-SYMPTOM
and O
dyspnea 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 B-SYMPTOM
2 O
years O
ago O
, O
polysubstance O
abuse O
, O
hep O
C O
, O
presents O
with O
abdominal B-SYMPTOM
pain I-SYMPTOM
in O
lower O
quadrants O
, O
radiating O
to O
the O
back O
, O
nausea B-SYMPTOM
, O
vomitting B-SYMPTOM
and O
diarrhea B-SYMPTOM
. O
Labs O
are O
significant O
for O
elevated B-SYMPTOM
lipase I-SYMPTOM
. O

78 O
year O
old O
female O
with O
PMHx O
HTN O
, O
dCHF O
, O
Diabetes O
, O
CKD O
, O
Atrial O
fibrillation O
on O
coumadin O
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
with O
confusion B-SYMPTOM
and O
somnolence B-SYMPTOM
. O
She O
was O
recently O
discharged O
after O
presyncope O
falls O
. O
Patient O
has O
had O
confusion B-SYMPTOM
at O
home O
for O
3 O
weeks O
. O
The O
patient O
denies O
headache B-SYMPTOM
, O
blurry B-SYMPTOM
vision I-SYMPTOM
, O
numbness B-SYMPTOM
, O
tingling B-SYMPTOM
or O
weakness B-SYMPTOM
, O
nausea B-SYMPTOM
or O
vomiting B-SYMPTOM
. O

A O
87 O
yo O
female O
reports O
several O
days O
abdominal B-SYMPTOM
pain I-SYMPTOM
, O
worse O
yesterday O
, O
severe O
and O
more O
localized O
to O
the O
right O
, O
accompanied O
by O
nausea B-SYMPTOM
and O
vomitting B-SYMPTOM
. O
Labs O
show O
elevated B-SYMPTOM
bilirubin I-SYMPTOM
, O
transaminitis O
, O
amylase O
and O
lipase O
. O


A O
63 O
year O
old O
male O
with O
biphenotypic O
ALL O
, O
Day O
32 O
after O
BMT O
, O
h O
o O
CMV O
infection O
, O
aspergillus O
and O
Leggionare O
's O
disease O
, O
presents O
with O
acute O
onset O
of O
hypoxia O
accompanied O
by O
fever B-SYMPTOM
and O
two O
days O
of O
productive B-SYMPTOM
cough I-SYMPTOM
. 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
. 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 O
of O
atrial O
septum O
defect O
, O
presenting O
with O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. O
Patient O
denies O
recent O
palpitations B-SYMPTOM
, 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 B-SYMPTOM
and O
2 O
pillow O
orthopnea O
which O
has O
been O
present O
for O
months O
. O
Patient O
underwent O
cardioversion O
and O
became O
hypotensive B-SYMPTOM
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
96 O
y O
o O
female O
found O
unresponsive B-SYMPTOM
on O
ground O
at O
nursing O
home O
pressents O
with O
headache B-SYMPTOM
, O
herniation B-SYMPTOM
, O
and O
some O
neck O
shoulder O
discomfort O
. O
CT O
head O
shows O
acute O
left O
subdural O
hematoma 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
presenting O
an O
acute B-SYMPTOM
dyspnea I-SYMPTOM
on O
exertion O
, O
secondary O
to O
superimposed O
pneumonia O
on O
patient O
with O
no O
pulmonary O
reserve O
. O
Appears O
he O
has O
been O
experiencing O
worsening O
dyspnea B-SYMPTOM
with O
increased O
O2 O
requirement O
for O
the O
last O
several O
weeks O
. O

An O
85 O
year O
old O
woman O
on O
verapamil O
presents O
with O
junctional O
heart O
rhythm O
in O
30s O
with O
associated O
hypotension B-SYMPTOM
. O

A O
47 O
year O
old O
man O
comes O
to O
the O
clinic O
for O
the O
follow O
up O
of O
his O
neuromuscular O
disease O
. O
He O
experienced O
gradual O
, O
progressive O
weakness B-SYMPTOM
of O
the O
left O
upper O
extremity O
over O
the O
last O
year O
. O
Over O
the O
last O
few O
months O
, O
he O
has O
also O
noticed O
weakness B-SYMPTOM
in O
the O
right O
upper O
extremity O
. O
BP O
is O
120 O
75 O
, O
PR O
is O
80 O
and O
temperature O
is O
37 O
C O
. O
Reflexes O
are O
brisk O
in O
the O
upper O
extremities O
, O
and O
the O
plantar O
responses O
are O
extensor O
. O
Mild O
gait O
ataxia O
is O
present O
. O
The O
patient O
is O
under O
treatment O
of O
Riluzole O
50 O
mg O
BID O
with O
the O
diagnosis O
of O
ALS 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 B-SYMPTOM
sensation I-SYMPTOM
in I-SYMPTOM
her I-SYMPTOM
eyes I-SYMPTOM
. O
She O
also O
has O
difficulty B-SYMPTOM
swallowing I-SYMPTOM
dry O
foods O
with O
no O
pain B-SYMPTOM
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 B-SYMPTOM
dryness I-SYMPTOM
. O
She O
also O
reports O
occasional O
joint B-SYMPTOM
pain I-SYMPTOM
. 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 O
. 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
31 O
year O
old O
woman O
comes O
to O
the O
office O
due O
to O
3 O
days O
of O
rash B-SYMPTOM
on O
her O
left O
arm O
. O
The O
lesion B-SYMPTOM
is O
mildly O
pruritic O
but O
not O
painful B-SYMPTOM
. O
She O
is O
otherwise O
healthy O
and O
occasionally O
takes O
ibuprofen O
during O
the O
first O
few O
days O
of O
her O
menstrual O
period O
. O
Temperature O
is O
37 O
C O
, O
blood O
pressure O
is O
110 O
75 O
mm O
Hg O
, O
and O
pulse O
is O
95 O
min O
. O
The O
lesion B-SYMPTOM
is O
like O
a O
target O
sign O
known O
as O
erythema O
migrans O
. O
She O
recently O
went O
for O
an O
adventure O
trip O
in O
New O
Hampshire O
. O
The O
patient O
is O
diagnosed O
with O
Lyme O
disease O
. O

A O
57 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
due O
to O
constipation B-SYMPTOM
. O
His O
last O
bowel O
movement O
was O
2 O
days O
ago O
. O
He O
complains O
of O
spending O
about O
30 O
minutes O
once O
attempting O
to O
defecate O
. O
He O
also O
has O
lower B-SYMPTOM
back I-SYMPTOM
pain I-SYMPTOM
. O
There O
is O
no O
history O
of O
trauma B-SYMPTOM
. O
The O
pain B-SYMPTOM
is O
not O
relieved O
with O
over O
the O
counter O
pain O
medications O
. O
His O
vital O
signs O
are O
within O
normal O
limits O
. O
Examination O
shows O
low B-SYMPTOM
back I-SYMPTOM
pain I-SYMPTOM
that O
is O
worse O
with O
back O
flexion O
and O
raising O
of O
the O
legs O
; O
it O
radiates O
into O
his O
left O
leg O
. O
Pinprick O
in O
the O
perianal O
area O
does O
not O
cause O
rapid O
contraction O
of O
the O
anal O
sphincter O
. O
The O
rest O
of O
the O
neurologic O
examination O
is O
normal O
. O
He O
is O
suspected O
of O
Cauda O
Equina O
syndrome O
and O
referred O
to O
a O
spinal O
MRI 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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
and O
persistent B-SYMPTOM
cough I-SYMPTOM
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 B-SYMPTOM
or O
any O
kind O
of O
surgery O
. 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
47 O
year O
old O
woman O
comes O
to O
the O
clinic O
complaining O
of O
dizziness B-SYMPTOM
. O
She O
also O
has O
occasional O
nausea B-SYMPTOM
and O
ringing O
in O
her O
right O
ear O
. O
The O
patient O
also O
has O
difficulty B-SYMPTOM
hearing I-SYMPTOM
while O
holding O
her O
phone O
to O
the O
left O
ear O
, O
although O
hearing O
in O
her O
right O
ear O
is O
normal O
. O
The O
dizziness B-SYMPTOM
improves O
spontaneously O
, O
and O
she O
feels O
fine O
between O
episodes O
. O
Past O
medical O
history O
is O
notable O
for O
hypothyroidism O
and O
low B-SYMPTOM
vit I-SYMPTOM
D I-SYMPTOM
level I-SYMPTOM
, O
for O
which O
she O
is O
using O
Levothyroxine O
and O
Vit O
D O
pearl O
. O
She O
does O
not O
use O
tobacco O
or O
drink O
alcohol O
. O
Physical O
examination O
shows O
sensorineural O
hearing O
loss O
in O
the O
left O
ear O
. O
She O
has O
only O
one O
man O
sexual O
partner O
and O
menopaused O
2 O
years O
ago O
. O

A O
47 O
year O
old O
man O
comes O
to O
the O
office O
due O
to O
weight B-SYMPTOM
gain I-SYMPTOM
and O
fatigue B-SYMPTOM
. O
He O
is O
not O
able O
to O
lift O
heavy O
objects O
or O
climb O
stairs O
. O
Family O
history O
is O
positive O
for O
DM O
type O
2 O
and O
HTN O
in O
his O
father O
. O
Blood O
pressure O
is O
165 O
90 O
mm O
Hg O
and O
pulse O
is O
85 O
min O
. O
On O
physical O
examination O
, O
there O
is O
symmetric O
proximal O
muscle B-SYMPTOM
weakness I-SYMPTOM
of O
the O
upper O
and O
lower O
extremities O
. O
Fasting O
plasma O
glucose O
level O
is O
138 O
mg O
dL O
and O
24 O
hour O
urinary O
cortisol O
is O
twice O
the O
upper O
normal O
limit O
. O
Further O
evaluation O
reveals O
that O
high O
dose O
, O
but O
not O
low O
dose O
, O
dexamethasone O
suppresses O
serum O
cortisol O
levels O
. O
Serum O
ACTH O
levels O
are O
high O
normal O
. O
This O
patient O
's O
findings O
are O
consistent O
with O
endogenous O
Cushing O
Syndrome O
. O

A O
23 O
year O
old O
female O
has O
prolonged O
oral O
bleeding O
immediately O
after O
a O
tooth O
extraction O
. O
Despite O
several O
interventions O
, O
the O
bleeding O
persists O
for O
hours O
and O
stops O
only O
after O
desmopressin O
DDAVP O
administration O
. O
The O
patient O
has O
heavy O
menstrual O
cycles O
each O
month O
. O
She O
has O
no O
other O
medical O
problems O
and O
takes O
no O
medications O
. O
Her O
mother O
and O
grandmother O
have O
also O
had O
excessive O
bleeding O
during O
menstrual O
period O
. O
Review O
of O
systems O
is O
positive O
for O
mild O
bruising B-SYMPTOM
on O
his O
legs O
. O
Laboratory O
findings O
reveal O
a O
normal O
platelet O
count O
and O
an O
abnormal O
ristocetin O
cofactor O
assay O
, O
as O
well O
as O
CB O
0 O
. O
30 O
IU O
mL O
and O
FVIII O
C O
0 O
. O
40 O
IU O
mL 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 B-SYMPTOM
rash I-SYMPTOM
and O
oral O
ulcers O
. O
The O
rashes B-SYMPTOM
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 O
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

The O
patient O
is O
a O
38 O
year O
old O
man O
with O
cough B-SYMPTOM
and O
body B-SYMPTOM
ache I-SYMPTOM
that O
started O
3 O
days O
ago O
. O
He O
had O
fever B-SYMPTOM
and O
chills B-SYMPTOM
at O
the O
beginning O
and O
has O
low O
grade O
fever B-SYMPTOM
at O
the O
time O
of O
visit O
. O
He O
feels O
tired O
and O
sleepy O
. O
His O
body B-SYMPTOM
ache I-SYMPTOM
and O
myalgia O
get O
better O
after O
using O
Tylenol O
. O
The O
PCR O
test O
for O
Covid O
is O
positive O
. O
His O
vital O
signs O
are O
within O
normal O
limits O
with O
a O
body O
temperature O
of O
37 O
. O
9 O
C O
. O
There O
is O
no O
lymphadenopathy O
or O
white O
exudates O
in O
the O
pharynx O
. O

A O
41 O
year O
old O
woman O
comes O
to O
the O
dermatology O
clinic O
complaining O
of O
facial B-SYMPTOM
redness I-SYMPTOM
, O
especially O
on O
her O
forehead O
and O
cheeks O
. O
She O
noticed O
that O
the O
redness O
gets O
worse O
in O
the O
summer O
and O
after O
sun O
exposure O
. O
She O
is O
otherwise O
healthy O
. O
On O
physical O
examination O
, O
she O
has O
multiple O
papules O
and O
pustules O
present O
on O
her O
forehead O
, O
cheeks O
, O
and O
nose O
on O
a O
background O
of O
erythema O
and O
telangiectasias O
. O
There O
are O
no O
other O
lesions O
or O
nodules O
. O
The O
patient O
is O
married O
and O
has O
2 O
children O
who O
are O
5 O
and O
9 O
years O
old O
. O
She O
has O
IUD O
and O
doesn O
' O
t O
wish O
to O
have O
more O
kids O
. O
She O
does O
not O
smoke O
or O
drink O
alcohol O
. O
Her O
vital O
signs O
are O
normal O
, O
and O
BMI O
is O
21 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 B-SYMPTOM
swallowing I-SYMPTOM
both O
liquids O
and O
solid O
foods O
, O
as O
well O
as O
occasional O
cough B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
rash I-SYMPTOM
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 O
biopsy O
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
19 O
year O
old O
male O
came O
to O
clinic O
with O
some O
sexual O
concern O
. O
He O
recently O
engaged O
in O
a O
relationship O
and O
is O
worried O
about O
the O
satisfaction O
of O
his O
girlfriend O
. O
He O
has O
a O
" O
baby O
face O
" O
according O
to O
his O
girlfriend O
's O
statement O
and O
he O
is O
not O
as O
muscular O
as O
his O
classmates O
. O
On O
physical O
examination O
, O
there O
is O
some O
pubic O
hair O
and O
poorly O
developed O
secondary O
sexual O
characteristics O
. O
He O
is O
unable B-SYMPTOM
to I-SYMPTOM
detect I-SYMPTOM
coffee I-SYMPTOM
smell I-SYMPTOM
during O
the O
examination O
, O
but O
the O
visual O
acuity O
is O
normal O
. O
Ultrasound O
reveals O
the O
testes O
volume O
of O
1 O
2 O
ml O
. O
The O
hormonal O
evaluation O
showed O
serum O
testosterone O
level O
of O
65 O
ng O
dL O
with O
low O
levels O
of O
GnRH O
. O

A O
32 O
year O
old O
woman O
comes O
to O
the O
hospital O
with O
vaginal B-SYMPTOM
spotting I-SYMPTOM
. 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 O
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
51 O
year O
old O
man O
comes O
to O
the O
office O
complaining O
of O
fatigue O
and O
some O
sexual O
problems O
including O
lack B-SYMPTOM
of I-SYMPTOM
libido I-SYMPTOM
. O
The O
patient O
doesn O
' O
t O
smoke O
or O
use O
any O
illicit O
drug O
. O
Blood O
pressure O
is O
120 O
80 O
mm O
Hg O
and O
pulse O
is O
70 O
min O
. O
Oxygen O
saturation O
is O
99 O
on O
room O
air O
. O
BMI O
is O
24 O
kg O
m2 O
. O
Skin O
examination O
shows O
increased O
pigmentation O
. O
Genotype O
testing O
is O
consistent O
with O
homozygosity O
for O
the O
C282Y O
mutation O
. O
Laboratory O
study O
shows O
transferrin O
saturation O
of O
55 O
and O
serum O
ferritin O
of O
550 O
μg O
L O
. O
He O
is O
diagnosed O
as O
a O
case O
of O
hemochromatosis 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 B-SYMPTOM
cough I-SYMPTOM
and O
progressive B-SYMPTOM
dyspnea I-SYMPTOM
. 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 B-SYMPTOM
breath I-SYMPTOM
sounds I-SYMPTOM
and O
percussive B-SYMPTOM
dullness I-SYMPTOM
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 O
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 B-SYMPTOM
and O
inability B-SYMPTOM
to I-SYMPTOM
defecate I-SYMPTOM
for O
the O
past O
3 O
days O
. O
The O
patient O
has O
had O
constipation B-SYMPTOM
and O
discomfort B-SYMPTOM
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 O
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
47 O
year O
old O
man O
comes O
to O
the O
office O
for O
routine O
checkup O
. O
He O
is O
complaining O
of O
chronic B-SYMPTOM
cough I-SYMPTOM
and O
occasional O
but O
progressive O
dyspnea B-SYMPTOM
. O
Other O
medical O
conditions O
include O
hypertension O
and O
osteoarthritis O
. O
The O
patient O
smokes O
a O
pack O
of O
cigarettes O
daily O
and O
does O
not O
use O
alcohol O
or O
illicit O
drugs O
. O
He O
used O
to O
be O
a O
construction O
worker O
. O
On O
examination O
, O
there O
are O
decreased B-SYMPTOM
breath I-SYMPTOM
sounds I-SYMPTOM
and O
percussive B-SYMPTOM
dullness I-SYMPTOM
at O
the O
base O
of O
both O
lungs O
. O
Chest O
CT O
scan O
reveals O
a O
mild O
bilateral O
pleural O
effusion O
and O
diffuse O
thickening O
of O
the O
pleura O
. O
The O
patient O
's O
documents O
show O
chronic O
exposure O
to O
asbestosis O
. O
The O
specimen O
of O
the O
lungs O
reveled O
pulmonary O
fibrosis O
that O
is O
most O
predominant O
in O
the O
lower O
lobes O
, O
characterized O
by O
the O
presence O
of O
asbestos O
bodies O
golden O
brown O
beaded O
rods O
with O
translucent O
centers O
. O


A O
39 O
year O
old O
woman O
comes O
to O
the O
clinic O
complaining O
of O
arthralgias O
and O
nodules O
on O
her O
legs O
. O
She O
has O
no O
fever B-SYMPTOM
or O
other O
skin B-SYMPTOM
rashes I-SYMPTOM
. O
The O
prior O
medical O
condition O
is O
unremarkable O
, O
and O
she O
takes O
no O
medications O
. O
On O
physical O
examination O
, O
there O
is O
moderate O
hepatomegaly O
. O
The O
lesions B-SYMPTOM
on O
her O
legs O
are O
tender O
and O
present O
predominantly O
on O
the O
anterior O
surface O
of O
the O
lower O
extremities O
. O
She O
doesn O
' O
t O
smoke O
and O
drinks O
alcohol O
occasionally O
. O
The O
patient O
has O
2 O
male O
sexual O
partners O
. O
Vital O
signs O
are O
normal O
. O
Chest O
x O
ray O
demonstrates O
enlarged O
hilar O
lymph O
nodes O
, O
and O
laboratory O
testing O
reveals O
an O
elevated B-SYMPTOM
ACE I-SYMPTOM
level I-SYMPTOM
. O
Biopsy O
of O
the O
skin O
lesion O
shows O
noncaseating O
granulomas O
that O
stain O
negative O
for O
fungi O
acid O
fast O
bacilli O
. O

A O
2 O
year O
old O
boy O
is O
brought O
to O
the O
office O
by O
his O
parents O
due O
to O
a O
rash B-SYMPTOM
that O
started O
1 O
week O
ago O
. O
A O
similar O
red O
, O
itchy O
rash B-SYMPTOM
on O
the O
cheeks O
, O
trunk O
, O
and O
arms O
has O
occurred O
intermittently O
since O
infancy O
. O
The O
patient O
has O
had O
a O
few O
upper O
respiratory O
infections O
but O
no O
major O
illnesses O
. O
Vaccinations O
are O
up O
to O
date O
, O
and O
he O
takes O
no O
medications O
. O
He O
is O
on O
a O
balanced O
diet O
, O
and O
he O
is O
healthy O
in O
appearance O
. O
Vital O
signs O
and O
milestone O
examination O
are O
within O
normal O
limits O
. O
Similar O
findings O
are O
observed O
on O
the O
cheeks O
and O
proximal O
upper O
extremities O
. O
The O
diaper O
area O
is O
clear O
, O
and O
no O
mucosal B-SYMPTOM
lesions I-SYMPTOM
are O
present 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 B-SYMPTOM
. 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 B-SYMPTOM
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 B-SYMPTOM
over O
the O
trunk O
, O
extremities O
, O
and O
face O
. O
Lung O
auscultation O
reveals O
bilateral B-SYMPTOM
expiratory I-SYMPTOM
wheezes I-SYMPTOM
. O


A O
66 O
year O
old O
woman O
comes O
to O
the O
office O
due O
to O
joint B-SYMPTOM
pain I-SYMPTOM
in O
the O
hands O
and O
periodic B-SYMPTOM
morning I-SYMPTOM
stiffness I-SYMPTOM
that O
lasts O
less O
than O
15 O
minutes O
. O
The O
pain B-SYMPTOM
is O
moderately O
severe O
and O
worsens O
with O
daily O
activity O
. O
The O
patient O
used O
Tylenol O
with O
minimal O
relief O
. O
Past O
medical O
history O
is O
notable O
for O
hypertension O
and O
hypercholesteremia O
. O
Physical O
examination O
shows O
firm O
nodules O
over O
the O
distal O
interphalangeal O
joints O
, O
bilaterally O
. O
The O
patient O
has O
pain O
in O
her O
knees O
as O
well O
. O
The O
knees O
are O
stiff O
in O
the O
morning O
for O
less O
than O
30 O
minutes O
and O
become O
worse O
with O
climbing O
stairs O
. O
She O
has O
some O
sensation O
of O
bone O
friction O
during O
activity O
. O
X O
ray O
shows O
narrowing O
of O
the O
joint O
space O
, O
subchondral O
bone O
sclerosis O
and O
osteophyte O
formation O
along O
the O
joints O
. 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 B-SYMPTOM
injury I-SYMPTOM
. O
He O
has O
had O
3 O
other O
episodes O
of O
light B-SYMPTOM
headedness I-SYMPTOM
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 O
shows O
asymmetric O
interventricular O
septal O
hypertrophy O
. O


A O
19 O
year O
old O
girl O
comes O
to O
the O
clinic O
due O
to O
a O
left B-SYMPTOM
wrist I-SYMPTOM
mass I-SYMPTOM
. O
She O
noticed O
swelling B-SYMPTOM
on O
the O
top O
of O
her O
wrist O
about O
4 O
months O
ago O
and O
came O
to O
the O
clinic O
due O
to O
cosmetic O
concerns O
. O
Examination O
shows O
a O
nontender O
, O
rounded O
mass O
on O
the O
dorsal O
wrist O
that O
transilluminates O
with O
a O
penlight O
. O
Vital O
signs O
are O
normal O
. O
The O
patient O
needs O
to O
type O
on O
her O
computer O
almost O
all O
day O
. O
She O
is O
left O
handed O
. O
She O
does O
not O
smoke O
or O
use O
illicit O
drugs O
. O
She O
is O
in O
sexual O
relationship O
with O
two O
male O
partners O
and O
uses O
condoms 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 B-SYMPTOM
weight I-SYMPTOM
loss I-SYMPTOM
. O
The O
patient O
also O
has O
epigastric B-SYMPTOM
discomfort I-SYMPTOM
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 B-SYMPTOM
. O
Upper O
endoscopy O
shows O
a O
lesion B-SYMPTOM
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

A O
39 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
with O
an O
acute O
onset O
of O
severe O
left O
toe O
pain B-SYMPTOM
. O
The O
toe O
is O
red O
and O
exhibits O
swelling O
. O
The O
patient O
is O
not O
febrile B-SYMPTOM
, O
and O
does O
not O
remember O
any O
recent O
trauma O
. O
Medical O
history O
is O
not O
significant O
except O
for O
the O
similar O
attacks O
and O
the O
diagnosis O
of O
gouty O
arthritis O
. O
His O
medication O
history O
includes O
Allopurinol O
to O
prevent O
gouty O
attacks O
. O
His O
father O
has O
the O
same O
medical O
condition O
. O
However O
, O
his O
older O
brother O
who O
is O
41 O
years O
old O
is O
healthy O
with O
no O
history O
of O
gouty O
arthritis O
. O
Physical O
examination O
shows O
a O
swollen O
, O
tender O
first O
metatarsophalangeal B-SYMPTOM
joint I-SYMPTOM
. O
Aspiration O
of O
the O
joint O
showed O
high B-SYMPTOM
leukocyte I-SYMPTOM
count I-SYMPTOM
, O
negative O
Gram O
stain O
, O
and O
numerous O
needle O
shaped O
crystals O
, O
which O
is O
compatible O
with O
gouty O
arthritis 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 B-SYMPTOM
and O
difficulty B-SYMPTOM
of I-SYMPTOM
standing I-SYMPTOM
up I-SYMPTOM
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 O
biopsy O
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
67 O
year O
old O
man O
comes O
to O
the O
clinic O
with O
slowly O
worsening B-SYMPTOM
vision I-SYMPTOM
in I-SYMPTOM
both I-SYMPTOM
eyes I-SYMPTOM
. O
He O
is O
not O
able O
to O
drive O
at O
night O
, O
as O
the O
symptoms O
are O
worse O
at O
night O
. O
His O
pupils O
are O
normal O
in O
diameter O
both O
in O
the O
light O
and O
darkness O
. O
Other O
medical O
history O
is O
unremarkable O
. O
Ocular O
examination O
shows O
loss O
of O
the O
red O
reflex O
and O
blurry B-SYMPTOM
vision I-SYMPTOM
. O
Acuity O
testing O
shows O
50 O
100 O
vision O
in O
both O
eyes O
with O
normal O
visual O
field O
testing O
. O
His O
blood O
pressure O
is O
130 O
70 O
and O
pulse O
is O
68 O
min O
. O
the O
other O
physical O
examinations O
are O
normal O
. O



A O
33 O
year O
old O
woman O
comes O
to O
clinic O
complaining O
of O
progressive O
fatigue B-SYMPTOM
, O
decreased B-SYMPTOM
appetite I-SYMPTOM
, O
and O
11 O
lb O
weight B-SYMPTOM
loss I-SYMPTOM
in O
the O
past O
2 O
months O
. O
She O
uses O
levothyroxine O
because O
of O
the O
previously O
diagnosed O
Hashimoto O
disease O
. O
She O
has O
no O
other O
medical O
conditions O
and O
does O
not O
use O
tobacco O
, O
alcohol O
, O
or O
illicit O
drugs O
. O
Physical O
examination O
shows O
a O
generalized O
increase O
in O
pigmentation O
of O
the O
skin O
. O
Measurement O
of O
serum O
cortisol O
before O
and O
after O
administration O
of O
exogenous O
adrenocorticotropic O
hormone O
ACTH O
shows O
no O
difference O
in O
the O
levels O
. O
Stable O
glucocorticoid O
replacement O
therapy O
starts O
for O
her O
with O
the O
diagnosis O
for O
primary O
adrenal O
insufficiency O
Addison O
disease 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 B-SYMPTOM
lasting O
for O
1 O
hour O
. O
She O
has O
a O
history O
of O
heavy B-SYMPTOM
menses I-SYMPTOM
as O
well O
as O
occasional O
gum B-SYMPTOM
bleeding I-SYMPTOM
following O
dental O
procedures O
. 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
47 O
year O
old O
woman O
comes O
to O
the O
office O
complaining O
of O
pain O
in O
the O
calf B-SYMPTOM
and O
knee O
when O
she O
bends O
down O
. O
The O
pain B-SYMPTOM
limits O
her O
activity O
. O
Her O
medical O
history O
is O
significant O
for O
osteoarthritis O
, O
for O
which O
she O
uses O
nonsteroidal O
anti O
inflammatory O
drugs O
NSAIDs O
for O
the O
past O
two O
years O
. O
She O
is O
living O
with O
her O
husband O
and O
has O
3 O
children O
. O
She O
doesn O
' O
t O
smoke O
but O
drinks O
alcohol O
occasionally O
. O
Her O
vital O
signs O
are O
normal O
. O
On O
physical O
examination O
, O
there O
is O
a O
small O
effusion B-SYMPTOM
in O
the O
right O
knee O
. O
The O
effusion B-SYMPTOM
grew O
a O
little O
larger O
and O
she O
developed O
a O
tender B-SYMPTOM
swelling I-SYMPTOM
in O
the O
popliteal O
fossa O
and O
calf O
. O
Both O
the O
pain B-SYMPTOM
and O
swelling B-SYMPTOM
worsened O
as O
she O
bent O
and O
straightened O
her O
knee O
. O

A O
25 O
year O
old O
woman O
comes O
to O
the O
clinic O
with O
her O
roommate O
. O
The O
roommate O
says O
that O
the O
patient O
has O
twice O
fallen O
asleep O
while O
they O
were O
talking O
. O
The O
patient O
has O
regularly O
fallen O
asleep O
in O
the O
afternoon O
while O
reading O
or O
watching O
television O
but O
typically O
feels O
refreshed O
after O
a O
brief O
nap O
. O
She O
also O
reveals O
that O
she O
sometimes O
hears O
a O
voice O
prior O
to O
falling O
asleep O
. O
She O
also O
complains O
of O
some O
episodes O
of O
clumsiness B-SYMPTOM
that O
cause O
her O
to O
drop O
objects O
or O
fall O
. O
MSLT O
showed O
that O
the O
sleep O
latency O
was O
less O
than O
8 O
min O
and O
that O
the O
patient O
enters O
rapid O
eye O
movement O
REM O
sleep O
almost O
immediately O
. O

A O
17 O
year O
old O
male O
comes O
to O
the O
office O
due O
to O
several O
months O
of O
right B-SYMPTOM
elbow I-SYMPTOM
pain I-SYMPTOM
. O
The O
pain B-SYMPTOM
is O
worse O
with O
activity O
and O
limits O
his O
workouts O
and O
activities O
. O
He O
has O
tried O
over O
the O
counter O
medications O
with O
limited O
relief O
. O
Medical O
history O
is O
notable O
for O
eczema O
, O
and O
current O
medications O
include O
a O
topical O
hydrocortisone O
ointment O
. O
He O
is O
sexually O
active O
with O
his O
girlfriend O
and O
uses O
condoms O
. O
He O
does O
not O
smoke O
or O
drink O
alcohol O
. O
He O
plays O
tennis O
most O
of O
the O
days O
of O
the O
week O
. O
The O
comprehensive O
evaluation O
shows O
pain B-SYMPTOM
on O
the O
lateral O
side O
of O
the O
elbow O
, O
made O
worse O
by O
pressure O
applied O
on O
the O
lateral O
epicondyle O
of O
the O
humerus O
and O
when O
making O
a O
fist O
with O
the O
elbow O
joint O
straightened O
. O
The O
patient O
has O
this O
pain B-SYMPTOM
since O
last O
year O
and O
had O
several O
courses O
of O
physical O
therapy O
. O

A O
43 O
year O
old O
woman O
, O
gravida O
3 O
para O
3 O
, O
comes O
to O
the O
clinic O
complaining O
of O
recently O
painful B-SYMPTOM
menstrual I-SYMPTOM
cycles I-SYMPTOM
. O
The O
patient O
's O
last O
menstrual O
period O
was O
2 O
weeks O
ago O
. O
Urine O
β O
hCG O
is O
negative O
. O
Menarche O
was O
at O
age O
12 O
, O
and O
menstrual O
periods O
occur O
every O
28 O
days O
and O
lasts O
for O
5 O
days O
. O
She O
is O
sexually O
active O
with O
her O
husband O
and O
does O
not O
have O
pain B-SYMPTOM
with O
intercourse O
. O
BMI O
is O
23 O
kg O
m2 O
and O
Vital O
signs O
are O
normal O
. O
On O
physical O
examination O
, O
the O
uterus O
is O
uniformly O
enlarged O
and O
tender O
. O
She O
is O
candidate O
for O
hysterectomy O
with O
the O
diagnosis O
of O
adenomyosis O
. O


A O
55 O
year O
old O
white O
woman O
comes O
for O
a O
routine O
checkup O
. O
She O
has O
no O
significant O
medical O
history O
and O
does O
not O
use O
tobacco O
, O
alcohol O
, O
or O
illicit O
drugs O
. O
The O
patient O
's O
only O
medication O
is O
an O
over O
the O
counter O
multivitamin O
. O
Family O
history O
is O
notable O
for O
a O
hip O
fracture O
in O
her O
mother O
. O
Blood O
pressure O
is O
130 O
80 O
mm O
Hg O
and O
pulse O
is O
112 O
min O
. O
She O
has O
occasional O
back B-SYMPTOM
pain I-SYMPTOM
and O
lives O
a O
sedentary O
lifestyle O
with O
the O
BMI O
of O
24 O
Kg O
m2 O
. O
Plain O
X O
ray O
of O
the O
spine O
shows O
mild O
compression O
fracture O
at O
the O
level O
of O
T10 O
. O
X O
ray O
absorptiometry O
studies O
demonstrate O
abnormally O
low O
bone O
density O
in O
the O
lumbar O
vertebrae O
and O
T O
score O
values O
below O
2 O
. O
5 O
, O
which O
confirms O
the O
diagnosis O
of O
osteoporosis O
. O

A O
61 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
complaining O
of O
an O
acute B-SYMPTOM
vision I-SYMPTOM
disturbance I-SYMPTOM
. O
He O
had O
an O
episode O
of O
vision B-SYMPTOM
disturbance I-SYMPTOM
in O
the O
right O
eye O
that O
occurred O
suddenly O
and O
resolved O
spontaneously O
in O
15 O
minutes O
. O
He O
also O
has O
right B-SYMPTOM
jaw I-SYMPTOM
pain I-SYMPTOM
while O
chewing O
. O
He O
also O
complains O
of O
fatigue B-SYMPTOM
and O
hip B-SYMPTOM
muscle I-SYMPTOM
aches I-SYMPTOM
over O
the O
last O
several O
months O
. O
The O
patient O
has O
a O
history O
of O
mild O
hyperlipidemia O
that O
has O
been O
controlled O
by O
diet O
and O
lifestyle O
modifications O
. O
On O
examination O
, O
his O
blood O
pressure O
is O
130 O
70 O
mm O
Hg O
and O
pulse O
is O
66 O
min O
. O
Neurological O
examination O
is O
unremarkable O
. O
Visual O
examination O
is O
also O
normal O
. O
ESR O
is O
103 O
mm O
h O
. O
Temporal O
artery O
biopsy O
shows O
multinuclear O
giant O
cells O
and O
internal O
elastic O
membrane O
fragmentation 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 B-SYMPTOM
and O
acid B-SYMPTOM
reflux I-SYMPTOM
. 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 O
swallow O
study O
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 B-SYMPTOM
after O
a O
tooth O
extraction O
. O
The O
bleeding B-SYMPTOM
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

A O
70 O
year O
old O
man O
comes O
to O
the O
office O
accompanied O
by O
his O
wife O
. O
The O
patient O
has O
experienced O
progressive O
memory B-SYMPTOM
loss I-SYMPTOM
over O
the O
last O
years O
. O
He O
needs O
help O
with O
some O
of O
his O
routine O
activities O
, O
such O
as O
paying O
bills O
. O
The O
patient O
's O
wife O
says O
, O
" O
He O
used O
to O
be O
such O
an O
independent O
person O
, O
but O
now O
he O
needs O
help O
with O
many O
things O
, O
even O
finding O
direction O
to O
home O
! O
" O
Medical O
history O
includes O
hypertension O
, O
hyperlipidemia O
, O
and O
type O
2 O
diabetes O
mellitus O
. O
Family O
history O
includes O
Alzheimer O
disease O
in O
his O
father O
. O
MRI O
reveals O
diffuse O
cortical O
and O
hippocampal O
atrophy O
. O
The O
diagnosis O
of O
AD O
is O
made O
using O
the O
National O
Institute O
on O
Aging O
and O
the O
Alzheimer O
's O
Association O
NIA O
AA O
criteria 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 B-SYMPTOM
extremity I-SYMPTOM
weakness I-SYMPTOM
and O
urinary B-SYMPTOM
retention I-SYMPTOM
s O
p O
Foley O
catheter O
, O
high O
dose O
steroids O
, O
hypertension O
, O
and O
chronic B-SYMPTOM
pain I-SYMPTOM
. 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 O
. O
Complicated O
by O
progressive O
lower B-SYMPTOM
extremity I-SYMPTOM
weakness I-SYMPTOM
and O
urinary B-SYMPTOM
retention I-SYMPTOM
. O
Patient O
initially O
presented O
with O
RLE B-SYMPTOM
weakness I-SYMPTOM
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 B-SYMPTOM
numbness I-SYMPTOM
. O
MRI O
showed O
a O
spinal B-SYMPTOM
cord I-SYMPTOM
conus I-SYMPTOM
mass I-SYMPTOM
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 B-SYMPTOM
and O
LE O
edema O
. O
TTE O
revealed O
severe O
aortic O
stenosis O
with O
worsening B-SYMPTOM
LV I-SYMPTOM
function I-SYMPTOM
. 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 B-SYMPTOM
SOB I-SYMPTOM
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 B-SYMPTOM
ventricular I-SYMPTOM
hypertrophy I-SYMPTOM
with O
cavity O
dilation O
and O
severe O
global O
hypokinesis B-SYMPTOM
, 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 B-SYMPTOM
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 B-SYMPTOM
. 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 B-SYMPTOM
. O
She O
came O
to O
the O
hospital O
where O
head O
CT O
showed O
a O
significant O
amount O
of O
blood O
in O
her O
right O
ventricle O
. O
NSGY O
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 O
angiogram O
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 B-SYMPTOM
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 O
was O
performed O
and O
the O
fluid O
analysis O
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 O
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 O
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 B-SYMPTOM
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 O
filter O
placement O
8 O
. O
Knee O
surgery O

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 B-SYMPTOM
defects I-SYMPTOM
. 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 O
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 B-SYMPTOM
pain I-SYMPTOM
, O
dyspnea B-SYMPTOM
on I-SYMPTOM
exertion I-SYMPTOM
, O
paroxysmal B-SYMPTOM
nocturnal I-SYMPTOM
dyspnea I-SYMPTOM
, O
orthopnea O
, O
palpitations O
, O
syncope O
or O
presyncope O
. O
He O
underwent O
Carotid O
U O
S O
that O
showed O
significant O
bilateral O
carotid O
stenosis O
, O
L O
R O
. O
Angiography O
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 O
angiography O
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 O
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 O
and O
peripheral O
neuropathy O
Cataracts O
s O
p O
surgery O
Thyroid O
nodule O
Colon O
polyps O
s O
p O
resection O
Intermittent O
Lower B-SYMPTOM
back I-SYMPTOM
pain I-SYMPTOM
Proteinuria O
s O
p O
right O
elbow O
fracture O
as O
a O
child O
Arthritis O

Patient O
is O
a O
55yo O
woman O
with O
h O
o O
ESRD O
on O
HD O
and O
peritoneal O
dialysis O
who O
presented O
with O
watery O
, O
non O
bloody O
diarrhea B-SYMPTOM
and O
weakness B-SYMPTOM
. O
She O
has O
a O
history O
of O
2 O
prior O
C O
diff O
infections O
, O
the O
most O
recent O
just O
1 O
month O
ago O
. O
Recent O
antibx O
use O
in O
the O
last O
month O
on O
prior O
admission O
. O
Was O
also O
txd O
for O
Cdiff O
at O
that O
time O
for O
14 O
d O
. O
course O
with O
po O
vanco O
. O
Pt O
was O
initially O
admitted O
to O
the O
ICU O
and O
was O
septic O
on O
pressors O
levophed O
until O
the O
morning O
of O
8 O
26 O
with O
leukocytosis O
but O
no O
fever B-SYMPTOM
. O
C O
diff O
assay O
positive O
on O
admission O
, O
and O
pt O
had O
leukocytosis O
consistent O
with O
C O
diff O
. O
Patient O
was O
placed O
on O
Vanco O
po O
, O
Flagyl O
IV O
and O
Flagyl O
po O
initially O
, O
and O
when O
patient O
improved O
she O
was O
transitioned O
to O
Vanco O
oral O
and O
Flagyl O
oral O
on O
8 O
29 O
. O
Patient O
was O
treated O
with O
Vanco O
for O
an O
extended O
course O
of O
6 O
weeks O
given O
her O
recurrent O
C O
diff O
. O
Pt O
was O
also O
encouraged O
to O
take O
probiotics O
and O
to O
bleach O
her O
home O
when O
she O
was O
discharged O
. 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 B-SYMPTOM
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 B-SYMPTOM
speech I-SYMPTOM
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 O
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 O
function O
tests O
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

This O
is O
a O
57 O
year O
old O
gentleman O
with O
CLL O
and O
large O
cell O
transformation O
. O
He O
presented O
with O
his O
disease O
back O
in O
10 O
2119 O
with O
an O
elevated B-SYMPTOM
white I-SYMPTOM
count I-SYMPTOM
and O
LDH O
. O
He O
was O
without O
any O
splenomegaly O
or O
any O
cytopenias O
at O
that O
time O
. O
He O
did O
have O
some O
bulky O
lymphadenopathy O
. O
He O
then O
completed O
four O
cycles O
of O
FCR O
therapy O
, O
which O
he O
completed O
back O
in O
09 O
2119 O
. O
He O
had O
an O
excellent O
response O
to O
therapy O
and O
was O
monitored O
off O
treatment O
for O
approximately O
two O
years O
. O
He O
then O
presented O
in O
7 O
2122 O
with O
a O
rising O
white O
count O
, O
approximately O
50 O
lymphocytes O
, O
and O
a O
mildly B-SYMPTOM
elevated I-SYMPTOM
LDH I-SYMPTOM
. O
He O
also O
had O
some O
mild O
worsening O
palpable O
lymphadenopathy O
. O
He O
then O
received O
four O
cycles O
of O
PCR O
, O
but O
did O
not O
have O
much O
in O
the O
way O
of O
response O
and O
his O
treatment O
regimen O
was O
switched O
to O
R O
CVP O
of O
which O
he O
received O
two O
cycles O
. O
He O
did O
again O
not O
have O
a O
significant O
response O
, O
though O
continued O
to O
have O
an O
excellent O
performance O
status O
, O
and O
he O
was O
ultimately O
switched O
to O
Campath O
therapy O
. O
He O
did O
have O
resolution O
of O
his O
lymphocytosis O
, O
and O
his O
white O
count O
has O
come O
down O
nicely O
, O
but O
did O
not O
have O
much O
in O
the O
way O
of O
response O
in O
terms O
of O
reducing O
his O
bulky O
lymphadenopathy O
. O
He O
then O
eventually O
had O
developed O
an O
enlarging O
left O
cervical O
node O
which O
was O
biopsied O
and O
was O
found O
to O
have O
Richter O
's O
transformation O
. 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 B-SYMPTOM
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 O
, 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 O
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 O
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 B-SYMPTOM
. 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 O
to O
neck O
s O
p O
RAI O
ablation O
Metastatic O
to O
lymph O
nodes O
and O
adrenal O
glands O
s O
p O
hernia O
repair O
s O
p O
tonsillectomy 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 B-SYMPTOM
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 B-SYMPTOM
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 B-SYMPTOM
gain I-SYMPTOM
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 B-SYMPTOM
appetite I-SYMPTOM
, O
PO B-SYMPTOM
intake I-SYMPTOM
, O
energy O
level O
at O
home O
with O
difficulty B-SYMPTOM
with I-SYMPTOM
ADLs I-SYMPTOM
. O
No O
recent O
history O
of O
fever B-SYMPTOM
, O
cough B-SYMPTOM
, O
chills B-SYMPTOM
, O
sputum B-SYMPTOM
production I-SYMPTOM
, O
CP B-SYMPTOM
, O
abd B-SYMPTOM
pain I-SYMPTOM
, O
or O
other O
complaints O
other O
than O
chronic B-SYMPTOM
right I-SYMPTOM
thigh I-SYMPTOM
pain I-SYMPTOM
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 O
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 O
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 O
catheter O
with O
multiple O
prior O
admissions O
for O
UTIs O
, O
altered B-SYMPTOM
mental I-SYMPTOM
status I-SYMPTOM
, 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 O
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 B-SYMPTOM
strictures I-SYMPTOM
. 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 O
Neurogenic O
bladder O
s O
p O
suprapubic O
cath O
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 O
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 B-SYMPTOM
rigors B-SYMPTOM
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 B-SYMPTOM
abdominal I-SYMPTOM
pain I-SYMPTOM
, 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 O
. O
The O
results O
of O
the O
biopsy O
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
, O
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 B-SYMPTOM
thought O
due O
to O
diastolic O
CHF O
, O
pulmonary O
hypertension B-SYMPTOM
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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
. 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 B-SYMPTOM
. 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 O
placement O
. 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 O
, O
sphincterotomy O
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 O
transplant O
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 O
for O
ESRD O
who O
represents O
for O
malaise O
, O
weakness B-SYMPTOM
, O
and O
generalized B-SYMPTOM
body I-SYMPTOM
aching I-SYMPTOM
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 O
stem O
cell O
transplant O
. 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 O
procedures O
, O
including O
s O
p O
Suprapubic O
prostatectomy O
. O
He O
was O
noted O
to O
have O
low B-SYMPTOM
urine I-SYMPTOM
output I-SYMPTOM
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 O
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 O
of O
a O
cardiac O
monitoring O
device O
. 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 O
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 B-SYMPTOM
, O
but O
denies O
chest B-SYMPTOM
pain I-SYMPTOM
. O
Patient O
is O
to O
be O
transferred O
to O
the O
CCU O
for O
catheterization O
and O
EPS O
. O

A O
35 O
year O
old O
woman O
presents O
with O
history O
of O
acne B-SYMPTOM
and O
mild O
hirsutism O
. O
The O
primary O
evaluation O
revealed O
elevated B-SYMPTOM
testosterone I-SYMPTOM
levels I-SYMPTOM
. O
She O
recently O
noticed O
gradual O
enlargement B-SYMPTOM
of I-SYMPTOM
her I-SYMPTOM
hands I-SYMPTOM
and I-SYMPTOM
feet I-SYMPTOM
and O
recognized O
that O
her O
ring O
is O
getting O
small O
for O
her O
finger O
. O
There O
is O
some O
irregularity O
in O
her O
menstrual O
cycle O
as O
well O
as O
some O
nipple B-SYMPTOM
discharge I-SYMPTOM
. O
She O
also O
has O
positive O
history O
for O
snoring B-SYMPTOM
and O
headache B-SYMPTOM
. O
The O
physical O
examination O
revealed O
subtle O
facial O
features O
of O
acromegaly O
and O
prognathism O
. O
Visual O
fields O
are O
normal O
by O
confrontation O
. O
Hirsutism O
, O
soft O
tissue O
thickening O
and O
diaphoresis O
of O
the O
hands O
and O
feet O
are O
noted O
. O
Laboratory O
evaluation O
in O
the O
fasting O
state O
reveals O
IGF O
1 O
of O
968 O
ng O
mL O
and O
random O
GH O
of O
19 O
. O
7 O
ng O
mL O
. O
MRI O
reveals O
a O
macroadenoma O
with O
no O
invasion O
. O
She O
is O
on O
stable O
doses O
of O
octreotide O
LAR O
since O
her O
diagnosis O
was O
confirmed O
. O
She O
is O
married O
and O
has O
2 O
children O
. O
She O
is O
using O
IUD O
as O
her O
contraceptive O
method O
. O

The O
patient O
is O
a O
57 O
year O
old O
man O
with O
abdominal B-SYMPTOM
pain I-SYMPTOM
and O
vomiting B-SYMPTOM
. O
The O
pain B-SYMPTOM
started O
gradually O
about O
20 O
hours O
ago O
in O
the O
epigastric O
and O
periumbilical O
regions O
, O
radiating O
to O
his O
back O
. O
He O
drinks O
around O
60 O
units O
of O
alcohol O
per O
week O
and O
smokes O
22 O
cigarettes O
per O
day O
. O
He O
is O
healthy O
with O
no O
history O
of O
allergies B-SYMPTOM
or O
using O
any O
medications O
. O
His O
family O
history O
is O
positive O
for O
type O
2 O
diabetes O
his O
father O
and O
sister O
. O
He O
lives O
alone O
and O
has O
no O
children O
. O
The O
abdomen O
is O
tender O
and O
soft O
. O
His O
bowel O
sounds O
are O
normal O
. O
His O
heart O
rate O
is O
115 O
min O
and O
blood O
pressure O
110 O
75 O
mmHg O
. O
The O
lab O
results O
are O
remarkable O
for O
leukocytosis O
19 O
. O
5 O
, O
urea O
of O
8 O
. O
5 O
, O
high B-SYMPTOM
CRP I-SYMPTOM
145 O
, O
high B-SYMPTOM
amylase I-SYMPTOM
1200 O
and O
Glc O
level O
of O
15 O
. O
Cross O
sectional O
imaging O
was O
negative O
for O
obstructive O
pancreatitis O
. O

The O
patient O
is O
a O
31 O
year O
old O
woman O
complaining O
of O
abdominal B-SYMPTOM
pain I-SYMPTOM
. O
The O
pain B-SYMPTOM
started O
last O
night O
as O
diffuse O
abdominal B-SYMPTOM
discomfort I-SYMPTOM
. O
She O
had O
poor B-SYMPTOM
appetite I-SYMPTOM
as O
well O
as O
malaise O
. O
The O
pain B-SYMPTOM
worsened O
in O
intensity O
and O
became O
sharp O
in O
the O
morning O
. O
The O
pain B-SYMPTOM
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 B-SYMPTOM
of O
the O
left O
lower O
quadrant O
causes O
pain B-SYMPTOM
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 B-SYMPTOM
appendix I-SYMPTOM
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 O
appendectomy O
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 B-SYMPTOM
and O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
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 B-SYMPTOM
cough I-SYMPTOM
, O
wheezing B-SYMPTOM
, O
and O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
and O
chest B-SYMPTOM
tightness I-SYMPTOM
. 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 O
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
55 O
year O
old O
man O
visiting O
his O
primary O
care O
physician O
for O
lower B-SYMPTOM
urinary I-SYMPTOM
tract I-SYMPTOM
symptoms I-SYMPTOM
including O
frequency O
, O
urgency O
, O
weak O
stream O
, O
incomplete O
emptying O
and O
intermittent O
flow O
for O
the O
past O
9 O
months O
. O
Further O
evaluation O
revealed O
IPSS O
score O
15 O
Post O
void O
residual O
70 O
mL O
Prostate O
volume O
TRUS O
60 O
mL O
Prostate O
specific O
antigen O
PSA O
level O
3 O
. O
2 O
ng O
mL O
10 O
mL O
sec O
of O
maximum O
flow O
rate O
when O
urine O
volume O
was O
130 O
mL O
He O
is O
otherwise O
healthy O
only O
using O
Vit O
D O
1000 O
units O
daily O
. O
His O
recent O
blood O
chemistry O
3 O
days O
ago O
was O
normal O
Hgb O
13 O
. O
5 O
g O
dl O
WBC O
135000 O
mm3 O
Plt O
350000 O
ml O
PT O
11 O
second O
PTT O
35 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
42 O
year O
old O
postmenopausal O
woman O
who O
had O
a O
screening O
sonogram O
which O
revealed O
an O
abnormality B-SYMPTOM
in I-SYMPTOM
the I-SYMPTOM
right I-SYMPTOM
breast I-SYMPTOM
. O
She O
had O
no O
palpable O
masses O
on O
breast O
exam O
. O
Core O
biopsy O
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 O
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 B-SYMPTOM
pain I-SYMPTOM
lasting O
about O
4 O
days O
accompanied O
by O
nausea B-SYMPTOM
and O
2 O
episodes O
of O
vomiting B-SYMPTOM
. O
The O
pain B-SYMPTOM
is I-SYMPTOM
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 B-SYMPTOM
is I-SYMPTOM
worsening O
after O
eating O
fatty O
food O
. O
The O
patient O
experienced O
similar O
pain B-SYMPTOM
twice I-SYMPTOM
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 O
sections O
. 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 B-SYMPTOM
febrile I-SYMPTOM
. 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 B-SYMPTOM
tenderness I-SYMPTOM
and O
tenderness B-SYMPTOM
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 B-SYMPTOM
ESR I-SYMPTOM
and O
leukocytosis O
with O
a O
left O
shift O
. O
The O
ultrasound O
revealed O
several O
gallstones B-SYMPTOM
and O
biliary B-SYMPTOM
sludge I-SYMPTOM
. 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 O
hernia O
surgery O
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 B-SYMPTOM
RNA I-SYMPTOM
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 O
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 B-SYMPTOM
from I-SYMPTOM
esophageal I-SYMPTOM
varices I-SYMPTOM
, 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 B-SYMPTOM
. 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 B-SYMPTOM
or O
tenderness B-SYMPTOM
. 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
60 O
year O
old O
Spanish O
man O
presenting O
with O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
about O
a O
day O
before O
. O
The O
symptoms O
began O
acutely O
and O
progressively O
worsened O
. O
He O
is O
a O
known O
case O
of O
COPD O
since O
2 O
years O
ago O
. O
The O
spirometry O
revealed O
post O
bronchodilator O
FEV1 O
FVC O
60 O
of O
predicted O
values O
. O
He O
smokes O
20 O
cigarette O
per O
day O
. O
His O
past O
medical O
history O
is O
remarkable O
for O
BPH O
and O
he O
is O
using O
Flomax O
for O
that O
. O
His O
family O
history O
is O
positive O
for O
HTN O
in O
his O
brother O
. O
His O
medication O
includes O
Duo O
Neb O
inhaled O
q4 O
hr O
PRN O
, O
Vit O
D3 O
1000 O
units O
per O
day O
and O
Flomax O
for O
his O
PBH O
. O
He O
is O
an O
obese O
man O
who O
is O
acutely O
ill O
but O
oriented O
and O
conscious O
. O
The O
vital O
signs O
are O
as O
bellow O
BP O
135 O
80 O
RR O
25 O
min O
HR O
75 O
bpm O
BMI O
40 O
O2sat O
90 O

The O
patient O
is O
a O
24 O
year O
old O
man O
who O
has O
had O
type O
1 O
diabetes O
for O
11 O
years O
. O
He O
presents O
to O
the O
emergency O
room O
with O
hyperglycemia O
and O
concern O
for O
possible O
diabetic O
ketoacidosis O
after O
not O
taking O
his O
insulin O
for O
3 O
days O
. O
The O
patient O
reports O
that O
he O
is O
currently O
homeless O
and O
has O
lost O
his O
supply O
of O
insulin O
, O
syringes O
, O
glucometer O
, O
and O
glucose O
testing O
supplies O
. O
The O
patient O
states O
that O
at O
the O
time O
of O
his O
initial O
diagnosis O
with O
type O
1 O
diabetes O
he O
was O
hospitalized O
with O
a O
glucose O
value O
1000 O
mg O
dL O
. O
At O
the O
time O
, O
he O
was O
experiencing O
polyuria O
, O
polydipsia O
, O
and O
polyphagia O
. O
He O
reports O
that O
he O
has O
been O
on O
insulin O
since O
the O
time O
of O
his O
diagnosis O
, O
and O
he O
has O
never O
been O
prescribed O
oral O
agents O
for O
diabetes O
management O
. O
Most O
recently O
, O
he O
has O
been O
using O
insulin O
glargine O
55 O
units O
once O
daily O
, O
and O
insulin O
aspart O
sliding O
scale O
3 O
times O
daily O
. O
The O
patient O
has O
had O
previous O
episodes O
of O
diabetic O
ketoacidosis O
, O
for O
which O
he O
was O
hospitalized O
. O
With O
this O
episode O
of O
hyperglycemia O
, O
he O
is O
not O
experiencing O
any O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
, O
or O
abdominal B-SYMPTOM
discomfort I-SYMPTOM
, O
and O
he O
appears O
well O
. O
His O
lab O
studies O
showed O
A1c O
11 O
. O
3 O
Creatinine O
0 O
. O
9 O
mg O
dL O
with O
eGFR O
60 O
mL O
min O
Aspartate O
aminotransferase O
AST O
17 O
U O
L O
Alanine O
aminotransferase O
ALT O
14 O
U O
L O
Beta O
hydroxybutyrate O
0 O
. O
1 O
mmol O
L O
Bicarbonate O
25 O
mEq O
L O
Anion O
Gap O
14 O
mEq O
L O

The O
patient O
is O
a O
33 O
year O
old O
woman O
complained O
of O
fatigue B-SYMPTOM
, O
weight B-SYMPTOM
gain I-SYMPTOM
and O
abnormal B-SYMPTOM
spotting I-SYMPTOM
between O
menses O
. O
No O
hirsutism O
or O
nipple B-SYMPTOM
discharge I-SYMPTOM
was O
detected O
. O
Her O
BMI O
was O
34 O
. O
Her O
lab O
results O
were O
remarkable O
for O
high O
TSH O
level O
13 O
mU O
L O
and O
low O
free O
T4 O
level O
0 O
. O
2 O
ng O
dl O
. O
Her O
anti O
TPO O
levels O
were O
extremely O
high O
120 O
IU O
ml O
. O
She O
was O
diagnosed O
with O
Hashimoto O
's O
thyroiditis O
. O
Her O
aunt O
, O
brother O
and O
mother O
have O
the O
same O
disease O
. O
After O
starting O
250 O
mcg O
Levothyroxine O
per O
day O
, O
her O
symptoms O
improved O
significantly O
and O
her O
periods O
are O
normal O
. O
She O
is O
still O
overweight O
with O
BMI O
of O
31 O
. O
Her O
most O
recent O
thyroid O
profile O
revealed O
all O
results O
except O
for O
anti O
TPO O
within O
the O
normal O
range O
TSH O
2 O
. O
35 O
mU O
L O
Free O
T4 O
2 O
. O
7 O
ng O
dl O
Anti O
TPO O
75 O
IU O
ml 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 B-SYMPTOM
. O
She O
lost B-SYMPTOM
interest I-SYMPTOM
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 B-SYMPTOM
for O
the O
past O
3 O
weeks O
. O
She O
also O
lost B-SYMPTOM
her I-SYMPTOM
appetite I-SYMPTOM
, O
which O
led O
to O
about O
5kg O
weight O
loss O
. O
She O
complains O
of O
loss B-SYMPTOM
of I-SYMPTOM
energy I-SYMPTOM
and O
feelings B-SYMPTOM
of I-SYMPTOM
worthlessness I-SYMPTOM
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 B-SYMPTOM
issues I-SYMPTOM
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal B-SYMPTOM
. 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 O
. 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 B-SYMPTOM
problems I-SYMPTOM
. O
Her O
HAM O
D O
score O
is O
20 O
. O

The O
patient O
is O
a O
32 O
year O
old O
obese O
woman O
who O
came O
to O
the O
clinic O
with O
weight O
concerns O
. O
She O
is O
165 O
cm O
tall O
and O
her O
weight O
is O
113 O
kg O
. O
She O
is O
complaining O
of O
sleep B-SYMPTOM
apnea I-SYMPTOM
, O
PCO O
and O
dissatisfaction B-SYMPTOM
with O
her O
body O
shape O
. O
She O
is O
a O
high O
school O
teacher O
married O
for O
5 O
years O
. O
She O
doesn O
' O
t O
use O
any O
contraceptive O
methods O
for O
the O
past O
4 O
months O
and O
she O
had O
no O
prior O
pregnancies O
. O
She O
doesn O
' O
t O
smoke O
or O
use O
any O
drugs O
. O
She O
likes O
to O
try O
diets O
and O
exercise O
to O
lose O
weight O
. O
She O
completed O
the O
four O
square O
step O
test O
in O
14 O
seconds O
. O
Her O
BP O
130 O
80 O
, O
HR O
195 O
min O
and O
her O
BMI O
is O
41 O
. O
54 O
. O
Her O
labs O
FBS O
98 O
mg O
dl O
TG O
150 O
mg O
dl O
Cholesterol O
180 O
mg O
dl O
LDL O
90 O
mg O
dl O
HDL O
35 O
mg O
dl O
Her O
cardiac O
assessment O
is O
normal O
. O
Her O
joints O
and O
ROM O
are O
within O
normal 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 B-SYMPTOM
and O
weakness B-SYMPTOM
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 O
fiber O
electromyography O
SFEMG O
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 B-SYMPTOM
or O
any O
other O
abnormalities B-SYMPTOM
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 O
. O

A O
57 O
year O
old O
farmer O
was O
diagnosed O
with O
Parkinson O
's O
disease O
a O
year O
ago O
. O
He O
experiences O
slowness B-SYMPTOM
of I-SYMPTOM
movement I-SYMPTOM
and O
tremors O
. O
His O
past O
medical O
history O
is O
significant O
for O
hypertension O
and O
hypercholesterolemia O
. O
He O
lives O
with O
his O
wife O
. O
They O
have O
three O
children O
. O
He O
used O
to O
be O
active O
with O
planting O
and O
taking O
care O
of O
their O
farm O
animals O
before O
his O
diagnosis O
. O
The O
patient O
complains O
of O
shaking B-SYMPTOM
and O
slow B-SYMPTOM
movement I-SYMPTOM
. O
He O
had O
difficulty O
entering O
through O
a O
door O
, O
as O
he O
was O
frozen O
and O
needed O
guidance O
to O
step O
in O
. O
His O
handwriting O
is O
getting O
smaller O
. O
He O
is O
on O
Levodopa O
and O
Trihexyphenidyl O
. O
He O
stated O
his O
medications O
help O
with O
shaking B-SYMPTOM
and O
slow B-SYMPTOM
movement I-SYMPTOM
. O
But O
he O
still O
has O
difficulty B-SYMPTOM
initiating I-SYMPTOM
movements I-SYMPTOM
, O
stiffness B-SYMPTOM
and O
slowness B-SYMPTOM
in O
general O
. O
He O
is O
an O
alert O
and O
cooperative O
man O
who O
doesn O
' O
t O
have O
any O
signs O
of O
dementia O
. O
He O
doesn O
' O
t O
smoke O
or O
use O
any O
illicit O
drugs O
. 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 B-SYMPTOM
pain I-SYMPTOM
. 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 B-SYMPTOM
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 O
surgery O
according O
to O
perioperative O
MEP O
monitoring O

Patient O
A O
is O
a O
30 O
year O
old O
male O
who O
was O
admitted O
to O
the O
hospital O
after O
10 O
days O
of O
cough B-SYMPTOM
, O
profuse O
nocturnal B-SYMPTOM
sweating I-SYMPTOM
and O
loss B-SYMPTOM
of I-SYMPTOM
appetite I-SYMPTOM
. O
He O
had O
traveled O
to O
India O
1 O
months O
ago O
and O
has O
not O
any O
positive O
history O
of O
TB O
vaccination O
. O
He O
is O
a O
previously O
healthy O
man O
, O
working O
as O
an O
engineer O
in O
a O
high O
tech O
company O
. O
He O
doesn O
' O
t O
smoke O
o O
use O
any O
illicit O
drugs O
. O
He O
was O
febrile B-SYMPTOM
38 O
c O
with O
heart O
rate O
of O
115 O
b O
min O
, O
respiratory O
rate O
of O
22 O
, O
BP O
of O
125 O
75 O
mmHg O
and O
O2 O
sat O
of O
97 O
. O
Chest O
X O
ray O
showed O
infiltrate O
in O
the O
middle O
of O
left O
lung O
with O
diameter O
of O
1 O
. O
8 O
cm O
with O
signs O
of O
cavitation O
. O
The O
sputum O
smear O
revealed O
positive O
sputum O
culture O
for O
Mycobacterium O
tuberculosis O
which O
are O
sensitive O
of O
the O
first O
line O
TB O
drugs O
isoniazid O
, O
streptomycin O
, O
rifampicin O
and O
ethambutol O
. O
Lab O
study O
is O
reported O
bellow O
Hgb O
13 O
g O
dl O
WBC O
14000 O
mm3 O
Plt O
300000 O
ml O
AST O
13 O
U O
L O
ALT O
15 O
U O
L O
Alk O
P O
53 O
U O
L O
Bill O
total O
0 O
. O
6 O
mg O
dl O
Na O
137 O
mEq O
l O
K O
4 O
mEq O
l O
Creatinine O
0 O
. O
5 O
mg O
dl O
BUN O
10 O
mg O
dl O
ESR O
120 O
mm O
hr 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 B-SYMPTOM
extremity I-SYMPTOM
weakness I-SYMPTOM
, O
associated O
with O
dark O
visual O
spot O
in O
right O
eye O
, O
right B-SYMPTOM
facial I-SYMPTOM
numbness I-SYMPTOM
, O
facial B-SYMPTOM
drop I-SYMPTOM
and O
slurred B-SYMPTOM
speech I-SYMPTOM
. O
He O
denied O
dyspnea B-SYMPTOM
, O
headache B-SYMPTOM
, O
palpitations B-SYMPTOM
, O
chest B-SYMPTOM
pain I-SYMPTOM
, O
fever B-SYMPTOM
, O
dizziness B-SYMPTOM
, O
bowel B-SYMPTOM
or O
urinary B-SYMPTOM
incontinence I-SYMPTOM
, O
loss B-SYMPTOM
of I-SYMPTOM
consciousness I-SYMPTOM
. 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 B-SYMPTOM
sided I-SYMPTOM
facial I-SYMPTOM
droop I-SYMPTOM
, 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 O
angiogram O
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 O
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
12 O
year O
old O
girl O
came O
to O
the O
clinic O
with O
her O
mother O
, O
complaining O
of O
short O
stature O
, O
delayed O
in O
puberty O
and O
developmental B-SYMPTOM
delay I-SYMPTOM
. O
Her O
karyotype O
study O
revealed O
45X O
and O
confirmed O
the O
diagnosis O
of O
Turner O
syndrome O
. O
She O
is O
treating O
with O
GH O
since O
6 O
months O
ago O
without O
estrogen O
therapy O
to O
avoid O
menarche O
and O
reach O
the O
ideal O
height O
. O
She O
is O
an O
obese O
, O
mentally O
retarded O
girl O
in O
the O
physical O
exam O
. O
Her O
breast O
bulb O
were O
in O
stage O
1 O
with O
no O
course O
hair O
in O
the O
pubic O
or O
axillary O
. O
Her O
TSH O
was O
3 O
and O
FBS O
was O
75 O
in O
the O
latest O
lab O
study O
. O

A O
34 O
year O
old O
man O
comes O
to O
the O
clinic O
complaining O
of O
dizziness B-SYMPTOM
and O
severe O
diarrhea B-SYMPTOM
since O
yesterday O
. O
He O
has O
returned O
from O
an O
international O
trip O
few O
days O
ago O
and O
was O
living O
in O
a O
camp O
in O
Sudan O
for O
a O
month O
. O
He O
developed O
abdominal B-SYMPTOM
pain I-SYMPTOM
followed O
by O
bloating B-SYMPTOM
and O
nausea B-SYMPTOM
as O
well O
as O
loose B-SYMPTOM
bowel I-SYMPTOM
movements I-SYMPTOM
. O
Soon O
he O
was O
having O
profuse O
watery O
diarrhea B-SYMPTOM
without O
odor O
. O
The O
stool O
is O
watery O
and O
white O
but O
the O
patient O
has O
no O
fever B-SYMPTOM
. O
Blood O
pressure O
is O
95 O
62 O
lying O
down O
and O
drops O
to O
75 O
40 O
standing O
. O
The O
skin O
turgor O
has O
reduced O
. O
HR O
is O
110 O
and O
he O
looks B-SYMPTOM
ill I-SYMPTOM
with O
dry O
mucosa O
. O
V O
. O
cholerae O
was O
seen O
in O
dark O
field O
microscopy O
of O
a O
fresh O
stool O
specimen O
. O
The O
lab O
study O
is O
as O
bellow O
Sodium O
137 O
meq O
L O
Potassium O
2 O
meq O
L O
Chloride O
94meq O
L O
CO2 O
15 O
meq O
L O
Fecal O
leukocytes O
None O
seen O
Fecal O
occult O
blood O
Negative 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 B-SYMPTOM
loss I-SYMPTOM
and O
persistent B-SYMPTOM
dry I-SYMPTOM
cough I-SYMPTOM
4 O
months O
ago O
. O
Chest O
computed O
topography O
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 O
biopsy O
revealed O
necrotic B-SYMPTOM
granulomas I-SYMPTOM
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
17 O
year O
old O
boy O
complaining O
of O
severe O
migratory B-SYMPTOM
pain I-SYMPTOM
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 B-SYMPTOM
is O
accompanied O
by O
nausea B-SYMPTOM
and O
vomiting B-SYMPTOM
. O
He O
was O
febrile B-SYMPTOM
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 O
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 O
laparoscopy O
revealed O
phlegmon O
with O
no O
other O
abdominal B-SYMPTOM
abnormalities I-SYMPTOM
. O
He O
is O
now O
a O
candidate O
for O
emergent O
laparoscopic O
appendectomy O
under O
general O
anesthesia O
. O

A O
17 O
year O
old O
boy O
complains O
of O
vomiting B-SYMPTOM
, O
non B-SYMPTOM
bloody I-SYMPTOM
diarrhea I-SYMPTOM
, O
abdominal B-SYMPTOM
pain I-SYMPTOM
, O
fever B-SYMPTOM
, O
chills B-SYMPTOM
and O
loss B-SYMPTOM
of I-SYMPTOM
appetite I-SYMPTOM
for O
the O
past O
3 O
days O
. O
He O
ate O
a O
salad O
at O
a O
restaurant O
prior O
to O
his O
diarrhea B-SYMPTOM
onset O
. O
Physical O
exam O
was O
remarkable O
for O
pallor O
, O
jaundice O
, O
and O
diffuse O
abdominal O
tenderness O
. O
Lab O
results O
were O
as O
follows O
Hemoglobin O
9 O
. O
7 O
g O
dL O
Platelet O
110 O
, O
000 O
cu O
. O
mm O
Creatinine O
3 O
. O
6 O
mg O
dL O
blood O
urea O
nitrogen O
BUN O
73 O
mg O
dL O
direct O
bilirubin O
2 O
. O
4 O
mg O
dL O
lactate O
dehydrogenase O
LDH O
881 O
IU O
L O
normal O
110 O
265 O
IU O
L O
Peripheral O
blood O
smear O
showed O
a O
moderate O
number O
of O
schistocytes O
and O
helmet O
cells O
. O
Shiga O
like O
toxin O
producing O
E O
. O
coli O
STEC O
stx1 O
stx2 O
were O
found O
in O
stools O
. O
He O
has O
no O
other O
underlying O
disease O
and O
he O
is O
not O
on O
any O
medications 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 B-SYMPTOM
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 O
and O
she O
is O
otherwise O
healthy O
. O

The O
patient O
is O
a O
15 O
year O
old O
girl O
with O
the O
history O
of O
recurrent O
bilateral B-SYMPTOM
headache I-SYMPTOM
. O
The O
attacks O
come O
2 O
times O
or O
more O
per O
week O
and O
each O
episode O
lasts O
around O
a O
day O
or O
a O
half O
. O
The O
pain B-SYMPTOM
is O
pulsating O
in O
quality O
and O
severe O
in O
intensity O
, O
causing O
trouble O
in O
her O
routine O
physical O
activity O
. O
The O
attacks O
are O
associated O
with O
nausea B-SYMPTOM
and O
photophobia O
. O
She O
recently O
noticed O
that O
that O
there O
are O
more O
attacks O
around O
her O
menstrual O
period O
. O
She O
is O
diagnosed O
with O
the O
migraine B-SYMPTOM
headache I-SYMPTOM
and O
is O
under O
treatment O
. O
She O
is O
a O
high O
school O
student O
and O
living O
with O
her O
both O
parents O
. O
She O
is O
a O
book O
worm O
and O
spend O
her O
free O
time O
in O
a O
public O
library O
near O
her O
home O
. O
She O
is O
also O
interested O
in O
writing O
stories O
and O
has O
several O
short O
stories O
in O
English O
. O
She O
rarely O
does O
exercise O
. O
Her O
BMI O
is O
21 O
with O
the O
BP O
of O
100 O
60 O
. O
There O
is O
nothing O
remarkable O
in O
her O
physical O
exam 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 B-SYMPTOM
sided I-SYMPTOM
vision I-SYMPTOM
lost O
and O
facial B-SYMPTOM
weakness I-SYMPTOM
, O
dysarthria O
and O
numbness B-SYMPTOM
lasting O
for O
1 O
day O
. O
She O
visited O
her O
PCP O
and O
underwent O
brain O
MRI O
which O
revealed O
a O
single O
plaque B-SYMPTOM
in O
the O
brainstem O
. O
After O
few O
months O
, O
she O
experienced O
lower B-SYMPTOM
extremities I-SYMPTOM
weakness I-SYMPTOM
led O
to O
balance O
problem O
. O
The O
second O
MRI O
revealed O
another O
lesion B-SYMPTOM
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 O
section O
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

The O
patient O
is O
a O
60 O
year O
old O
man O
complaining O
of O
frequent O
headaches B-SYMPTOM
, O
generalized O
bone B-SYMPTOM
pain I-SYMPTOM
and O
difficulty B-SYMPTOM
chewing I-SYMPTOM
that O
started O
6 O
years O
ago O
and O
is O
worsening O
. O
Examination O
shows O
bilateral B-SYMPTOM
swellings I-SYMPTOM
around O
the O
molars O
. O
The O
swellings B-SYMPTOM
have O
increased O
since O
his O
last O
examination O
. O
Several O
extraoral B-SYMPTOM
lesions I-SYMPTOM
are O
detected O
in O
the O
head O
and O
face O
. O
The O
swellings B-SYMPTOM
are O
non O
tender O
and O
attached O
to O
the O
underlying O
bone O
. O
Further O
evaluation O
shows O
increased O
uptake O
of O
radioactive O
substance O
as O
well O
as O
an O
increase O
in O
urinary O
pyridinoline O
. O
His O
serum O
alkaline O
phosphatase O
is O
300 O
IU O
L O
the O
normal O
range O
is O
44 O
147 O
IU O
L O
. O
His O
family O
history O
is O
only O
significant O
for O
hypertension O
in O
his O
mother O
and O
DM O
type O
2 O
in O
his O
father O
. O
The O
diagnosis O
of O
Paget O
's O
Disease O
of O
Bone O
was O
confirmed O
and O
Bisphosphonate O
will O
be O
started O
as O
first O
line O
therapy O
. O

19 O
yo O
Hispanic O
female O
G1P1 O
at O
32 O
6 O
weeks O
of O
gestational O
age O
presented O
to O
the O
OB O
clinic O
for O
routine O
follow O
up O
complaining O
of O
mild B-SYMPTOM
headache I-SYMPTOM
and O
leg B-SYMPTOM
swelling I-SYMPTOM
. O
Primary O
evaluation O
revealed O
BP O
of O
146 O
99 O
and O
urine O
dipstick O
with O
3 O
proteins O
. O
Her O
BP O
and O
U O
A O
were O
normal O
in O
previous O
visit O
. O
Repeat O
BP O
a O
few O
hours O
later O
is O
150 O
100 O
mmHg O
. O
Laboratory O
studies O
showed O
a O
normal O
hematocrit O
, O
platelet O
count O
, O
and O
liver O
transaminase O
levels O
. O
She O
is O
complaining O
of O
fatigue B-SYMPTOM
but O
no O
fever B-SYMPTOM
or O
chills B-SYMPTOM
. O
She O
is O
also O
suffering O
of O
headaches B-SYMPTOM
with O
no O
vision B-SYMPTOM
changes I-SYMPTOM
. O
No O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
cough B-SYMPTOM
, O
chest B-SYMPTOM
pain I-SYMPTOM
, O
orthopnea O
and O
palpitations B-SYMPTOM
or O
skin B-SYMPTOM
rash I-SYMPTOM
were O
observed O
. O
Her O
physical O
exam O
was O
negative O
for O
abdominal B-SYMPTOM
pain I-SYMPTOM
, O
change B-SYMPTOM
in I-SYMPTOM
bowel I-SYMPTOM
habits I-SYMPTOM
, O
nausea B-SYMPTOM
, O
vomiting B-SYMPTOM
, O
dysuria B-SYMPTOM
, O
frequency B-SYMPTOM
, O
hematuria B-SYMPTOM
or O
frothy B-SYMPTOM
urine I-SYMPTOM
. O
Leg B-SYMPTOM
swelling I-SYMPTOM
was O
observed O
with O
no O
arthralgia O
or O
back B-SYMPTOM
pain I-SYMPTOM
. O
She O
has O
no O
specific O
past O
medical O
issues O
and O
only O
uses O
prenatal B-SYMPTOM
vitamins I-SYMPTOM
. O
Her O
family O
history O
is O
positive O
for O
DM O
type O
2 O
and O
HTN O
. O
She O
is O
a O
social O
alcohol O
consumer O
with O
the O
negative O
history O
of O
smoking O
or O
drug O
use O
. O
She O
is O
only O
have O
one O
partner O
in O
past O
2 O
years O
and O
didn O
' O
t O
have O
any O
contraceptive O
methods O
since O
2 O
years O
ago O
. O
Her O
BMI O
was O
24 O
at O
the O
first O
visit O
when O
she O
was O
at O
6 O
weeks O
of O
gestational O
age O
. O
She O
is O
getting O
weight O
normally O
during O
her O
pregnancies O
. O


The O
patient O
is O
a O
34 O
year O
old O
African O
American O
man O
with O
the O
known O
history O
of O
Sickle O
cell O
disease O
comes O
to O
the O
clinic O
with O
severe O
bone O
pain O
. O
The O
patient O
had O
severe O
pain O
in O
his O
lower O
back O
that O
radiated O
to O
both O
thighs O
scored O
9 O
out O
of O
10 O
. O
The O
patient O
has O
had O
positive O
history O
of O
sickle O
cell O
crises O
since O
childhood O
. O
He O
also O
had O
the O
same O
symptoms O
in O
past O
two O
weeks O
treated O
with O
oxycodone O
which O
was O
not O
beneficial O
to O
his O
pain B-SYMPTOM
. O
His O
PCP O
sent O
him O
to O
the O
emergency O
department O
to O
receive O
intra O
venous O
pain O
modulators O
. O
The O
patient O
is O
afebrile B-SYMPTOM
within O
the O
normal O
blood O
pressure O
. O
No O
splenomegaly O
was O
detected O
in O
the O
physical O
exam O
. O
He O
has O
no O
positive O
history O
of O
drug O
allergy O
. O
He O
won O
' O
t O
smoke O
or O
uses O
any O
illicit O
drugs O
. O
The O
lab O
study O
is O
as O
bellow O
Hgb O
8 O
g O
dl O
WBC O
10000 O
mm3 O
Plt O
300000 O
ml O
MCV O
106 O
fL O
Hemoglobine O
electrophoresis O
91 O
HbS O
6 O
HbF O
3 O
HbA2 O
AST O
22 O
U O
L O
ALT O
43 O
U O
L O
Alk O
P O
53 O
U O
L O
Ferritin O
1200 O
ng O
ml O

Fernandez O
is O
a O
41 O
year O
man O
who O
is O
a O
professional O
soccer O
player O
. O
He O
came O
to O
the O
clinic O
with O
itchy B-SYMPTOM
foot I-SYMPTOM
. O
Physical O
exam O
revealed O
localized O
scaling O
and O
maceration O
between O
the O
third O
and O
fourth O
of O
his O
right O
toe O
. O
It O
became O
inflamed B-SYMPTOM
and O
sore B-SYMPTOM
, O
with O
mild B-SYMPTOM
fissuring I-SYMPTOM
. O
The O
dorsum O
and O
sole O
of O
the O
foot O
was O
unaffected O
. O
There O
is O
no O
pus O
or O
tearing O
in O
the O
affected O
area O
. O
He O
didn O
' O
t O
use O
ant O
topical O
ointment O
on O
the O
lesion B-SYMPTOM
and O
has O
no O
positive O
history O
for O
any O
underlying O
disease O
such O
as O
DM O
. O
He O
smokes O
15 O
cigarettes O
per O
day O
and O
drinks O
a O
beer O
per O
day O
. O
His O
family O
history O
is O
positive O
for O
hyperlipidemia O
in O
her O
mother O
and O
MI O
in O
her O
father O
. O
He O
is O
in O
relation O
with O
several O
partners O
and O
use O
condom O
during O
the O
intercourse O
. O
His O
physical O
exam O
and O
lab O
studies O
were O
normal O
otherwise O
. O
Tinea O
pedis O
infection O
confirmed O
as O
his O
diagnosis O
by O
the O
observation O
of O
segmented O
fungal O
hyphae O
during O
a O
microscopic O
KOH O
wet O
mount O
examination O
. O

A O
5 O
months O
old O
male O
brought O
to O
the O
pediatrics O
surgery O
clinic O
with O
the O
complaint O
of O
empty B-SYMPTOM
scrotum I-SYMPTOM
at O
the O
right O
side O
. O
The O
baby O
boy O
is O
a O
first O
child O
who O
was O
born O
at O
the O
age O
of O
38 O
weeks O
with O
NVD O
from O
a O
healthy O
mother O
. O
The O
mother O
had O
a O
normal O
pregnancy O
with O
no O
complication O
. O
The O
baby O
boy O
weighted O
3200 O
gr O
with O
the O
height O
of O
50 O
cm O
. O
He O
is O
breast O
feeding O
and O
now O
weighted O
as O
6 O
. O
5 O
kg O
with O
the O
height O
of O
62 O
cm O
. O
He O
has O
no O
developmental B-SYMPTOM
delay I-SYMPTOM
in O
the O
physical O
assessment O
. O
There O
is O
a O
palpable O
testis O
is O
the O
left O
scrotum O
with O
non O
palpable O
testis O
in O
the O
right O
scrotum O
. O
The O
penis O
is O
normal O
in O
shape O
and O
size O
and O
he O
is O
not O
circumcised O
. O
The O
diagnostic O
laparoscopy O
showed O
an O
abdominal O
undescended O
testis O
. O

The O
patients O
is O
a O
25 O
year O
old O
G1 O
P1 O
pregnant O
woman O
who O
is O
24W3D O
gestational O
old O
who O
developed O
a O
sudden O
unset O
of O
fever B-SYMPTOM
and O
chills B-SYMPTOM
, O
accompany O
with O
nausea B-SYMPTOM
and O
vomiting B-SYMPTOM
. O
She O
also O
complains O
of O
dysuria B-SYMPTOM
, O
urgency O
and O
frequency O
. O
She O
also O
reports O
some O
severe O
pain B-SYMPTOM
in O
the O
flank O
. O
Her O
vital O
signs O
are O
T O
39 O
. O
7ºC O
, O
P O
117 O
, O
R O
20 O
, O
and O
BP O
113 O
74 O
mm O
Hg O
. O
Physical O
examination O
reveals O
tenderness B-SYMPTOM
on O
palpation O
of O
both O
costovertebral O
angles O
. O
She O
has O
no O
history O
of O
recurrent O
UTI O
prior O
to O
her O
pregnancy O
or O
any O
other O
underlying O
disease O
. O
The O
urine O
culture O
showed O
Gram O
negative O
rod O
shaped O
bacterial O
cells O
, O
leukocytes O
, O
and O
leukocyte O
casts O
. O
The O
blood O
culture O
is O
negative O
. O
A O
CBC O
shows O
Hb O
12 O
. O
9 O
g O
dL O
, O
Hct O
39 O
, O
MCV O
76 O
fL O
, O
WBC O
count O
14 O
, O
120 O
µL O
. O

Patient O
is O
a O
34 O
year O
old O
woman O
from O
Jordan O
who O
comes O
to O
clinic O
with O
some O
general O
and O
non O
specific O
bones B-SYMPTOM
and I-SYMPTOM
joints I-SYMPTOM
pain I-SYMPTOM
. O
She O
is O
married O
and O
has O
3 O
children O
. O
Her O
past O
medical O
and O
drug O
history O
are O
unremarkable O
. O
Her O
BMI O
is O
23 O
, O
BP O
120 O
75 O
, O
HR O
75 O
min O
. O
Her O
laboratory O
study O
is O
remarkable O
for O
Vit O
D O
14ng O
ml O
and O
otherwise O
healthy O
. O
Ca O
9 O
. O
2mg O
dl O
, O
Phosphorus O
3 O
. O
2mg O
dl O
, O
PTH O
28pg O
ml 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 O
exam O
. 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 B-SYMPTOM
serum I-SYMPTOM
caeruloplasmin I-SYMPTOM
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
41 O
year O
old O
obese O
woman O
coming O
to O
the O
emergency O
room O
with O
abdominal B-SYMPTOM
pain I-SYMPTOM
and O
vomiting B-SYMPTOM
. O
The O
pain B-SYMPTOM
that O
started O
gradually O
yesterday O
is O
located O
in O
the O
epigastric O
and O
periumbilical O
regions O
, O
radiating O
to O
her O
back O
. O
She O
drinks O
alcohol O
frequently O
and O
does O
not O
smoke O
. O
She O
has O
no O
history O
of O
allergies O
and O
uses O
only O
multivitamins O
daily O
. O
Her O
family O
history O
is O
positive O
for O
hypertension O
her O
mother O
. O
She O
lives O
with O
her O
husband O
and O
has O
3 O
children O
. O
The O
abdomen O
is O
tender O
and O
soft O
. O
Her O
bowel O
sounds O
are O
normal O
. O
Her O
heart O
rate O
is O
115 O
min O
and O
blood O
pressure O
110 O
75 O
mmHg O
. O
The O
lab O
studies O
are O
remarkable O
for O
leukocytosis O
19 O
. O
5 O
, O
urea O
of O
8 O
. O
5 O
, O
high O
CRP O
145 O
, O
high O
amylase O
1200 O
and O
Glucose O
level O
of O
15 O
. O
Her O
abdominal O
CT O
scan O
revealed O
acute O
edematous O
interstitial O
pancreatitis O
with O
enlarged O
common O
bile O
duct O
and O
intrahepatic O
duct O
confirming O
gall O
stone O
pancreatitis O
. O
Her O
pregnancy O
test O
is O
negative O
and O
she O
is O
not O
breastfeeding 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 B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
, O
chest B-SYMPTOM
tightening I-SYMPTOM
and O
cough B-SYMPTOM
. 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 O
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



A O
46 O
year O
old O
man O
presents O
with O
dizziness B-SYMPTOM
and O
frequent O
headaches B-SYMPTOM
. 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 B-SYMPTOM
blood I-SYMPTOM
pressure I-SYMPTOM
, 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 O
auscultation O
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 O
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 B-SYMPTOM
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

A O
54 O
year O
old O
obese O
woman O
admitted O
to O
the O
emergency O
department O
with O
abdominal B-SYMPTOM
pain I-SYMPTOM
that O
started O
4 O
days O
ago O
with O
nausea B-SYMPTOM
and O
vomiting B-SYMPTOM
. O
The O
epigastric B-SYMPTOM
pain I-SYMPTOM
radiates O
to O
the O
right O
upper O
quadrant O
, O
getting O
worse O
after O
eating O
fatty O
food O
. O
The O
patient O
experienced O
similar O
pain B-SYMPTOM
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
2 O
NVDs B-SYMPTOM
. O
She O
has O
2 O
children O
, O
and O
she O
is O
menopausal B-SYMPTOM
. O
She O
does O
not 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 B-SYMPTOM
. 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
She O
is O
an O
obese O
woman O
with O
no O
acute O
distress B-SYMPTOM
. O
On O
palpation O
, O
she O
experiences O
epigastric B-SYMPTOM
tenderness I-SYMPTOM
and O
tenderness B-SYMPTOM
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 B-SYMPTOM
ESR I-SYMPTOM
and O
leukocytosis O
with O
a O
left O
shift O
. O
The O
ultrasound O
revealed O
several O
gallstones B-SYMPTOM
, O
biliary B-SYMPTOM
sludge I-SYMPTOM
and O
CBD B-SYMPTOM
stones I-SYMPTOM
. O
The O
smallest O
stone O
is O
14mm 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 O
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 B-SYMPTOM
from I-SYMPTOM
esophageal I-SYMPTOM
varices I-SYMPTOM
, 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 B-SYMPTOM
. 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 O
analysis O
7 O
years O
ago O
. O
He O
presents O
to O
the O
clinic O
with O
shortness B-SYMPTOM
of I-SYMPTOM
breath I-SYMPTOM
and O
fatigue B-SYMPTOM
during O
activities O
. O
He O
claims O
mild O
dyspnea B-SYMPTOM
after O
climbing O
3 O
floors O
, O
no O
dyspnea B-SYMPTOM
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
16 O
year O
old O
girl O
came O
to O
the O
clinic O
complaining O
of O
weight B-SYMPTOM
gain I-SYMPTOM
and O
abnormal B-SYMPTOM
menstrual I-SYMPTOM
cycles I-SYMPTOM
. O
Her O
BMI O
was O
24 O
, O
but O
she O
has O
gained O
5 O
kg O
in O
the O
past O
few O
weeks O
. O
She O
gets O
tired O
more O
frequently O
and O
does O
not O
have O
energy O
to O
go O
dancing O
with O
her O
friends O
. O
Her O
lab O
results O
were O
remarkable O
for O
high B-SYMPTOM
TSH I-SYMPTOM
levels I-SYMPTOM
15 O
mU O
L O
and O
low B-SYMPTOM
free I-SYMPTOM
T4 I-SYMPTOM
levels I-SYMPTOM
0 O
. O
18 O
ng O
dl O
. O
Her O
anti O
TPO O
levels O
were O
extremely O
high O
136 O
IU O
ml O
. O
She O
was O
diagnosed O
with O
Hashimoto O
disease O
. O
She O
does O
not O
smoke O
and O
she O
is O
not O
sexually O
active O
. O

A O
Pap O
smear O
in O
a O
54 O
year O
old O
woman O
revealed O
abnormal B-SYMPTOM
cervical I-SYMPTOM
squamous I-SYMPTOM
intraepithelial I-SYMPTOM
glandular B-SYMPTOM
lesion I-SYMPTOM
. 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 B-SYMPTOM
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 O
. 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 B-SYMPTOM
blood I-SYMPTOM
pressure I-SYMPTOM
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 O
. 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 B-SYMPTOM
lactate I-SYMPTOM
dehydrogenase I-SYMPTOM
and O
reduced B-SYMPTOM
human I-SYMPTOM
complement I-SYMPTOM
C3 I-SYMPTOM
levels I-SYMPTOM
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
67 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
at O
a O
rehab O
center O
and O
has O
no O
underlying O
disease O
. O
It O
is O
her O
first O
vaccination O
this O
year O
. O
she O
is O
menopausal B-SYMPTOM
and O
has O
4 O
children O
. O
She O
does O
not O
some O
. O
She O
takes O
daily O
multivitamins O
and O
anti O
hypertensive O
drugs 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
allergies O
to O
any O
food O
or O
drugs 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 B-SYMPTOM
and O
loss B-SYMPTOM
of I-SYMPTOM
interest I-SYMPTOM
in O
daily O
activities O
. O
She O
states O
that O
her O
mood O
is O
still O
depressed B-SYMPTOM
most O
of O
the O
days O
. O
She O
complains O
of O
loss B-SYMPTOM
of I-SYMPTOM
energy I-SYMPTOM
and O
feelings B-SYMPTOM
of I-SYMPTOM
worthlessness I-SYMPTOM
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 B-SYMPTOM
issues I-SYMPTOM
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal B-SYMPTOM
. 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 O
. 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
16 O
year O
old O
girl O
recently O
diagnosed O
with O
myasthenia O
gravis O
, O
class O
IIa O
. O
She O
complains O
of O
diplopia O
and O
weakness B-SYMPTOM
affecting O
in O
her O
upper O
extremities O
. O
She O
had O
a O
positive O
anti O
AChR O
antibody O
test O
, O
and O
her O
single O
fiber O
electromyography O
SFEMG O
was O
positive O
. O
She O
is O
on O
acetylcholinesterase O
inhibitor O
treatment O
combined O
with O
immunosuppressants O
. O
But O
she O
still O
has O
some O
symptoms O
. O
She O
does O
not O
smoke O
or O
use O
illicit O
drugs O
. O
She O
is O
not O
sexually O
active O
, O
and O
her O
menses O
are O
regular O
. O
Her O
physical O
exam O
and O
lab O
studies O
are 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

The O
patient O
is O
a O
53 O
year O
old O
man O
complaining O
of O
frequent O
headaches B-SYMPTOM
, O
generalized O
bone B-SYMPTOM
pain I-SYMPTOM
and O
difficulty B-SYMPTOM
chewing I-SYMPTOM
that O
started O
6 O
years O
ago O
and O
is O
getting O
worse O
. O
Examination O
shows O
bilateral B-SYMPTOM
swellings I-SYMPTOM
around O
the O
molars O
. O
The O
swellings B-SYMPTOM
have O
increased O
since O
his O
last O
examination O
. O
Several O
extraoral B-SYMPTOM
lesions I-SYMPTOM
of O
the O
head O
and O
face O
are O
detected O
. O
The O
swellings B-SYMPTOM
are O
non O
tender O
and O
attached O
to O
the O
underlying O
bone O
. O
Further O
evaluation O
shows O
increased O
uptake O
of O
radioactive O
substance O
as O
well O
as O
an O
increase O
in O
urinary O
pyridinoline O
. O
The O
serum O
alkaline O
phosphatase O
is O
300 O
IU O
L O
the O
normal O
range O
is O
44 O
147 O
IU O
L O
. O
The O
patient O
's O
sister O
had O
the O
same O
problems O
. O
She O
was O
diagnosed O
with O
Paget O
's O
disease O
of O
bone O
when O
she O
was O
52 O
years O
old O
. O
The O
diagnosis O
of O
Paget O
's O
Disease O
of O
Bone O
is O
confirmed O
and O
Bisphosphonate O
will O
be O
started O
as O
first O
line O
therapy O
. O


The O
patient O
is O
a O
55 O
year O
old O
man O
who O
was O
recently O
diagnosed O
with O
Parkinson O
's O
disease O
. O
He O
is O
complaining O
of O
slowness B-SYMPTOM
of O
movement O
and O
tremors O
. O
His O
disease O
is O
ranked O
as O
mild O
, O
Hoehn O
Yahr O
Stage O
I O
. O
His O
past O
medical O
history O
is O
significant O
for O
hypertension O
and O
hypercholesterolemia O
. O
He O
lives O
with O
his O
wife O
. O
They O
have O
three O
children O
. O
He O
used O
to O
be O
active O
with O
gardening O
before O
his O
diagnosis O
. O
He O
complains O
of O
shaking B-SYMPTOM
and O
slow B-SYMPTOM
movement I-SYMPTOM
. O
He O
had O
difficulty O
entering O
through O
a O
door O
, O
as O
he O
was O
frozen O
and O
needed O
guidance O
to O
step O
in O
. O
His O
handwriting O
is O
getting O
smaller O
. O
He O
is O
offered O
Levodopa O
and O
Trihexyphenidyl O
. O
He O
is O
an O
alert O
and O
cooperative O
man O
who O
does O
not O
have O
any O
signs O
of O
dementia O
. O
He O
does O
not O
smoke O
or O
use O
any O
illicit O
drugs O
. O