20867 lines (20611 with data), 157.3 kB

The O
patient O
has O
a O
definitive O
diagnosis O
of O
COPD O
with O
an O
FEV1 O
Forced O
Expiratory O
Volume O
in O
1 O
second O
of O
85 O
. O
The O
patient O
is O
classified O
as O
GOLD O
stage O
III O
. O
They O
have O
experienced O
three O
exacerbations O
in O
the O
past O
year O
. O
The O
prescribed O
COPD O
treatments O
include O
bronchodilators B-MEDICATION
and O
steroids B-MEDICATION
. O
The O
patient O
had O
a O
smoking O
history O
of O
5 O
cigarettes O
per O
day O
until O
quitting O
two O
years O
ago O
. O
They O
also O
have O
a O
history O
of O
interstitial O
lung O
disease O
as O
a O
lung O
comorbidity O
, O
and O
hypertension O
as O
another O
comorbidity O
. O


The O
patient O
, O
diagnosed O
with O
COPD O
, O
has O
a O
definitive O
diagnosis O
and O
is O
in O
Stage O
IV O
according O
to O
the O
GOLD O
classification O
. O
Their O
FEV1 O
is O
measured O
at O
65 O
, O
indicating O
impaired O
lung O
function O
. O
Over O
the O
past O
12 O
months O
, O
they O
have O
experienced O
8 O
exacerbations O
of O
their O
COPD O
. O
The O
patient O
is O
undergoing O
treatment O
, O
including O
using O
EVB B-MEDICATION
and O
participating O
in O
pulmonary B-MEDICATION
rehabilitation I-MEDICATION
. O
They O
have O
a O
history O
of O
heavy O
smoking O
, O
with O
a O
daily O
consumption O
of O
2 O
packs O
of O
cigarettes O
. O
Alongside O
COPD O
, O
the O
patient O
has O
been O
diagnosed O
with O
lung O
cancer O
, O
making O
it O
a O
comorbid O
condition O
. O
No O
other O
comorbidities O
are O
reported O
in O
the O
medical O
history O
. O

Patient O
has O
a O
confirmed O
diagnosis O
of O
Chronic O
Obstructive O
Pulmonary O
Disease O
COPD O
characterized O
by O
an O
FEV1 O
of O
72 O
, O
placing O
him O
in O
GOLD O
stage O
II O
. O
Notably O
, O
he O
experienced O
his O
first O
exacerbation O
two O
weeks O
ago O
. O
Current O
COPD O
treatments O
include O
the O
administration O
of O
steroids B-MEDICATION
. O
Notably O
, O
he O
has O
no O
history O
of O
smoking O
and O
does O
not O
report O
any O
lung O
related O
comorbidities O
. O
However O
, O
he O
does O
have O
a O
history O
of O
glaucoma O
as O
an O
additional O
comorbidity O
. O


The O
patient O
, O
diagnosed O
with O
breast O
cancer O
, O
has O
undergone O
a O
definitive O
diagnosis O
. O
HER2 O
status O
is O
positive O
, O
while O
information O
about O
hormone O
receptors O
is O
not O
specified O
. O
The O
patient O
has O
not O
received O
prior O
chemotherapy B-MEDICATION
or O
radiotherapy B-MEDICATION
. O
No O
prior O
mastectomy O
has O
been O
performed O
The O
patient O
's O
performance O
status O
is O
ECOG O
1 O
. O

The O
patient O
's O
definitive O
diagnosis O
is O
stage O
III O
breast O
cancer O
. O
HER2 O
status O
is O
negative O
, O
while O
hormone O
receptor O
status O
is O
ER O
and O
PR O
. O
The O
patient O
has O
undergone O
neoadjuvant B-MEDICATION
chemotherapy I-MEDICATION
and O
prior O
stereotactic B-MEDICATION
radiotherapy I-MEDICATION
. O
A O
prior O
mastectomy O
has O
been O
performed O
. O
Surgery O
related O
therapy O
included O
neoadjuvant B-MEDICATION
chemotherapy I-MEDICATION
. O
The O
patient O
's O
performance O
status O
is O
ECOG O
2 O
. O

The O
patient O
's O
breast O
cancer O
is O
at O
stage O
2 O
. O
The O
HER2 O
status O
is O
positive O
, O
while O
hormone O
receptors O
PR O
and O
ER O
are O
negative O
. O
The O
patient O
hasn O
' O
t O
undergone O
prior O
chemotherapy B-MEDICATION
, O
but O
has O
received O
prior O
radiotherapy B-MEDICATION
. O
Mastectomy O
has O
not O
been O
performed O
previously O
. O
The O
patient O
's O
performance O
status O
is O
Karnofsky O
70 O
. O

The O
patient O
has O
been O
diagnosed O
with O
stage O
IV O
breast O
cancer O
. O
The O
cancer O
is O
HER2 O
positive O
and O
hormone O
receptor O
positive O
for O
PR O
. O
The O
patient O
has O
undergone O
prior O
chemotherapy B-MEDICATION
and O
radiotherapy B-MEDICATION
treatments O
. O
A O
mastectomy O
has O
also O
been O
performed O
previously O
. O
The O
treatment O
approach O
included O
neoadjuvant B-MEDICATION
chemotherapy I-MEDICATION
in O
relation O
to O
surgery O
. O
The O
patient O
's O
performance O
status O
is O
ECOG O
3 O
, O
with O
a O
Karnofsky O
score O
of O
50 O
. O

The O
patient O
has O
received O
a O
definitive O
diagnosis O
of O
breast O
cancer O
. O
Key O
details O
include O
a O
negative O
HER2 O
status O
and O
hormone O
receptor O
information O
. O
The O
patient O
has O
not O
undergone O
prior O
chemotherapy B-MEDICATION
, O
radiotherapy B-MEDICATION
, O
or O
mastectomy B-MEDICATION
. O
Their O
performance O
status O
is O
ECOG O
1 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 O
, O
headache O
, O
and O
body O
pains O
. 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 B-MEDICATION
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 O
and O
muscle O
pain O
. 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 B-MEDICATION
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
has O
been O
diagnosed O
definitively O
with O
rheumatoid O
arthritis O
and O
is O
undergoing O
active O
treatment O
with O
methotrexate B-MEDICATION
, O
with O
no O
prior O
DMARD B-MEDICATION
treatment I-MEDICATION
. O
They O
are O
also O
taking O
ibuprofen B-MEDICATION
for O
their O
condition O
. O
The O
patient O
has O
3 O
swollen B-MEDICATION
joints I-MEDICATION
and O
does O
not O
have O
tuberculosis O
. O
Comorbidities O
include O
hypertension 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 B-MEDICATION
treatment I-MEDICATION
, O
but O
there O
was O
prior O
treatment B-MEDICATION
with I-MEDICATION
hydroxychloroquine I-MEDICATION
. O
Prednisone B-MEDICATION
is O
being O
used O
along O
with O
other O
RA B-MEDICATION
medications I-MEDICATION
. O
The O
patient O
has O
3 O
swollen O
and O
2 O
tender O
joints O
. 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 B-MEDICATION
TNF I-MEDICATION
therapy I-MEDICATION
as O
their O
DMARD B-MEDICATION
treatment I-MEDICATION
. O
Prior O
to O
this O
, O
they O
were O
treated O
with O
methotrexate B-MEDICATION
. O
Naproxen B-MEDICATION
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 O
joints O
and O
2 O
tender O
joints O
. 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 B-MEDICATION
with I-MEDICATION
hydroxychloroquine I-MEDICATION
, O
without O
prior O
DMARD B-MEDICATION
treatment I-MEDICATION
. O
Additionally O
, O
the O
patient O
is O
taking O
ibuprofen B-MEDICATION
for O
their O
condition O
. O
They O
are O
experiencing O
symptoms O
in O
6 O
tender O
joints O
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

Patient O
has O
a O
definitive O
diagnosis O
of O
rheumatoid O
arthritis O
. O
They O
are O
undergoing O
active O
anti B-MEDICATION
TNF I-MEDICATION
therapy I-MEDICATION
as O
their O
DMARD B-MEDICATION
treatment I-MEDICATION
, O
with O
no O
prior O
DMARD B-MEDICATION
treatment I-MEDICATION
or O
other O
RA B-MEDICATION
medications I-MEDICATION
. O
The O
patient O
does O
not O
have O
tuberculosis O
and O
reports O
no O
comorbidities O
. O






The O
patient O
, O
diagnosed O
with O
type O
2 O
diabetes O
, O
has O
a O
confirmed O
diagnosis O
with O
a O
definitive O
assessment O
. O
Their O
HbA1c O
level O
stands O
at O
7 O
. O
2 O
, O
indicating O
their O
blood O
glucose O
control O
over O
recent O
months O
. O
Fasting O
glucose O
measures O
138 O
, O
while O
their O
BMI O
is O
45 O
, O
signifying O
their O
body O
mass O
index O
. O
The O
patient O
is O
not O
on O
insulin B-MEDICATION
therapy I-MEDICATION
nor O
taking O
metformin B-MEDICATION
or O
other O
anti B-MEDICATION
diabetic I-MEDICATION
drugs I-MEDICATION
. O
There O
are O
no O
specific O
diet O
restrictions O
in O
place O
. O
Limited O
exercise O
is O
possible O
due O
to O
being O
confined O
to O
a O
wheelchair O
. O
There O
is O
no O
history O
of O
ketoacidosis O
. O
The O
patient O
has O
comorbidities O
including O
lung O
cancer O
, O
hypertension O
, O
and O
dementia O
. O
Recent O
medical O
events O
include O
a O
myocardial O
infarction O
six O
months O
ago O
. O

The O
individual O
under O
consideration O
exhibits O
characteristics O
indicative O
of O
type O
2 O
diabetes O
. O
The O
diagnosis O
is O
definitive O
, O
with O
a O
recorded O
HbA1c O
level O
of O
4 O
. O
5 O
and O
a O
glucose O
level O
of O
95 O
. O
The O
patient O
's O
BMI O
is O
28 O
, O
and O
they O
do O
not O
require O
insulin B-MEDICATION
treatment O
. O
Instead O
, O
they O
are O
prescribed O
5 O
ml O
of O
metformin B-MEDICATION
and O
a O
thiazolidinedione B-MEDICATION
as O
other O
anti B-MEDICATION
diabetic I-MEDICATION
medications O
. O
The O
patient O
adheres O
to O
a O
low O
calorie O
diet O
and O
engages O
in O
a O
weekly O
regimen O
of O
walking O
2 O
miles O
. O
A O
history O
of O
ketoacidosis O
is O
present O
, O
along O
with O
comorbidities O
encompassing O
hypertension O
and O
a O
thyroid O
disorder O
. O
Notably O
, O
the O
patient O
has O
not O
experienced O
any O
instances O
of O
hospitalization O
. O

The O
patient O
is O
diagnosed O
with O
type O
2 O
diabetes O
. O
The O
diagnosis O
is O
definitive O
, O
indicated O
by O
an O
HbA1c O
level O
of O
6 O
and O
fasting O
blood O
sugar O
of O
115 O
. O
The O
patient O
has O
a O
BMI O
of O
35 O
. O
Insulin B-MEDICATION
is O
being O
used O
, O
along O
with O
8 O
. O
5 O
mL O
of O
metformin B-MEDICATION
and O
a O
sulfonylurea B-MEDICATION
for O
additional O
anti B-MEDICATION
diabetic I-MEDICATION
treatment I-MEDICATION
. O
Dietary O
restrictions O
involve O
periodic O
fasting O
, O
and O
the O
patient O
engages O
in O
500 O
meters O
of O
daily O
walking O
for O
exercise O
. O
There O
is O
no O
history O
of O
ketoacidosis O
, O
and O
comorbidities O
are O
absent O
, O
except O
for O
a O
stroke O
event O
in O
the O
previous O
year O
. O

The O
patient O
, O
diagnosed O
with O
type O
2 O
diabetes O
, O
has O
received O
a O
definitive O
diagnosis O
. O
Their O
HbA1c O
level O
is O
5 O
. O
5 O
, O
with O
a O
glucose O
level O
of O
100 O
. O
The O
patient O
's O
BMI O
is O
32 O
. O
They O
are O
not O
using O
insulin B-MEDICATION
, O
but O
they O
are O
taking O
5 O
mL O
of O
metformin B-MEDICATION
. O
No O
other O
anti B-MEDICATION
diabetic I-MEDICATION
drugs I-MEDICATION
are O
being O
used O
. O
The O
patient O
follows O
a O
keto O
diet O
and O
engages O
in O
regular O
exercise O
by O
jogging O
2 O
miles O
per O
day O
. O
The O
patient O
has O
a O
history O
of O
ketoacidosis O
and O
hypertension O
. O
They O
have O
never O
been O
hospitalized O
due O
to O
their O
condition O
. O

The O
patient O
, O
diagnosed O
with O
type O
2 O
diabetes O
HbA1c O
6 O
. O
3 O
, O
fasting O
blood O
sugar O
115 O
, O
has O
a O
BMI O
of O
40 O
. O
Insulin B-MEDICATION
is O
not O
currently O
prescribed O
, O
but O
they O
are O
taking O
8 O
. O
5 O
mL O
of O
metformin B-MEDICATION
. O
No O
other O
anti B-MEDICATION
diabetic I-MEDICATION
drugs I-MEDICATION
are O
being O
used O
. O
The O
patient O
follows O
a O
low O
calorie O
diet O
and O
does O
not O
engage O
in O
regular O
exercise O
. O
There O
's O
no O
history O
of O
ketoacidosis O
, O
but O
they O
do O
have O
chronic O
kidney O
disease O
as O
a O
comorbidity O
. O
Hospitalization O
due O
to O
diabetes O
has O
not O
occurred O
. O



A O
75F O
with O
a O
PMHx O
significant O
for O
severe O
PVD O
, O
CAD O
, O
DM O
, O
and O
CKD O
presented O
after O
being O
found O
down O
unresponsive O
at O
home O
. O
She O
was O
found O
to O
be O
hypoglycemic O
to O
29 O
with O
hypotension O
and O
bradycardia O
. O
Her O
hypotension O
and O
confusion O
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA 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 O
throughout O
the O
day O
. O
She O
received O
80mg O
IV O
solumedrol B-MEDICATION
this O
morning O
in O
the O
setting O
of O
low O
BPs O
and O
rare O
eos O
in O
urine O
. O
On O
arrival O
to O
the O
MICU O
pt O
was O
awake O
but O
drowsy O
. O
On O
ROS O
, O
pt O
denies O
pain O
, O
lightheadedness O
, O
headache O
, O
neck O
pain O
, O
sore O
throat O
, O
recent O
illness O
or O
sick O
contacts O
, O
cough O
, O
shortness O
of O
breath O
, O
chest O
discomfort O
, O
heartburn O
, O
abd O
pain O
, O
n O
v O
, O
diarrhea O
, O
constipation O
, O
dysuria O
. O
Is O
a O
poor O
historian O
regarding O
how O
long O
she O
has O
had O
a O
rash O
on O
her O
legs O
. O



A O
94 O
year O
old O
female O
with O
hx O
recent O
PE O
DVT O
, O
atrial O
fibrillation O
, O
CAD O
presents O
with O
fever O
and O
abdominal O
pain O
. O
Earlier O
, O
she O
presented O
with O
back O
pain O
and O
shortness O
of O
breath O
. O
She O
was O
found O
to O
have O
bilateral O
PE O
's O
and O
new O
afib O
and O
started O
on O
coumadin B-MEDICATION
. O
Her O
HCT O
dropped O
slightly O
, O
requiring O
blood O
transfusion O
, O
with O
guaic O
positive O
stools O
. O
She O
was O
discharged O
and O
returned O
with O
abdominal O
cramping O
and O
black O
stools O
. O
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

This O
is O
a O
41 O
year O
old O
male O
patient O
with O
medical O
history O
of O
alcohol O
abuse O
, O
cholelithiasis O
, O
hypertension O
, O
obesity O
who O
presented O
to O
his O
local O
hospital O
with O
hematemasis O
. O
On O
Friday O
evening O
he O
had O
several O
episodes O
of O
vomiting O
of O
bright O
and O
dark O
red O
material O
. O
In O
the O
emergency O
department O
, O
initial O
vs O
were O
T O
98 O
. O
6 O
P66 O
BP145 O
89 O
R16 O
O2 O
sat O
98 O
RA O
. O
He O
was O
started O
on O
a O
protonix O
gtt O
and O
octreotide O
gtt O
given O
his O
elevated O
liver O
function O
tests O
. O
Lab O
tests O
show O
elevated O
lipase O
, O
pancytopenia O
and O
coagulopathy O
. O
He O
had O
a O
right O
upper O
abdominal O
quadrant O
ultrasound O
which O
demonstrated O
gallstones O
and O
sludge O
and O
ascites O
. O
As O
such O
given O
new O
ascites O
and O
abdominal O
pain O
he O
was O
given O
levofloxacin B-MEDICATION
750mg O
IV O
and O
flagyl B-MEDICATION
500mg O
IV O
reportedly O
for O
spontaneous O
bacterial O
peritonitis O
prophylaxis O
. O
On O
the O
floor O
, O
he O
reports O
that O
he O
had O
two O
episodes O
of O
vomiting O
of O
dark O
red O
emesis O
. O
Per O
his O
nurse O
it O
was O
about O
75ml O
and O
was O
gastrocult O
positive O
. O
He O
has O
right O
upper O
abdominal O
quadrant O
pain O
radiating O
to O
his O
back O
. O
He O
also O
reports O
slow O
increase O
in O
abdominal O
girth O
with O
more O
acute O
distention O
and O
lower O
extremity O
swelling O
over O
the O
two O
days O
prior O
to O
admission O
. O
The O
patient O
denies O
fever O
, O
chills O
, O
night O
sweats O
, O
headache O
, O
sinus O
tenderness O
, O
rhinorrhea O
or O
congestion O
. O
Denied O
cough O
, O
shortness O
of O
breath O
. O
He O
also O
denied O
chest O
pain O
or O
tightness O
. O

A O
G2P0010 O
26 O
yo O
F O
, O
now O
estimated O
to O
10 O
weeks O
pregnant O
, O
with O
4yr O
hx O
of O
IDDM O
. O
Last O
menstrual O
period O
is O
not O
known O
but O
was O
sometime O
three O
months O
ago O
. O
Five O
days O
ago O
, O
the O
patient O
began O
feeling O
achy O
and O
congested O
. O
She O
had O
received O
a O
flu 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 B-MEDICATION
, O
Reglan B-MEDICATION
and O
Tylenol B-MEDICATION
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 B-MEDICATION
and O
Reglan B-MEDICATION
. O
Of O
note O
, O
her O
labwork O
demonstrates O
a O
blood O
glucose O
of O
160 O
, O
bicarbonate O
of O
11 O
, O
beta O
hCG O
of O
3373 O
and O
ketones O
in O
her O
urine O
. O
Her O
family O
noted O
that O
she O
was O
breathing O
rapidly O
and O
was O
quite O
somnolent O
. O
She O
appears O
to O
be O
in O
respiratory O
distress O
. O

This O
is O
a O
24 O
and O
2 O
7 O
weeks O
, O
678 O
gm O
male O
, O
born O
to O
a O
34 O
year O
old O
G2 O
, O
P0 O
to O
3 O
woman O
. O
Prenatal O
screens O
were O
O O
positive O
, O
antibody O
negative O
, O
hepatitis O
B O
surface O
antigen O
negative O
, O
RPR O
nonreactive O
, O
rubella O
immune O
, O
and O
GBS O
unknown O
. O
This O
was O
an O
IVF O
pregnancy O
, O
notable O
for O
bleeding O
in O
the O
first O
trimester O
. O
The O
mother O
presented O
to O
the O
Hospital O
on O
the O
morning O
of O
delivery O
with O
premature O
rupture O
of O
membranes O
. O
Betamethasone B-MEDICATION
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 B-MEDICATION
, O
gentamycin B-MEDICATION
, O
and O
magnesium B-MEDICATION
sulfate I-MEDICATION
. O
Mother O
's O
labor O
progressed O
despite O
magnesium B-MEDICATION
and O
she O
developed O
fever O
and O
chills O
. O
Maximum O
temperature O
was O
101 O
. O
2 O
degrees O
. O
Because O
of O
progressive O
labor O
and O
concerns O
for O
chorioamnionitis O
, O
the O
decision O
was O
made O
to O
deliver O
the O
infants O
. O
Delivery O
was O
by O
cesarean 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 O
. O
She O
was O
brought O
to O
the O
ED O
by O
her O
husband O
for O
evaluation O
after O
he O
noted O
worsening O
asterixis O
. O
While O
in O
the O
waiting O
room O
the O
pt O
became O
more O
combative O
and O
then O
unresponsive O
. O
In O
the O
ED O
VS O
Temp O
97 O
. O
9F O
, O
HR O
115 O
, O
BP O
122 O
80 O
, O
R O
18 O
, O
O2 O
sat O
98 O
2L O
NC O
. O
She O
was O
unresponsive O
but O
able O
to O
protect O
her O
airway O
and O
so O
not O
intubated O
. O
She O
vomited O
x1 O
and O
received O
Zofran B-MEDICATION
as O
well O
as O
1 O
. O
5 O
L O
NS B-MEDICATION
. 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 O
fluid O
. 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 O
pain O
and O
nausea O
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 O
pain O
with O
relief O
with O
morphine B-MEDICATION
. O
Pt O
is O
on O
ASA B-MEDICATION
, O
Statins B-MEDICATION
, O
Imdur B-MEDICATION
, O
and O
Heparin B-MEDICATION
. 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 O
. O
According O
to O
the O
family O
, O
the O
patient O
has O
increasing O
episodes O
of O
chest O
pain O
with O
minimal O
exertion O
in O
the O
last O
two O
weeks O
. O



A O
52 O
year O
old O
woman O
with O
chronic O
obstructive O
pulmonary O
disease O
and O
breast O
cancer O
who O
presented O
to O
an O
outside O
hospital O
with O
shortness O
of O
breath O
and O
back O
pain O
for O
several O
weeks O
. O
Had O
been O
seen O
by O
primary O
care O
provider O
for O
the O
back O
pain O
and O
treated O
with O
pain B-MEDICATION
medications I-MEDICATION
. O
Subsequently O
developed O
rash O
that O
was O
thought O
to O
be O
zoster O
. O
In O
the O
last O
few O
days O
, O
oxygen O
requirement O
increased O
and O
she O
had O
cough O
, O
fevers O
and O
sore O
throat O
. O
Noted O
oxygen O
saturation O
of O
79 O
with O
ambulation O
at O
home O
. O
At O
outside O
hospital O
she O
was O
diagnosed O
with O
" O
multi O
focal O
pneumonia O
. O
" O
In O
the O
process O
of O
obtaining O
a O
computerized O
tomography O
scan O
, O
contrast O
infiltrated O
her O
arm O
with O
skin O
blistering O
and O
swelling O
. O
She O
was O
treated O
with O
ceftriaxone B-MEDICATION
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 B-MEDICATION
treatment I-MEDICATION
. O
Patient O
had O
Y O
stent O
placed O
complicated O
by O
cough O
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy 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 B-MEDICATION
nebs I-MEDICATION
and O
Mucinex B-MEDICATION
. O
Patient O
reports O
decreaed O
appetitie O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
Smokes O
5 O
cig O
day O
. O
PET 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 O
pain O
, O
palpitations O
, O
trauma O
, O
F O
C O
, O
N O
V O
D O
. O
Pt O
. O
presents O
with O
worsening O
SOB O
with O
R O
shoulder O
pain O
and O
weakness O
. O


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 B-MEDICATION
, O
presenting O
with O
low O
hematocrit O
and O
shortness O
of O
breath O
. 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 O
of O
breath O
, 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 O
, O
chills O
, O
chest O
pain O
, O
palpitaitons O
, O
cough O
, O
abdominal O
pain O
, O
constipation O
or O
diahrrea O
, O
melena O
, O
blood O
in O
her O
stool O
, O
dysuria O
or O
rash O
. 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


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 B-MEDICATION
, 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
after O
presyncope O
falls O
. O
At O
that O
time O
, O
lasix B-MEDICATION
was O
stopped O
and O
atenolol B-MEDICATION
was O
switched O
to O
metoprolol B-MEDICATION
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
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 O
, O
somnolent O
, O
and O
confused O
. O
The O
patient O
denies O
headache O
, O
blurry O
vision O
, O
numbness O
, O
tingling O
or O
weakness O
. O
No O
CP O
. O
SOB O
, O
worsening O
DOE O
. O
No O
nausea O
, O
vomiting O
. 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 O
pain 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 O
pain O
. O
Her O
abdominal O
pain O
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 O
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 O
and O
vomitting O
. 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 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 B-MEDICATION
, O
flagyl B-MEDICATION
and O
500cc O
NS B-MEDICATION
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


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 O
and O
two O
days O
of O
a O
clear O
productive O
cough O
. O
The O
patient O
states O
his O
SOB O
occured O
when O
lying O
flat O
, O
but O
not O
with O
activity O
. O
Also O
admitted O
to O
chest O
pressure O
which O
would O
come O
and O
go O
in O
his O
left O
chest O
no O
related O
to O
the O
SOB O
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND O
; O
admits O
to O
a O
slight O
increase O
in O
lower O
extremity O
edema O
. O
Admits O
to O
low O
grade O
fevers O
to O
the O
99 O
's O
and O
crampy O
abdominal O
pain O
. O
Denies O
chills O
, O
night O
sweats O
, O
vomiting O
, O
or O
diarrhea O
. O
Patient O
also O
has O
a O
history O
of O
CMV O
infection O
, O
aspergillus O
and O
Leggionare O
's O
disease O
and O
is O
on O
posaconazole B-MEDICATION
. 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



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 O
of O
breath O
. O
According O
to O
Pt O
, O
her O
primary O
complaint O
is O
not O
shortness O
of O
breath O
, O
but O
cough O
X O
1 O
week O
which O
has O
been O
rarely O
productive O
of O
white O
sputum O
. O
She O
denies O
associated O
fevers O
, O
chills O
, O
nausea O
, O
vomiting O
, O
pleuritic O
pain O
, O
weight O
gain O
, O
or O
dietary O
indiscretion O
. O
She O
also O
reports O
a O
sore O
throat O
over O
the O
past O
3 O
days O
. O
She O
recently O
underwent O
thoracentesis 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 O
, O
and O
reports O
that O
she O
has O
been O
compliant O
with O
all O
medications O
. O
She O
admits O
to O
recent O
fatigue O
and O
2 O
pillow O
orthopnea O
which O
has O
been O
present O
for O
months O
. O
Current O
etiology O
considerations O
include O
CHF O
vs O
intrinsic O
pulmonary O
disease O
infiltrative O
vs O
embolic O
disease O
. O
In O
order O
to O
optimize O
cardic O
function O
with O
atrial O
kick O
, O
pt O
underwent O
cardioversion O
and O
became O
hypotensive O
with O
a O
junctional O
rhythm O
requiring O
intubation O
. O
She O
was O
placed O
on O
dobutamine B-MEDICATION
. O
Off O
of O
dobutamine B-MEDICATION
, 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 B-MEDICATION
, O
was O
initially O
admitted O
through O
the O
Emergency O
Department O
with O
shortness O
of O
breath O
and O
back O
pain O
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
rapid O
ventricular O
response O
. O
A O
computed 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 B-MEDICATION
. O
For O
the O
pneumonia O
, O
she O
was O
treated O
with O
antibiotics B-MEDICATION
. 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 B-MEDICATION
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 O
pain O
, O
shortness O
of O
breath O
and O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations O
. O

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 O
. O
Stools O
becoming O
less O
dark O
, O
but O
he O
had O
increased O
lethargy O
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 B-MEDICATION
81 O
mg O
Tablet O
by O
mouth O
daily 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 O
thought O
due O
to O
narcotics B-MEDICATION
. 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 B-MEDICATION
and O
her O
HR O
BP O
trended O
back O
up O
to O
baseline O
. O
However O
, O
there O
was O
a O
second O
event O
an O
hour O
later O
when O
she O
sat O
up O
and O
became O
bradycardic O
in O
the O
30s O
with O
associated O
hypotension O
. O
Second O
episode O
occurred O
with O
position O
change O
and O
again O
, O
pt O
developped O
junctional O
rhythm O
in O
30s O
. O

This O
is O
a O
54 O
year O
old O
male O
patient O
with O
an O
idiopathic O
pulmonary O
fibrosis O
, O
who O
called O
today O
with O
worsening O
dyspnea O
for O
3 O
days O
. O
He O
had O
been O
in O
unusual O
state O
of O
good O
health O
at O
baseline O
respiratory O
status O
using O
4L O
nasal O
canula O
at O
rest O
and O
6L O
with O
exertion O
when O
3 O
days O
prior O
to O
admission O
, O
he O
hugged O
his O
cousin O
who O
has O
rats O
for O
pets O
and O
also O
the O
heat O
came O
up O
from O
the O
basement O
of O
his O
house O
. O
He O
feels O
that O
with O
these O
two O
events O
, O
his O
breathing O
became O
acutely O
worse O
and O
he O
is O
concerned O
for O
allergen O
exposure O
. O
He O
denies O
any O
sick O
contacts O
, O
fevers O
, O
chills O
, O
rhinorrhea O
. O
He O
did O
receive O
flu O
and O
pneumovax B-MEDICATION
vaccines I-MEDICATION
. O
He O
has O
had O
a O
recent O
admission O
last O
month O
with O
progressive O
dyspnea O
on O
exertion O
. O
The O
computed 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 O
eosinophils O
peripherally O
12 O
. O
A O
bronchoalveolar O
lavage O
was O
also O
positive O
for O
eosinophils O
. O
He O
was O
started O
on O
high O
dose O
steroids B-MEDICATION
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 B-MEDICATION
canula I-MEDICATION
. O
He O
then O
represented O
to O
the O
emergency O
department O
for O
spontaneous O
pneumomediastinum O
of O
unclear O
etiology O
. O
On O
day O
of O
current O
admission O
, O
the O
patient O
called O
his O
pulmonologist O
complaining O
of O
worsening O
shortness O
of O
breath O
since O
Saturday O
. O
Yesterday O
he O
was O
at O
pulmonary B-MEDICATION
rehab I-MEDICATION
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 B-MEDICATION
canula I-MEDICATION
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


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 O
trauma O
or O
LOC O
. 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 O
mouth O
Cardiovascular O
Edema O
, O
Orthopnea O
Respiratory O
Dyspnea O
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 B-MEDICATION
. 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 B-MEDICATION
1g O
q8 O
continue O
morphine B-MEDICATION
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 B-MEDICATION
in O
perioperative O
period O
. O
ATRIAL O
FIBRILLATION O
In O
setting O
of O
acute O
pain O
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 B-MEDICATION
first O
, O
cardiovert B-MEDICATION
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 B-MEDICATION
5mg O
daily O
if O
BP O
sustains O
above O
SBP O
150s O
. O
Hyperlipidemia O
continue O
simvastatin B-MEDICATION
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 O
to O
29 O
with O
hypotension O
and O
bradycardia O
. O
Her O
hypotension O
and O
confusion O
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA O
which O
eventually O
grew O
klebsiella O
, O
treated O
initially O
with O
levofloxacin B-MEDICATION
. 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 B-MEDICATION
were O
switched O
to O
vancomycin B-MEDICATION
which O
was O
then O
changed O
to O
ceftriaxone B-MEDICATION
. 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 B-MEDICATION
of O
bicarb O
and O
transfered O
to O
their O
ICU O
. O
After O
an O
additional O
bolus B-MEDICATION
of O
500cc O
she O
was O
started O
on O
levophed B-MEDICATION
. O
She O
was O
anuric O
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 B-MEDICATION
this O
morning O
in O
the O
setting O
of O
low O
BPs O
and O
rare O
eos O
in O
urine O
. O
On O
arrival O
to O
the O
MICU O
pt O
was O
awake O
but O
drowsy O
. O
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 B-MEDICATION
. O
On O
ROS O
, O
pt O
denies O
pain O
, O
lightheadedness O
, O
headache O
, O
neck O
pain O
, O
sore O
throat O
, O
recent O
illness O
or O
sick O
contacts O
, O
cough O
, O
shortness O
of O
breath O
, O
chest O
discomfort O
, O
heartburn O
, O
abd O
pain O
, O
n O
v O
, O
diarrhea O
, O
constipation O
, O
dysuria O
. O
Is O
a O
poor O
historian O
regarding O
how O
long O
she O
has O
had O
a O
rash O
on O
her O
legs O
. O
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

The O
patient O
is O
an O
87 O
yo O
woman O
with O
h O
o O
osteoporosis O
, O
multiple O
recent O
falls O
, O
CAD O
, O
who O
presents O
from O
nursing O
home O
with O
C2 O
fracture O
and O
evidence O
of O
pulmonary O
emoblus O
. O
The O
patient O
was O
in O
her O
usual O
state O
of O
health O
at O
her O
nursing O
home O
until O
yesterday O
morning O
when O
she O
sustained O
a O
fall O
when O
trying O
to O
get O
up O
to O
go O
to O
the O
bathroom O
. O
The O
fall O
was O
not O
witnessed O
, O
but O
the O
patient O
reportedly O
did O
not O
lose O
consciousness O
. O
At O
3 O
30 O
that O
afternoon O
, O
the O
patient O
complained O
of O
neck O
and O
rib O
pain O
. O
She O
was O
taken O
to O
OSH O
, O
where O
she O
was O
found O
to O
have O
a O
comminuted O
fracture O
of O
C2 O
. O
She O
was O
transferred O
to O
Hospital1 O
1 O
for O
further O
evaluation O
. O
Of O
note O
, O
the O
patient O
was O
recently O
treated O
for O
CDiff O
infection O
at O
her O
nursing O
facility O
, O
per O
discussion O
with O
her O
daughter O
. O
. O
In O
the O
ED O
, O
the O
patient O
's O
VS O
were O
T O
99 O
. O
1 O
, O
BP O
106 O
42 O
, O
P O
101 O
, O
R O
24 O
. O
She O
had O
an O
ECG 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
She O
was O
seen O
by O
Trauma O
surgery O
, O
who O
recommended O
stabalization B-MEDICATION
with I-MEDICATION
a I-MEDICATION
cervical I-MEDICATION
collar I-MEDICATION
for O
the O
next O
six O
to O
eight O
weeks O
, O
but O
they O
deemed O
that O
she O
is O
not O
an O
operable O
candidate O
. O

An O
82 O
M O
with O
COPD O
, O
s O
p O
bioprosthetic 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 O
and O
fevers O
. O
light O
of O
stairs O
baseline O
. O
dyspnea O
and O
productive O
cough O
of O
several O
weeks O
. O
Otherwise O
patient O
is O
without O
any O
complaints O
In O
the O
ED O
, O
initial O
vs O
were O
80 O
, O
sbp O
100 O
, O
mid O
90s O
on O
6L O
NC O
. O
Last O
vital O
signs O
prior O
to O
ER O
transfer O
were O
98 O
. O
1 O
, O
83 O
, O
116 O
40 O
, O
20 O
, O
95 O
on O
3L O
NC O
. O
Patient O
looked O
comnfortable O
. O
90 O
room O
air O
, O
INR O
8 O
, O
ABG O
, O
ARF O
, O
2 O
liters O
ivf O
. O
guiac O
brown O
, O
got O
levo O
, O
ceftriaxone B-MEDICATION
. O
Physical O
Examination O
General O
Appearance O
No O
acute O
distress O
Eyes O
Conjunctiva O
PERRL O
Head O
, O
Ears O
, O
Nose O
, O
Throat O
Normocephalic O
Cardiovascular O
PMI O
Normal O
, O
S1 O
Normal O
, O
S2 O
Normal O
, O
Murmur O
Systolic O
Peripheral O
Vascular O
Right O
radial O
pulse O
Present O
, O
Left O
radial O
pulse O
Present O
, O
Right O
DP O
pulse O
Present O
, O
Left O
DP O
pulse O
Present O
Respiratory O
Chest O
Expansion O
Symmetric O
, O
Breath O
Sounds O
Crackles O
RLL O
, O
Wheezes O
diffuse O
Abdominal O
Soft O
, O
Non O
tender O
, O
Bowel O
sounds O
present O
Extremities O
Right O
lower O
extremity O
edema O
Absent O
, O
Left O
lower O
extremity O
edema O
Absent O
Skin O
Warm O
Neurologic O
Attentive O
, O
Follows O
simple O
commands O
, O
Responds O
to O
Verbal O
stimuli O
, O
Oriented O
to O
x3 O
, O
Movement O
Purposeful O
, O
Tone O
Normal O

This O
is O
a O
Age O
over O
90 O
year O
old O
female O
with O
hx O
recent O
PE O
DVT O
, O
atrial O
fibrillation O
, O
CAD O
who O
is O
transfered O
from O
Hospital3 O
915 O
Hospital O
for O
ERCP 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 O
and O
shortness O
of O
breath O
. O
She O
was O
found O
to O
have O
bilateral O
PE O
's O
and O
new O
afib O
and O
started O
on O
coumadin B-MEDICATION
. O
Her O
HCT O
dropped O
slightly O
, O
requiring O
blood B-MEDICATION
transfusion I-MEDICATION
, O
with O
guaic O
positive O
stools O
. O
She O
was O
discharged O
and O
returned O
with O
abdominal O
cramping O
and O
black O
stools O
. O
She O
was O
found O
to O
have O
a O
HCT O
drop O
from O
32 O
to O
21 O
. O
She O
was O
given O
vit B-MEDICATION
K I-MEDICATION
, O
given O
a O
blood O
transfusion O
and O
started O
on O
protonix B-MEDICATION
. 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 O
and O
congested O
. O
She O
had O
received O
a O
flu B-MEDICATION
shot I-MEDICATION
about O
1 O
week O
prior O
. O
She O
continued O
to O
feel O
poorly O
on O
3243 O
11 O
11 O
, O
and O
developed O
hyperemesis O
. O
She O
was O
seen O
in O
the O
ED O
but O
not O
admitted O
at O
Hospital3 O
, O
where O
she O
was O
given O
IVF B-MEDICATION
, O
Reglan B-MEDICATION
and O
Tylenol B-MEDICATION
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 B-MEDICATION
and O
Reglan B-MEDICATION
. O
Of O
note O
, O
her O
labwork O
demonstrates O
a O
blood O
glucose O
of O
160 O
, O
bicarbonate O
of O
11 O
, O
beta O
hCG O
of O
3373 O
and O
ketones O
in O
her O
urine O
. O
Her O
family O
noted O
that O
she O
was O
breathing O
rapidly O
and O
was O
quite O
somnolent O
. O
She O
appears O
to O
be O
in O
respiratory O
distress O
. O
. O
The O
falling O
beta O
HCG O
and O
trans O
abdominal O
ultrasound O
indicate O
intra O
uterine O
fetal O
demise O
. O
Medications O
on O
Admission O
Lantus B-MEDICATION
65 I-MEDICATION
units I-MEDICATION
qAM I-MEDICATION
Novolog B-MEDICATION
SSI I-MEDICATION
Cortef B-MEDICATION
3mg I-MEDICATION
qAM I-MEDICATION
, I-MEDICATION
1mg I-MEDICATION
qHS I-MEDICATION
. O
Meds O
on O
Transfer O
Levophed B-MEDICATION
Dopamine B-MEDICATION
Solumedrol B-MEDICATION
80mg I-MEDICATION
IV I-MEDICATION
Amiodarone B-MEDICATION
load I-MEDICATION
Insulin B-MEDICATION
in I-MEDICATION
D10 I-MEDICATION

Mr O
. O
Known O
patient O
lastname O
7952 O
is O
a O
41 O
yo O
M O
with O
PMH O
ETOH O
abuse O
, O
cholelithiasis O
, O
HTN O
, O
obesity O
who O
presented O
to O
Hospital3 O
with O
hematemasis O
. O
He O
reports O
that O
for O
the O
past O
6 O
years O
he O
has O
been O
drinking O
2 O
9 O
of O
a O
1 O
. O
7L O
bottle O
of O
vodka O
daily O
. O
On O
Friday O
evening O
he O
had O
several O
episodes O
of O
vomiting O
of O
bright O
and O
dark O
red O
material O
for O
which O
he O
presented O
to O
Hospital1 O
. O
He O
had O
an O
NG O
tube O
which O
reportedly O
failed O
to O
clear O
with O
lavage O
and O
patient O
self O
d O
c O
' O
d O
the O
NGT O
because O
he O
was O
vomiting O
around O
the O
tube O
. O
He O
was O
given O
4mg B-MEDICATION
IV I-MEDICATION
morphine I-MEDICATION
for O
abdominal O
pain O
, O
ativan B-MEDICATION
2mg O
IV O
for O
withdrawal O
, O
protonix B-MEDICATION
40mg I-MEDICATION
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 O
and O
sludge O
and O
per O
ED O
resident O
report O
ascites O
. O
As O
such O
given O
new O
ascites O
and O
abdominal O
pain O
he O
was O
given O
levofloxacin O
750mg O
IV O
and O
flagyl O
500mg O
IV O
reportedly O
for O
SBP O
prophylaxis O
. O
He O
was O
evaluted O
by O
GI O
in O
the O
ED O
. O
. O
On O
the O
floor O
, O
he O
reports O
that O
he O
had O
two O
episodes O
of O
vomiting O
of O
dark O
red O
emesis O
. O
Per O
his O
nurse O
it O
was O
about O
75ml O
and O
was O
gastrocult O
positive O
. O
He O
otherwise O
endorese O
RUQ O
pain O
radiating O
to O
his O
back O
. O
He O
also O
reports O
slow O
increase O
in O
abdominal O
girth O
with O
more O
acute O
distention O
and O
lower O
extremity O
swelling O
over O
the O
two O
days O
prior O
to O
admission O
. O
Physical O
Examination O
Vitals O
BP O
153 O
92 O
P O
64 O
R O
20 O
O2 O
97 O
RA O
General O
Alert O
, O
oriented O
, O
no O
acute O
distress O
, O
no O
asterixis O
HEENT O
Sclera O
icteric O
, O
dry O
mucous O
membranes O
Neck O
supple O
, O
obese O
, O
JVP O
not O
elevated O
Lungs O
bibasilar O
crackles O
, O
no O
wheezes O
CV O
Regular O
rate O
and O
rhythm O
, O
3 O
16 O
soft O
nonradiating O
systolic O
murmur O
Abdomen O
obese O
distended O
, O
RUQ O
and O
epigastric O
tenderness O
to O
palpation O
, O
normoactive O
bowel O
sounds O
, O
no O
rebound O
or O
guarding O
. O
Ext O
warm O
, O
well O
perfused O
, O
1 O
pitting O
edema O
bilaterally O
, O
2 O
pulses O
Labs O
WBC O
2 O
. O
5 O
Hct O
36 O
. O
2 O
Plt O
28 O
Cr O
0 O
. O
5 O
Glucose O
111 O
Other O
labs O
PT O
PTT O
INR O
19 O
. O
1 O
31 O
. O
6 O
1 O
. O
7 O
, O
ALT O
AST O
37 O
165 O
, O
Alk O
Phos O
T O
Bili O
130 O
6 O
. O
9 O
, O
Amylase O
Lipase O
145 O
288 O
, O
Albumin O
2 O
. O
5 O
g O
dL O
, O
LDH O
278 O
IU O
L O
, O
Ca O
7 O
. O
9 O
mg O
dL O
, O
Mg O
1 O
. O
7 O
mg O
dL O
, O
PO4 O
3 O
. O
0 O
mg O
dL O

Infant O
is O
a O
24 O
1 O
31 O
week O
, O
678 O
gm O
male O
triplet O
II O
who O
was O
admitted O
to O
the O
NICU O
for O
management O
of O
extreme O
prematurity O
. O
Infant O
was O
born O
to O
a O
34 O
y O
. O
o O
. O
G2P0 O
now O
3 O
mother O
. O
Prenatal O
screens O
O O
, O
antibody O
negative O
, O
HBsAg O
negative O
, O
RPR O
NR O
, O
RI O
, O
GBS O
unknown O
. O
IVF O
pregnancy O
notable O
for O
bleeding O
in O
the O
first O
trimester O
, O
cerclage O
placement O
at O
19 O
weeks O
, O
and O
premature O
rupture O
of O
membranes O
on O
3435 O
11 O
28 O
am O
. O
Mother O
presented O
to O
Hospital1 O
53 O
. O
Betamethasone O
given O
11 O
28 O
at O
0640 O
. O
Also O
started O
on O
ampicillin B-MEDICATION
, O
gentamicin B-MEDICATION
, O
and O
magnesium B-MEDICATION
sulfate I-MEDICATION
. O
Mother O
's O
labor O
progressed O
despite O
magnesium B-MEDICATION
and O
she O
developed O
chills O
and O
a O
fever O
Tm O
101 O
. O
2 O
. O
Due O
to O
progressive O
labor O
and O
concerns O
for O
infection O
, O
decision O
made O
to O
deliver O
infants O
. O
Delivery O
by O
Cesarean 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

The O
patient O
is O
a O
55 O
year O
old O
woman O
with O
hepatic O
sarcoidosis O
and O
regenerative O
hyperplasia O
s O
p O
TIPS O
10 O
3245 O
placed O
1 O
27 O
variceal O
bleeding O
and O
portal O
hypertensive O
gastropathy O
s O
p O
TIPS O
re O
do O
with O
angioplasty O
and O
portal O
vein O
embolectomy O
, O
who O
was O
brought O
to O
the O
ED O
by O
her O
husband O
for O
evaluation O
after O
he O
noted O
worsening O
asterixis O
. O
While O
in O
the O
waiting O
room O
the O
pt O
became O
more O
combative O
and O
then O
unresponsive O
. O
In O
the O
ED O
VS O
Temp O
97 O
. O
9F O
, O
HR O
115 O
, O
BP O
122 O
80 O
, O
R O
18 O
, O
O2 O
sat O
98 O
2L O
NC O
. O
She O
was O
unresponsive O
but O
able O
to O
protect O
her O
airway O
and O
so O
not O
intubated O
. O
She O
vomited O
x1 O
and O
received O
Zofran B-MEDICATION
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 O
fluid O
. O
On O
arrival O
to O
the O
ICU O
the O
pt O
had O
another O
episode O
of O
emesis O
. O
NGT O
was O
placed O
to O
suction O
and O
1 O
. O
5L O
bilious O
material O
was O
drained O
. O
Allergies O
Cipro O
Oral O
Ciprofloxacin O
Hcl O
Hives O
; O
Doxycycline O
Hives O
; O
hallucin O
Paxil O
Oral O
Paroxetine O
Hcl O
hair O
loss O
; O
Quinine O
Rash O
; O
Compazine O
Injection O
Prochlorperazine O
Edisylate O
muscle O
spasm O
; O
Levaquin O
Oral O
Levofloxacin O
tendinitis O
of O
t O
Lithium O
Hives O
; O

Mr O
. O
Name13 O
STitle O
5827 O
is O
an O
80yo O
M O
with O
dementia O
, O
CAD O
s O
p O
CABG 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 O
pain O
and O
nausea O
over O
the O
past O
few O
days O
. O
Per O
report O
, O
patient O
has O
presented O
several O
times O
since O
last O
cathed O
for O
recurrent O
angina O
. O
Admitted O
to O
Hospital3 O
on O
3436 O
4 O
2 O
with O
recurrent O
chest O
pain O
. O
Ruled O
out O
for O
MI O
. O
Last O
episode O
of O
chest O
pressure O
was O
the O
morning O
of O
transfer O
, O
associated O
with O
dry O
heaves O
and O
belching O
relieved O
with O
morphine B-MEDICATION
. O
Pt O
was O
continued O
on O
ASA B-MEDICATION
, O
Plavix B-MEDICATION
, O
Statin B-MEDICATION
, O
BBker B-MEDICATION
, O
Imdur B-MEDICATION
and O
placed O
on O
Heparin B-MEDICATION
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 O
and O
back O
pain O
for O
several O
weeks O
. O
Had O
been O
seen O
by O
PCP O
for O
the O
back O
pain O
and O
treated O
with O
pain B-MEDICATION
meds I-MEDICATION
. O
Subsequently O
developed O
rash O
that O
was O
thought O
to O
be O
zoster O
. O
In O
the O
last O
few O
days O
, O
increased O
O2 O
requirement O
2 O
liters O
at O
baseline O
4 O
liters O
, O
cough O
, O
fevers O
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 B-MEDICATION
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 O
, O
sleepy O
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


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 O
and O
copious O
secretions O
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 O
secretions O
that O
were O
aspirated O
. O
Pt O
reports O
compliance O
with O
Mucomyst B-MEDICATION
nebs I-MEDICATION
and O
Mucinex B-MEDICATION
. O
He O
wears O
O2 O
" O
almost O
" O
24 O
hours O
day O
, O
but O
always O
at O
night O
. O
He O
does O
not O
wear O
his O
CPAP O
. O
Endorses O
inability O
to O
expectorate O
secretions O
and O
having O
" O
full O
feeling O
" O
for O
1 O
7 O
weeks O
. O
Decreaed O
appetitie O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
Smokes O
5 O
cig O
day O
. O
PET O
scan O
in O
6 O
12 O
revealed O
FDG O
avid O
soft O
tissue O
mass O
adjacent O
to O
RUL O
resection O
site O
with O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
On O
arrival O
to O
Hospital1 O
17 O
, O
vitals O
were O
T98 O
. O
6 O
HR86 O
BP106 O
78 O
O289 O
. O
Pt O
denied O
chest O
pain O
, O
palpitations O
, O
trauma O
, O
F O
C O
, O
N O
V O
D O
. O
R O
shoulder O
full O
PROM O
, O
limited O
abduction O
on O
active O
ROM O
. O


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 B-MEDICATION
, 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 O
of O
breath O
worse O
with O
exertion O
over O
the O
past O
two O
weeks O
. O
She O
denies O
fevers O
, O
chills O
, O
chest O
pain O
, O
palpitaitons O
, O
cough O
, O
abdominal O
pain O
, O
constipation O
or O
diahrrea O
, O
melena O
, O
blood O
in O
her O
stool O
, O
dysuria O
, O
rash O
. 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 O
pain O
, 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 O
has O
worsened O
since O
yesterday O
. O
She O
also O
complains O
of O
nausea O
, O
vomitting O
bilious O
but O
nonbloody O
, O
and O
diarrhea O
no O
black O
or O
red O
stools O
. O
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 B-MEDICATION
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 O
, O
orthopnea O
. O
Also O
describes O
weight O
gain O
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 O
and O
also O
complains O
of O
a O
moderate O
headache O
that O
's O
been O
stable O
. O
. O
Denies O
CP O
, O
fevers O
, O
chills O
, O
or O
cough O
, O
palpitations O
, O
edema O
, O
joint O
pains O
, O
rashes O
, 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 B-MEDICATION
, 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 B-MEDICATION
was O
stopped O
and O
atenolol B-MEDICATION
was O
switched O
to O
metoprolol B-MEDICATION
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 B-MEDICATION
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 O
, O
somnolent O
, O
and O
confused O
. O
The O
patient O
denies O
headache O
, O
blurry O
Vision O
, O
numbness O
, O
tingling O
or O
weakness O
. O
No O
CP O
. O
SOB O
, O
worsening O
DOE O
. O
No O
nausea O
, O
vomiting O
. 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 O
, 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 O
pain O
. O
Her O
abdominal O
pain O
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 O
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 O
and O
vomitting O
. 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 B-MEDICATION
, O
flagyl B-MEDICATION
and O
500cc B-MEDICATION
NS I-MEDICATION
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 O
and O
two O
days O
of O
a O
clear O
productive O
cough O
. O
The O
patient O
states O
his O
SOB O
occured O
when O
lying O
flat O
, O
but O
not O
with O
activity O
. O
Also O
admitted O
to O
chest O
pressure O
which O
would O
come O
and O
go O
in O
his O
left O
chest O
no O
related O
to O
the O
SOB O
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND O
; O
admits O
to O
a O
slight O
increase O
in O
lower O
extremity O
edema O
. O
Admits O
to O
low O
grade O
fevers O
to O
the O
99 O
's O
and O
crampy O
abdominal O
pain O
. O
Denies O
chills O
, O
night O
sweats O
, O
vomiting O
, O
or O
diarrhea O
. O
Assessment O
and O
Plan O
Assesment O
This O
is O
a O
63 O
year O
old O
male O
with O
a O
history O
of O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic O
SCT O
, O
who O
presents O
with O
hypoxia O
, O
one O
week O
of O
worsening O
SOB O
, O
and O
two O
days O
of O
productive O
cough O
. O
Plan O
Hypoxia O
The O
patient O
developed O
acute O
onset O
of O
hypoxia O
accompanied O
by O
fever O
and O
a O
one O
day O
cough O
with O
sputum O
production O
. O
Given O
that O
the O
patient O
is O
about O
1 O
month O
s O
p O
allogenic 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 B-MEDICATION
. 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



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 B-MEDICATION
, O
shingles O
treated O
w O
acyclovir B-MEDICATION
and O
SBO O
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 O
earaches O
, O
a O
sorethroat O
as O
well O
as O
some O
rhinorrhea O
. O
He O
has O
not O
noticed O
any O
watery O
itchy O
eyes O
. O
He O
has O
not O
sure O
if O
he O
has O
had O
a O
change O
in O
his O
ostomy O
output O
or O
suprapubic O
output O
. O
He O
has O
not O
noticed O
any O
visual O
changes O
, O
he O
has O
not O
noticed O
any O
new O
neurologic O
si O
sx O
. O
He O
denies O
any O
abdominal O
pain O
, O
has O
not O
sujectively O
noticed O
any O
change O
in O
abdominal O
distention O
. O
He O
denies O
any O
pain O
in O
regards O
to O
his O
zoster O
now O
or O
when O
diagnosed O
. O
Denies O
CP O
, O
has O
an O
occasional O
cough O
that O
is O
not O
worsening O
. O
. O
In O
the O
ED O
, O
he O
was O
noted O
to O
be O
severely O
dehydrated O
on O
exam O
. O
His O
BP O
nadir O
was O
79 O
43 O
and O
HR O
peak O
was O
97 O
. O
T O
99 O
he O
usually O
" O
runs O
low O
" O
, O
new O
ARF O
1 O
. O
4 O
up O
from O
0 O
. O
6 O
. O

A O
64 O
yo O
F O
w O
PMHx O
sx O
for O
AF O
, O
COPD O
, O
HTN O
, O
hyperlipidemia O
who O
initially O
had O
an O
open 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 B-MEDICATION
. O
On O
2 O
20 O
, O
she O
was O
initially O
admitted O
through O
the O
ED O
with O
SOB O
and O
back O
pain O
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
RVR O
. O
A O
CTA 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 B-MEDICATION
gtt I-MEDICATION
, 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 B-MEDICATION
. 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 B-MEDICATION
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 B-MEDICATION
gtt I-MEDICATION
. O
. O
In O
the O
Hospital O
Unit O
Name O
42 O
, O
she O
was O
started O
on O
po B-MEDICATION
diltiazem I-MEDICATION
, 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 B-MEDICATION
5 I-MEDICATION
mg I-MEDICATION
IV I-MEDICATION
x2 O
, O
followed O
by O
diltiazem B-MEDICATION
10 I-MEDICATION
mg I-MEDICATION
IV O
x2 O
without O
conversion O
. O
She O
denies O
chest O
pain O
, O
SOB O
, O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations O
. O



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 O
and O
and O
vomiting O
blackish O
liquid O
. O
He O
felt O
better O
but O
continued O
to O
have O
three O
more O
black O
stools O
over O
the O
next O
two O
days O
. O
He O
vomited O
a O
total O
of O
1 O
20 O
times O
before O
presenting O
to O
the O
hospital O
. O
He O
has O
been O
feeling O
lethargic O
and O
lightheaded O
and O
called O
the O
ambulence O
at O
the O
advice O
of O
his O
son O
. O
His O
stools O
were O
lightening O
in O
color O
prior O
arriving O
. O
He O
has O
not O
been O
using O
any O
new O
medications O
and O
has O
not O
had O
a O
prior O
GIB O
. O
. O
In O
the O
ED O
, O
initial O
VS O
98 O
. O
7 O
88 O
65 O
47 O
98 O
RA O
. O
He O
was O
BIBEMS O
with O
SBPs O
110 O
120s O
and O
has O
had O
similarly O
stable O
blood O
pressures O
since O
arrival O
. O
He O
had O
an O
NG O
lavage O
with O
coffee O
ground O
emesis O
that O
cleared O
with O
600 O
cc O
of O
flushing O
. O
During O
the O
lavage O
he O
had O
chest O
pressure O
and O
an O
EKG O
showed O
STD O
in O
V2 O
4 O
. O
He O
did O
not O
have O
radiation O
, O
pain O
, O
or O
diaphoresis O
. O
Home O
medications O
ALLOPURINOL B-MEDICATION
300 O
mg O
Tablet O
by O
mouth O
daily O
GLIPIZIDE B-MEDICATION
5 O
mg O
Extended O
Rel O
by O
mouth O
daily O
LOSARTAN B-MEDICATION
COZAAR O
100 O
mg O
by O
mouth O
daily O
METFORMIN B-MEDICATION
500 O
mg O
by O
mouth O
daily O
METOPROLOL B-MEDICATION
TARTRATE I-MEDICATION
50 O
mg O
by O
mouth O
daily O
PIOGLITAZONE B-MEDICATION
ACTOS O
15 O
mg O
by O
mouth O
daily O
SIMVASTATIN B-MEDICATION
80 O
mg O
Tablet O
by O
mouth O
daily O
ASPIRIN B-MEDICATION
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 O
, O
chills O
, 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 O
. 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 B-MEDICATION
dose I-MEDICATION
steroids I-MEDICATION
prednisone B-MEDICATION
60mg I-MEDICATION
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 O
of O
breath O
since O
Saturday O
3 O
23 O
. O
Yesterday O
he O
was O
at O
pulmonary O
rehab B-MEDICATION
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 O
thought O
due O
to O
narcotics B-MEDICATION
. O
Today O
, O
she O
was O
restarted O
on O
her O
home O
meds O
and O
while O
on O
telemetry O
, O
pt O
was O
noted O
to O
be O
bradycardic O
to O
40s O
. O
Pt O
was O
triggered O
for O
SBP O
of O
70 O
and O
HR O
of O
40 O
during O
which O
she O
remained O
asymptomatic O
. O
She O
was O
given O
1L O
IVF O
and O
her O
HR O
BP O
trended O
back O
up O
to O
baseline O
. O
However O
, O
there O
was O
a O
second O
event O
an O
hour O
later O
when O
she O
sat O
up O
and O
became O
bradycardic O
in O
the O
30s O
with O
associated O
hypotension O
. O
Second O
episode O
occurred O
with O
position O
change O
and O
again O
, O
pt O
developped O
junctional O
rhythm O
in O
30s O
. O
home O
meds O
Verapamil B-MEDICATION
240mg O
daily O
Lisinopril B-MEDICATION
5mg O
Rosuvastatin B-MEDICATION
10mg O
Meclizine B-MEDICATION
25 O
TID O
PRN O
Imipramine B-MEDICATION
25 O
QHS O
Colace B-MEDICATION
100mg O
Loratidine B-MEDICATION
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















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 O
and O
copious O
secretions O
requiring O
multiple O
therapeutic B-MEDICATION
aspirations I-MEDICATION
. O
Patient O
reports O
decreased O
appetite O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
PET O
scan O
revealed O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
Pt O
. O
presents O
with O
worsening O
SOB O
with O
R O
shoulder O
pain O
and O
weakness O
. O


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 B-MEDICATION
, O
presenting O
with O
low O
hematocrit O
and O
dyspnea O
. 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 B-MEDICATION
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
with O
confusion O
and O
somnolence O
. O
She O
was O
recently O
discharged O
after O
presyncope O
falls O
. O
Patient O
has O
had O
confusion O
at O
home O
for O
3 O
weeks O
. O
The O
patient O
denies O
headache O
, O
blurry O
vision O
, O
numbness O
, O
tingling O
or O
weakness O
, O
nausea O
or O
vomiting O
. O







A O
79 O
year O
old O
female O
wit O
history O
of O
CAD O
, O
diastolic O
CHF O
, O
HTN O
, O
Hyperlipidemia O
, O
previous O
smoking O
history O
, O
and O
atrial O
fibrillation O
who O
presents O
for O
direct O
admission O
from O
home O
for O
progressive O
shortness O
of O
breath O
. O
Patient O
denies O
recent O
palpitations O
, O
and O
reports O
that O
she O
has O
been O
compliant O
with O
all O
medications O
. O
She O
admits O
to O
recent O
fatigue O
and O
2 O
pillow O
orthopnea 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 O
with O
a O
junctional O
rhythm O
requiring O
intubation O
. O
She O
was O
placed O
on O
dobutamine B-MEDICATION
. O
Off O
of O
dobutamine B-MEDICATION
, O
cardiac O
monitoring O
demonstrated O
a O
long O
QTc O
and O
an O
atrial O
escape O
rhythm O
. O




An O
85 O
year O
old O
woman O
on O
verapamil B-MEDICATION
presents O
with O
junctional O
heart O
rhythm O
in O
30s O
with O
associated O
hypotension O
. 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 O
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 O
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 B-MEDICATION
50 O
mg O
BID O
with O
the O
diagnosis O
of O
ALS O
. O


A O
50 O
year O
old O
woman O
comes O
to O
the O
clinic O
with O
intermittent O
ear O
discharge O
and O
sense O
of O
hearing O
loss O
on O
her O
left O
ear O
. O
Past O
medical O
history O
is O
significant O
for O
obesity O
, O
hyperlipidemia O
, O
and O
diabetes O
mellitus O
. O
Her O
medications O
include O
Metformin B-MEDICATION
, O
Atorvastatin B-MEDICATION
and O
Vit B-MEDICATION
D I-MEDICATION
supplement I-MEDICATION
. O
Vital O
signs O
are O
normal O
. O
BMI O
is O
37 O
. O
Otoscopy O
shows O
a O
small O
perforation O
in O
the O
left O
tympanic O
membrane O
and O
a O
pearly O
mass O
behind O
the O
membrane O
. O
Conduction O
hearing O
loss O
is O
noted O
in O
the O
left O
ear O
. O
The O
remainder O
of O
the O
ear O
, O
nose O
, O
and O
throat O
examination O
is O
normal O
. O

A O
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 O
on O
her O
left O
arm O
. O
The O
lesion O
is O
mildly O
pruritic O
but O
not O
painful O
. O
She O
is O
otherwise O
healthy O
and O
occasionally O
takes O
ibuprofen B-MEDICATION
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 O
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 O
. 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 O
back O
pain O
. O
There O
is O
no O
history O
of O
trauma O
. O
The O
pain O
is O
not O
relieved O
with O
over O
the O
counter O
pain B-MEDICATION
medications I-MEDICATION
. O
His O
vital O
signs O
are O
within O
normal O
limits O
. O
Examination O
shows O
low O
back O
pain O
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
20 O
year O
old O
man O
comes O
to O
the O
clinic O
for O
his O
routine O
checkup O
. O
The O
patient O
wears O
glasses O
for O
myopia O
and O
takes O
no O
medications B-MEDICATION
. O
Vital O
signs O
are O
normal O
. O
On O
physical O
examination O
, O
the O
patient O
is O
tall O
with O
long O
upper O
extremities O
and O
fingers O
. O
The O
face O
appears O
narrow O
with O
down O
slanted O
palpebral O
fissures O
, O
flattened O
malar O
bones O
, O
and O
a O
small O
jaw O
. O
The O
lungs O
are O
clear O
on O
auscultation O
. O
The O
abdomen O
is O
soft O
with O
no O
organomegaly O
. O
The O
patient O
is O
diagnosed O
with O
Marfan O
syndrome O
, O
and O
he O
is O
cooperative O
with O
his O
medical O
appointments O
. O
He O
is O
working O
as O
driver 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 O
. O
She O
also O
has O
occasional O
nausea O
and O
ringing O
in O
her O
right O
ear O
. O
The O
patient O
also O
has O
difficulty O
hearing O
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 O
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 O
vit O
D O
level O
, O
for O
which O
she O
is O
using O
Levothyroxine B-MEDICATION
and O
Vit B-MEDICATION
D I-MEDICATION
pearl I-MEDICATION
. 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 O
gain O
and O
fatigue O
. 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 O
weakness O
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 B-MEDICATION
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 B-MEDICATION
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 O
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



The O
patient O
is O
a O
38 O
year O
old O
man O
with O
cough O
and O
body O
ache O
that O
started O
3 O
days O
ago O
. O
He O
had O
fever O
and O
chills O
at O
the O
beginning O
and O
has O
low O
grade O
fever O
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 O
ache O
and O
myalgia O
get O
better O
after O
using O
Tylenol B-MEDICATION
. 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
66 O
year O
old O
woman O
comes O
to O
the O
office O
due O
to O
joint O
pain O
in O
the O
hands O
and O
periodic O
morning O
stiffness O
that O
lasts O
less O
than O
15 O
minutes O
. O
The O
pain O
is O
moderately O
severe O
and O
worsens O
with O
daily O
activity O
. O
The O
patient O
used O
Tylenol B-MEDICATION
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 B-MEDICATION
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
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 O
. 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 O
, 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 B-MEDICATION
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 O
joint O
. O
Aspiration O
of O
the O
joint O
showed O
high O
leukocyte O
count O
, 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





A O
33 O
year O
old O
woman O
comes O
to O
clinic O
complaining O
of O
progressive O
fatigue O
, O
decreased O
appetite O
, O
and O
11 O
lb O
weight O
loss O
in O
the O
past O
2 O
months O
. O
She O
uses O
levothyroxine B-MEDICATION
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 B-MEDICATION
glucocorticoid I-MEDICATION
replacement I-MEDICATION
therapy I-MEDICATION
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
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 O
and O
knee O
when O
she O
bends O
down O
. O
The O
pain O
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 B-MEDICATION
anti I-MEDICATION
inflammatory I-MEDICATION
drugs I-MEDICATION
NSAIDs B-MEDICATION
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 O
in O
the O
right O
knee O
. O
The O
effusion O
grew O
a O
little O
larger O
and O
she O
developed O
a O
tender O
swelling O
in O
the O
popliteal O
fossa O
and O
calf O
. O
Both O
the O
pain O
and O
swelling O
worsened O
as O
she O
bent O
and O
straightened O
her O
knee 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 O
elbow O
pain O
. O
The O
pain O
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 B-MEDICATION
the I-MEDICATION
counter I-MEDICATION
medications I-MEDICATION
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 B-MEDICATION
hydrocortisone I-MEDICATION
ointment I-MEDICATION
. 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 O
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 O
since O
last O
year O
and O
had O
several O
courses O
of O
physical B-MEDICATION
therapy I-MEDICATION
. 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 B-MEDICATION
the I-MEDICATION
counter I-MEDICATION
multivitamin I-MEDICATION
. 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 O
pain O
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
48 O
year O
old O
man O
comes O
to O
the O
office O
complaining O
of O
heartburn O
and O
acid O
reflux O
. O
He O
has O
taken O
over B-MEDICATION
the I-MEDICATION
counter I-MEDICATION
antacids I-MEDICATION
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 O
after O
a O
tooth O
extraction O
. O
The O
bleeding O
has O
persisted O
for O
approximately O
30 O
minutes O
despite O
constant O
direct O
pressure O
. O
He O
is O
a O
known O
case O
of O
Hemophilia O
type O
A O
treated O
with O
FVIII B-MEDICATION
. O
Blood O
pressure O
is O
95 O
60 O
mm O
Hg O
and O
pulse O
is O
105 O
min O
. O
His O
weight O
is O
70 O
Kg O
. O
Family O
history O
is O
positive O
for O
Hemophilia O
type O
A O
in O
his O
maternal O
uncle O
. O
He O
also O
has O
a O
lipoma O
on O
his O
left O
arm O
which O
he O
plans O
to O
remove O
surgically O
. O
His O
FVIII O
activity O
is O
40 O
. O


Patient O
is O
a O
45 O
year O
old O
man O
with O
a O
history O
of O
anaplastic O
astrocytoma O
of O
the O
spine O
complicated O
by O
severe O
lower O
extremity O
weakness O
and O
urinary O
retention O
s O
p O
Foley O
catheter O
, O
high B-MEDICATION
dose I-MEDICATION
steroids I-MEDICATION
, O
hypertension O
, O
and O
chronic O
pain O
. O
The O
tumor O
is O
located O
in O
the O
T O
L O
spine O
, O
unresectable O
anaplastic O
astrocytoma O
s O
p O
radiation O
. O
Complicated O
by O
progressive O
lower O
extremity O
weakness O
and O
urinary O
retention O
. O
Patient O
initially O
presented O
with O
RLE O
weakness O
where O
his O
right O
knee O
gave O
out O
with O
difficulty O
walking O
and O
right O
anterior O
thigh O
numbness O
. O
MRI O
showed O
a O
spinal O
cord O
conus O
mass O
which O
was O
biopsied O
and O
found O
to O
be O
anaplastic O
astrocytoma O
. O
Therapy B-MEDICATION
included O
field B-MEDICATION
radiation I-MEDICATION
t10 O
l1 O
followed O
by O
11 O
cycles O
of O
temozolomide B-MEDICATION
7 O
days O
on O
and O
7 O
days O
off O
. O
This O
was O
followed O
by O
CPT B-MEDICATION
11 I-MEDICATION
Weekly O
x4 O
with O
Avastin B-MEDICATION
Q2 O
weeks O
2 O
weeks O
rest O
and O
repeat O
cycle O
. O

48 O
M O
with O
a O
h O
o O
HTN O
hyperlipidemia O
, O
bicuspid O
aortic O
valve O
, O
and O
tobacco O
abuse O
who O
presented O
to O
his O
cardiologist O
on O
2148 O
10 O
1 O
with O
progressive O
SOB O
and O
LE O
edema O
. O
TTE O
revealed O
severe O
aortic O
stenosis O
with O
worsening O
LV O
function O
. O
EF O
was O
25 O
. O
RV O
pressure O
was O
41 O
and O
had O
biatrial O
enlargement O
. O
Noted O
to O
have O
2 O
aortic O
insufficiency O
with O
mild O
MR O
. O
He O
was O
sent O
home O
from O
cardiology O
clinic O
with O
Lasix B-MEDICATION
and O
BB B-MEDICATION
which O
he O
did O
not O
tolerate O
, O
continued O
to O
have O
worsening O
SOB O
and O
LE O
edema O
and O
finally O
presented O
here O
for O
evaluation O
. O
During O
this O
admission O
repeat O
echo O
confirmed O
critical O
aortic O
stenosis O
showing O
left O
ventricular O
hypertrophy O
with O
cavity O
dilation O
and O
severe O
global O
hypokinesis O
, O
severe O
aortic O
valve O
stenosis O
with O
underlying O
bicuspid O
aortic O
valve O
, O
dilated O
ascending O
aorta O
, O
mild O
pulmonary O
artery O
systolic O
hypertension O
. O
The O
patient O
underwent O
a O
preop O
workup O
for O
valvular O
replacement O
with O
preop O
chest O
CT O
scan O
and O
carotid O
US O
showing O
moderate O
heterogeneous O
plaque O
with O
bilateral O
1 O
39 O
ICA O
stenosis O
. O
He O
also O
underwent O
a O
cardiac O
cath O
with O
right O
heart O
cath O
to O
evaluate O
his O
pulm O
art O
pressures O
which O
showed O
no O
angiographically O
apparent O
flow O
limiting O
coronary O
artery O
disease O
. O

A O
32 O
yo O
woman O
who O
presents O
following O
a O
severe O
' O
exploding O
' O
headache O
. O
She O
and O
her O
husband O
report O
that O
yesterday O
she O
was O
in O
the O
kitchen O
and O
stood O
up O
and O
hit O
her O
head O
on O
the O
corner O
of O
a O
cabinet O
. O
The O
next O
morning O
she O
developed O
a O
sudden O
' O
exploding O
' O
headache O
. O
She O
came O
to O
the O
hospital O
where O
head O
CT 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 O
but O
they O
were O
improving O
with O
pain B-MEDICATION
medication I-MEDICATION
. 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



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 O
and O
weakness O
. 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 O
. 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 B-MEDICATION
po I-MEDICATION
, O
Flagyl B-MEDICATION
IV I-MEDICATION
and O
Flagyl B-MEDICATION
po I-MEDICATION
initially O
, O
and O
when O
patient O
improved O
she O
was O
transitioned O
to O
Vanco B-MEDICATION
oral O
and O
Flagyl B-MEDICATION
oral O
on O
8 O
29 O
. O
Patient O
was O
treated O
with O
Vanco B-MEDICATION
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 B-MEDICATION
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 O
2 O
9 O
NSAID B-MEDICATION
gastritis O
, O
referred O
for O
admission O
throught O
the O
ED O
by O
hepatology O
clinic O
for O
new O
slurred O
speech O
and O
tangential O
thought O
process O
. O
Patient O
also O
describes O
new O
imbalance O
leading O
to O
a O
fall O
during O
which O
he O
may O
have O
hit O
his O
head O
on O
. O
Per O
last O
liver O
clinic O
note O
has O
been O
off O
ETOH O
for O
a O
year O
corroborated O
with O
pt O
, O
utox O
was O
negative O
for O
alocohol O
. O
CT 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 B-MEDICATION
. 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 B-MEDICATION
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 O
white O
count O
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 B-MEDICATION
therapy I-MEDICATION
, 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 B-MEDICATION
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 O
elevated O
LDH O
. 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 O
in O
at O
his O
NH O
which O
required O
20 O
mg O
valium O
to O
cease O
seizure O
activity O
. O
Per O
outside O
medical O
patient O
was O
felt O
to O
have O
focal O
epilepsy O
with O
secondary O
generalization O
, O
likely O
due O
to O
anoxic O
brain O
injury O
at O
birth O
, O
and O
probably O
related O
to O
the O
atrophic O
changes O
seen O
on O
MRI 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 B-MEDICATION
and O
phenobarbital B-MEDICATION
. 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 B-MEDICATION
, 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

Pt O
is O
a O
22yo O
F O
otherwise O
healthy O
with O
a O
5 O
yr O
history O
of O
the O
systemic O
mastocytosis O
, O
with O
flares O
normally O
3 O
year O
, O
presenting O
with O
flushing O
and O
tachycardia O
concerning O
for O
another O
flare O
. O
This O
is O
patient O
's O
3rd O
flare O
in O
2 O
months O
, O
while O
still O
on O
steroid B-MEDICATION
taper I-MEDICATION
which O
is O
new O
for O
her O
. O
She O
responded O
well O
to O
125 O
mg O
IV O
steroids B-MEDICATION
q O
8 O
hrs O
and O
IV O
diphenydramine B-MEDICATION
in O
addition O
to O
her O
continuing O
home O
regimen O
. O
CBC O
was O
at O
her O
baseline O
, O
w O
normal O
differential O
. O
Serum O
tryptase O
revealed O
a O
high O
value O
at O
84 O
. O
The O
patient O
failed O
aspirin B-MEDICATION
challenge O
due O
to O
adverse O
reaction O
. O
She O
was O
stabilized O
on O
IV O
steroids B-MEDICATION
and O
IV O
benadryl B-MEDICATION
and O
transferred O
back O
to O
the O
medical O
floor O
. O
She O
continued O
on O
her O
home O
histamine B-MEDICATION
receptor I-MEDICATION
blockers I-MEDICATION
and O
was O
transitioned O
from O
IV O
to O
PO O
steroids B-MEDICATION
and O
benadryl B-MEDICATION
and O
observed O
overnight O
and O
was O
discharged O
on O
her O
home B-MEDICATION
meds I-MEDICATION
, O
prednisone B-MEDICATION
taper I-MEDICATION
, O
GI B-MEDICATION
prophylaxis I-MEDICATION
with I-MEDICATION
PPI I-MEDICATION
, O
Calcium B-MEDICATION
and O
vitamin B-MEDICATION
D I-MEDICATION
, O
and O
SS B-MEDICATION
bactrim I-MEDICATION
for O
PCP O
. O



70 O
y O
o O
with O
COPD O
on O
2 O
. O
5 O
3 O
. O
5L O
O2 O
at O
baseline O
, O
OSA O
and O
obesity O
hypoventilation O
syndrome O
, O
dCHF O
, O
discharged O
2132 O
8 O
24 O
now O
presents O
with O
agitation O
and O
altered O
mental O
status O
with O
hypoxia O
and O
O2 O
sats O
70s O
on O
BipAp O
with O
5L O
. O
Pt O
agitated O
then O
somnolent O
at O
initial O
presentation O
. O
Daughter O
reported O
increased O
agitation O
and O
altered O
mental O
status O
x O
2 O
3 O
days O
with O
O2 O
sats O
60s O
70s O
at O
home O
. O
Daughter O
has O
also O
noted O
increased O
LE O
edema O
and O
weight O
gain O
which O
prompted O
a O
phone O
call O
to O
her O
PCP O
and O
increased O
lasix O
dose O
from O
80daily O
to O
100mg O
daily O
with O
some O
mild O
improvement O
in O
edema O
. O
She O
has O
had O
decreased O
appetite O
, O
PO O
intake O
, O
energy O
level O
at O
home O
with O
difficulty O
with O
ADLs O
. O
No O
recent O
history O
of O
fever O
, O
cough O
, O
chills O
, O
sputum O
production O
, O
CP O
, O
abd O
pain O
, O
or O
other O
complaints O
other O
than O
chronic O
right O
thigh O
pain O
last O
1 O
2 O
months O
. O
Daughter O
also O
reports O
med O
compliance O
and O
compliance O
with O
BiPap B-MEDICATION
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 O
mental O
status O
, O
and O
urosepsis O
presents O
to O
the O
hospital O
in O
urosepsis O
now O
resolved O
after O
treatment O
with O
vanc B-MEDICATION
meropenem B-MEDICATION
. 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 O
strictures O
. O
Significant O
leaking O
around O
suprapubic O
cath O
site O
. O
Started O
on O
ditropan B-MEDICATION
changed O
over O
to O
detrol B-MEDICATION
. 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 O
rigors O
and O
bandemia O
. O
Over O
the O
last O
few O
weeks O
leading O
up O
to O
admission O
, O
she O
has O
been O
experiencing O
mid O
abdominal O
pain O
, O
radiating O
to O
the O
left O
flank O
. O
It O
lasts O
throughout O
the O
day O
is O
not O
increased O
by O
eating O
though O
there O
is O
associated O
vomiting O
and O
is O
worsened O
with O
coughing O
. O
CT O
abdomen O
without O
contrast O
was O
then O
performed O
on O
4 O
20 O
showing O
a O
large O
9 O
. O
5 O
x O
7 O
. O
5 O
x O
6 O
. O
0 O
cm O
heterogeneous O
left O
upper O
abdominal O
mass O
. O
Patient O
underwent O
a O
EUS O
with O
biopsy 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 B-MEDICATION
antibiotics I-MEDICATION
Zosyn B-MEDICATION
, O
then O
ceftriaxone B-MEDICATION
and O
flagyl B-MEDICATION
and O
will O
continue O
on O
them O
until O
seen O
by O
ID O
as O
an O
outpatient O
. O
Past O
Medical O
History O
1 O
. O
Coronary O
artery O
disease O
with O
history O
of O
angioplasty O
in O
State O
108 O
one O
year O
ago O
2 O
. O
Mitral O
valve O
prolapse O
3 O
. O
Atrial O
fibrillation O
4 O
. O
Hyperlipemia O
5 O
. O
Hypertension O
6 O
. O
Chronic O
kidney O
disease O
SCr O
2 O
. O
1 O
in O
3 O
17 O
7 O
. O
Hypothyroidism O
? O
TSH O
10 O
in O
3 O
17 O
8 O
. O
Anemia O
HCT O
30 O
. O
7 O
in O
3 O
17 O

79 O
yo O
F O
with O
multifactorial O
chronic O
hypoxemia O
and O
dyspnea O
thought O
due O
to O
diastolic O
CHF O
, O
pulmonary O
hypertension O
thought O
secondary O
to O
a O
chronic O
ASD O
and O
COPD O
on O
5L O
home O
oxygen O
admitted O
with O
complaints O
of O
worsening O
shortness O
of O
breath O
. O
Cardiology O
consult O
recommended O
a O
right O
heart O
cath O
for O
evaluation O
of O
response O
to O
sildenafil B-MEDICATION
but O
the O
patient O
refused O
. O
Pulmonary O
consult O
recommended O
an O
empiric O
, O
compassionate O
sildenafil B-MEDICATION
trial O
due O
to O
severe O
dyspneic O
symptomology O
preventing O
outpatient O
living O
, O
and O
the O
patient O
tolerated O
an O
inpatient O
trial O
without O
hypotension O
. O
Patient O
to O
f O
u O
with O
pulmonology O
to O
start O
sildenifil B-MEDICATION
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 O
, O
and O
generalized O
body O
aching O
x O
2 O
days O
. O
She O
was O
admitted O
last O
week O
with O
hypercalcemia O
and O
treated O
with O
pamidronate B-MEDICATION
30mg I-MEDICATION
, O
calcitonin B-MEDICATION
, O
and O
dialysis B-MEDICATION
. O
Patient O
was O
Initially O
treated O
with O
melphalan B-MEDICATION
and O
prednisone B-MEDICATION
, O
followed O
by O
VAD B-MEDICATION
regimen I-MEDICATION
, 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 B-MEDICATION
velcade I-MEDICATION
and O
thalidomide B-MEDICATION
, 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






A O
39 O
year O
old O
man O
came O
to O
the O
clinic O
with O
cough O
and O
shortness O
of O
breath O
that O
was O
not O
relieved O
by O
his O
inhaler B-MEDICATION
. 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 B-MEDICATION
corticosteroids I-MEDICATION
in O
the O
past O
week O
. O
He O
is O
a O
chef O
with O
a O
history O
of O
asthma O
for O
3 O
years O
, O
suffering O
from O
frequent O
cough O
, O
wheezing O
, O
and O
shortness O
of O
breath O
and O
chest O
tightness O
. O
The O
symptoms O
become O
more O
bothersome O
within O
1 O
2 O
hours O
of O
starting O
work O
every O
day O
and O
worsen O
throughout O
the O
work O
week O
. O
His O
symptoms O
improve O
within O
1 O
2 O
hours O
outside O
the O
workplace O
. O
Spirometry 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 B-MEDICATION
corticosteroid I-MEDICATION
ICS B-MEDICATION
and O
fluticasone B-MEDICATION
500 O
mcg O
salmeterol B-MEDICATION
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 O
urinary O
tract O
symptoms O
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 B-MEDICATION
D I-MEDICATION
1000 I-MEDICATION
units I-MEDICATION
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 O
in O
the O
right O
breast O
. O
She O
had O
no O
palpable O
masses O
on O
breast O
exam O
. O
Core 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 B-MEDICATION
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
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 B-MEDICATION
100 O
mg O
week O
plus O
RBV B-MEDICATION
400 O
mg O
day O
combination O
therapy O
for O
the O
past O
9 O
months O
. O
Direct O
antiviral B-MEDICATION
drugs I-MEDICATION
were O
added O
to O
his O
treatment O
6 O
months O
ago O
. O
His O
medical O
record O
shows O
previous O
positive O
HCV O
RNA O
tests O
as O
well O
as O
positive O
enzyme O
immunoassay O
for O
anti O
HCV O
antibodies O
. O
The O
recent O
biopsy 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 O
from O
esophageal O
varices O
, O
hemochromatosis O
, O
autoimmune O
hepatitis O
or O
metabolic O
liver O
disease O
. O
He O
is O
an O
alert O
male O
with O
no O
acute O
distress O
. O
His O
BP O
130 O
75 O
, O
HR O
90 O
min O
and O
BMI O
27 O
. O
His O
abdomen O
is O
soft O
with O
no O
ascites O
or O
tenderness O
. O
The O
lower O
extremities O
are O
normal O
with O
no O
edema O
. O

The O
patient O
is O
a O
60 O
year O
old O
Spanish O
man O
presenting O
with O
shortness O
of O
breath O
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 B-MEDICATION
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 B-MEDICATION
Neb I-MEDICATION
inhaled O
q4 O
hr O
PRN O
, O
Vit B-MEDICATION
D3 I-MEDICATION
1000 I-MEDICATION
units O
per O
day O
and O
Flomax B-MEDICATION
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 B-MEDICATION
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 B-MEDICATION
, 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 B-MEDICATION
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 B-MEDICATION
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 O
, O
vomiting O
, O
or O
abdominal O
discomfort O
, 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 O
, O
weight O
gain O
and O
abnormal O
spotting O
between O
menses O
. O
No O
hirsutism O
or O
nipple O
discharge O
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 B-MEDICATION
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 O
. O
She O
lost O
interest O
in O
activities O
she O
used O
to O
enjoy O
. O
She O
states O
that O
her O
mood O
is O
mostly O
depressed O
for O
the O
past O
3 O
weeks O
. O
She O
also O
lost O
her O
appetite O
, O
which O
led O
to O
about O
5kg O
weight O
loss O
. O
She O
complains O
of O
loss O
of O
energy O
and O
feelings O
of O
worthlessness O
nearly O
every O
day O
. O
She O
is O
not O
using O
any O
drugs O
and O
she O
does O
not O
smoke O
. O
She O
doesn O
' O
t O
drink O
alcohol O
. O
She O
used O
to O
exercise O
every O
day O
for O
at O
least O
30 O
min O
. O
But O
she O
doesn O
' O
t O
have O
enough O
energy O
to O
do O
so O
for O
the O
past O
3 O
weeks O
. O
She O
also O
has O
some O
digestive O
issues O
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
. O
Her O
husband O
was O
recently O
diagnosed O
with O
colon O
cancer O
and O
he O
is O
starting O
his O
chemotherapy 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 B-MEDICATION
D3 I-MEDICATION
1000 I-MEDICATION
units O
daily O
. O
Her O
family O
history O
is O
negative O
for O
any O
psychologic O
problems O
. O
Her O
HAM O
D O
score O
is O
20 O
. O


The O
patient O
is O
a O
35 O
year O
old O
woman O
with O
myasthenia O
gravis O
, O
class O
IIa O
. O
She O
complains O
of O
diplopia O
and O
fatigue O
and O
weakness O
that O
affects O
mainly O
her O
upper O
limbs O
. O
She O
had O
a O
positive O
anti O
AChR O
antibody O
test O
, O
and O
her O
single O
fiber O
electromyography O
SFEMG O
was O
positive O
. O
She O
takes O
pyridostigmine B-MEDICATION
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
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 O
of O
movement O
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 O
and O
slow O
movement O
. 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 B-MEDICATION
and O
Trihexyphenidyl B-MEDICATION
. O
He O
stated O
his O
medications O
help O
with O
shaking O
and O
slow O
movement O
. O
But O
he O
still O
has O
difficulty O
initiating O
movements O
, O
stiffness O
and O
slowness O
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


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 O
, O
profuse O
nocturnal O
sweating O
and O
loss O
of O
appetite O
. 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 O
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 B-MEDICATION
, O
streptomycin B-MEDICATION
, O
rifampicin B-MEDICATION
and O
ethambutol B-MEDICATION
. 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 O
extremity O
weakness O
, O
associated O
with O
dark O
visual O
spot O
in O
right O
eye O
, O
right O
facial O
numbness O
, O
facial O
drop O
and O
slurred O
speech O
. O
He O
denied O
dyspnea O
, O
headache O
, O
palpitations O
, O
chest O
pain O
, O
fever O
, O
dizziness O
, O
bowel O
or O
urinary O
incontinence O
, O
loss O
of O
consciousness O
. O
His O
medical O
history O
was O
significant O
for O
hypertension O
, O
hyperlipidemia O
and O
hypothyroidism O
. O
He O
smokes O
cigarette O
1 O
pack O
per O
day O
for O
40 O
years O
and O
alcohol O
consumption O
of O
5 O
to O
6 O
beers O
per O
week O
. O
He O
is O
not O
aware O
about O
his O
family O
history O
. O
He O
is O
using O
Levothyroxine B-MEDICATION
, O
Atorvastatin B-MEDICATION
and O
HTCZ B-MEDICATION
. O
His O
vital O
signs O
were O
stable O
in O
the O
primary O
evaluation O
. O
Left O
sided O
facial O
droop O
, O
dysarthria O
, O
and O
left O
sided O
hemiplegia O
were O
seen O
in O
the O
physical O
exam O
. O
His O
National O
Institutes O
of O
Health O
Stroke O
Scale O
NIHSS O
score O
was O
calculated O
as O
7 O
. O
Initial O
CT 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 O
delay O
. 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 B-MEDICATION
therapy I-MEDICATION
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
57 O
year O
old O
man O
was O
admitted O
to O
the O
clinic O
because O
of O
weight O
loss O
and O
persistent O
dry O
cough O
4 O
months O
ago O
. O
Chest 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 O
granulomas O
with O
multinucleated O
giant O
cells O
and O
the O
Wegener O
's O
granulomatosis O
was O
diagnosed O
for O
him O
. O
He O
is O
treating O
with O
corticosteroid B-MEDICATION
and O
cyclophosphamides B-MEDICATION
since O
4 O
months O
ago O
. O
His O
Birmingham O
Vasculitis O
Activity O
Score O
BVAS O
is O
above O
4 O
since O
the O
beginning O
of O
his O
disease O
. O
His O
last O
physical O
exam O
and O
lab O
study O
was O
performed O
yesterday O
and O
showed O
the O
results O
bellow O
A O
wellbeing O
, O
well O
nourished O
man O
, O
non O
icteric O
, O
cooperative O
and O
alert O
Weight O
73 O
kg O
Height O
177 O
BP O
120 O
80 O
HR O
90 O
min O
RR O
22 O
min O
Hgb O
13 O
g O
dl O
WBC O
8000 O
mm3 O
Neutrophil O
2700 O
mm3 O
Plt O
300000 O
ml O
AST O
40 O
U O
L O
ALT O
56 O
U O
L O
Alk O
P O
147 O
U O
L O
Bill O
total O
1 O
. O
2 O
mg O
dl O
ESR O
120 O
mm O
hr O
MPO O
ANCA O
153 O
EU O

The O
patient O
is O
a O
41 O
year O
old O
man O
and O
a O
known O
case O
of O
Acromegaly O
who O
underwent O
transsphenoidal O
surgery O
4 O
months O
ago O
. O
He O
came O
to O
the O
clinic O
for O
the O
follow O
up O
lab O
studies O
after O
his O
primary O
resection O
surgery O
. O
His O
lab O
study O
shows O
the O
IGF O
1 O
level O
of O
4 O
. O
5 O
ULN O
adjusted O
by O
sex O
and O
age O
. O
His O
random O
GH O
level O
is O
4 O
ug O
L O
. O
The O
recent O
brain O
MRI O
confirmed O
the O
residual O
pituitary O
tumor O
. O
His O
past O
medical O
history O
is O
only O
significant O
for O
acromegaly O
due O
to O
pituitary O
adenoma O
and O
the O
recent O
surgery O
. O
After O
his O
surgery O
he O
takes O
only O
vitamin B-MEDICATION
D I-MEDICATION
and O
multivitamins B-MEDICATION
. 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 B-MEDICATION
shot I-MEDICATION
in O
early O
October O
. O
She O
works O
in O
a O
rehab O
center O
and O
has O
no O
underlying O
disease O
. O
It O
's O
her O
first O
time O
getting O
the O
vaccine O
this O
year O
. O
She O
is O
married O
for O
5 O
years O
and O
uses O
barrier O
methods O
of O
contraception O
. O
Her O
menstrual O
cycle O
is O
irregular O
. O
She O
does O
not O
smoke O
. O
She O
is O
not O
on O
any O
medications O
. O
She O
exercises O
regularly O
for O
30 O
minutes O
a O
day O
at O
least O
5 O
days O
a O
week O
. O
She O
has O
no O
history O
of O
allergies O
to O
any O
food O
or O
drugs O
. O
Her O
past O
surgical O
history O
is O
significant O
for O
tonsillectomy O
and O
she O
is O
otherwise O
healthy 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 O
, O
generalized O
bone O
pain O
and O
difficulty O
chewing O
that O
started O
6 O
years O
ago O
and O
is O
worsening O
. O
Examination O
shows O
bilateral O
swellings O
around O
the O
molars O
. O
The O
swellings O
have O
increased O
since O
his O
last O
examination O
. O
Several O
extraoral O
lesions O
are O
detected O
in O
the O
head O
and O
face O
. O
The O
swellings O
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 B-MEDICATION
will O
be O
started O
as O
first O
line O
therapy O
. O


The O
patient O
is O
a O
60 O
year O
old O
woman O
admitted O
to O
the O
stroke O
department O
with O
a O
recent O
history O
of O
a O
second O
course O
of O
intravenous B-MEDICATION
antibiotics I-MEDICATION
for O
aspiration O
pneumonia O
. O
She O
is O
febrile B-MEDICATION
and O
complained O
of O
abdominal B-MEDICATION
pain I-MEDICATION
and O
diarrhea B-MEDICATION
bowel O
movements O
eight O
times O
in O
3 O
hours O
, O
large O
volumes O
of O
greenish O
, O
liquid O
stool O
each O
time O
. O
The O
patient O
's O
abdomen O
is O
generally O
tender O
and O
distend O
with O
hyperactive O
bowel O
sounds O
. O
She O
is O
febrile B-MEDICATION
38 O
. O
4 O
C O
, O
tachycardic B-MEDICATION
113 O
min O
and O
hypotensive B-MEDICATION
80 O
40 O
mmHg O
. O
The O
stool O
samples O
must O
were O
positive O
for O
Clostridium O
difficile O
toxin 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 B-MEDICATION
pain I-MEDICATION
. O
The O
patient O
had O
severe O
pain B-MEDICATION
in I-MEDICATION
his I-MEDICATION
lower I-MEDICATION
back I-MEDICATION
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 B-MEDICATION
which O
was O
not O
beneficial O
to O
his O
pain O
. 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 O
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






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 O
pain O
and O
vomiting O
. O
The O
pain O
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 B-MEDICATION
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 O
of O
breath O
, O
chest O
tightening O
and O
cough O
. O
According O
to O
his O
mother O
, O
he O
didn O
' O
t O
respond O
to O
the O
usual O
corticosteroid B-MEDICATION
inhaler I-MEDICATION
. 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 B-MEDICATION
corticosteroid I-MEDICATION
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 B-MEDICATION
and O
Zafirlukast B-MEDICATION
. O


The O
patient O
is O
a O
45 O
year O
old O
postmenopausal O
woman O
with O
cytologically O
confirmed O
breast O
cancer O
. O
A O
core O
biopsy O
revealed O
a O
3 O
cm O
invasive O
ductal O
breast O
carcinoma O
in O
the O
left O
upper O
outer O
quadrant O
. O
The O
tumor O
is O
HER2 O
positive O
and O
ER O
PR O
negative O
. O
Axillary O
sampling O
revealed O
5 O
positive O
lymph O
nodes O
. O
CXR O
was O
remarkable O
for O
metastatic O
lesions O
. O
The O
patient O
is O
using O
multivitamins B-MEDICATION
and O
iron B-MEDICATION
supplements I-MEDICATION
. O
She O
does O
not O
smoke O
or O
consume O
alcohol O
. O
She O
is O
not O
sexually O
active O
and O
has O
no O
children O
. O
She O
is O
a O
candidate O
for O
tumor O
resection O
and O
agrees O
to O
do O
so O
prior O
to O
chemotherapy O
. O

A O
46 O
year O
old O
man O
presents O
with O
dizziness O
and O
frequent O
headaches O
. O
He O
has O
a O
family O
history O
of O
CAD O
, O
but O
no O
other O
cardiovascular O
risk O
factors O
such O
as O
smoking O
, O
high O
blood O
pressure O
, O
and O
diabetes O
mellitus O
and O
is O
physically O
active O
. O
The O
patient O
's O
LDL O
C O
and O
HDL O
C O
levels O
were O
545 O
and O
53 O
mg O
dL O
, O
respectively O
. O
His O
fasting O
glucose O
and O
triglyceride O
levels O
85 O
and O
158 O
mg O
dL O
, O
resp O
. O
were O
within O
normal O
limits O
. O
The O
patient O
reported O
no O
use O
of O
lipid B-MEDICATION
lowering I-MEDICATION
medications I-MEDICATION
. 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 O
was O
observed O
in O
the O
anterior O
and O
posterior O
walls O
of O
the O
internal O
carotid O
artery O
and O
common O
carotid O
artery O
, O
which O
were O
characterized O
as O
bulky O
plates O
extending O
to O
the O
middle O
third O
of O
the O
internal O
coronary O
arteries O
ICAs O
and O
as O
predominantly O
echogenic O
and O
hyperechoic O
, O
with O
less O
than O
50 O
of O
the O
area O
being O
echolucent O
with O
uneven O
surfaces O
. O


The O
patient O
is O
a O
55 O
year O
old O
man O
diagnosed O
with O
HCV O
2 O
years O
ago O
and O
the O
recent O
coinfection O
with O
HBV O
. O
His O
past O
medical O
history O
is O
non O
significant O
. O
He O
is O
on O
IFN B-MEDICATION
, O
RBV B-MEDICATION
and O
direct O
antiviral B-MEDICATION
drugs I-MEDICATION
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 O
from O
esophageal O
varices O
, O
hemochromatosis O
, O
autoimmune O
hepatitis O
, O
or O
metabolic O
liver O
disease O
. O
He O
is O
an O
alert O
male O
with O
no O
acute O
distress O
. O
His O
BP O
130 O
75 O
, O
HR O
90 O
min O
and O
BMI O
27 O
. O
His O
abdomen O
is O
soft O
with O
no O
ascites O
or O
tenderness O
. O
The O
lower O
extremities O
are O
normal O
with O
no O
edema O
. O

The O
patient O
is O
a O
25 O
year O
old O
man O
with O
type O
1 O
diabetes O
confirmed O
with O
molecular O
analysis O
7 O
years O
ago O
. O
He O
presents O
to O
the O
clinic O
with O
shortness O
of O
breath O
and O
fatigue O
during O
activities O
. O
He O
claims O
mild O
dyspnea O
after O
climbing O
3 O
floors O
, O
no O
dyspnea O
at O
rest O
and O
no O
angina O
New O
York O
Heart O
Association O
class O
2 O
. O
He O
is O
diagnosed O
with O
cardiomyopathy O
that O
will O
be O
treated O
with O
ACE B-MEDICATION
inhibitors I-MEDICATION
and O
Beta B-MEDICATION
blockers I-MEDICATION
. O
His O
takes O
70 B-MEDICATION
30 I-MEDICATION
Insulin I-MEDICATION
and O
vitamin B-MEDICATION
D I-MEDICATION
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



The O
patient O
is O
a O
23 O
year O
old O
man O
who O
came O
to O
the O
hospital O
with O
high O
blood O
pressure O
175 O
95 O
mmHg O
and O
signs O
of O
septicemia O
. O
He O
developed O
respiratory O
failure O
requiring O
mechanical O
ventilation O
and O
renal O
failure O
requiring O
hemodialysis 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 O
lactate O
dehydrogenase O
and O
reduced O
human O
complement O
C3 O
levels O
with O
a O
normal O
coagulation O
profile O
. O
He O
was O
diagnosed O
with O
atypical O
hemolytic O
uremic O
syndrome O
. O
He O
was O
treated O
with O
plasma B-MEDICATION
exchange I-MEDICATION
and O
corticosteroids B-MEDICATION
. 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 B-MEDICATION
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 B-MEDICATION
this O
year O
. O
she O
is O
menopausal O
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 B-MEDICATION
and O
anti B-MEDICATION
hypertensive I-MEDICATION
drugs I-MEDICATION
. 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 O
and O
loss O
of O
interest O
in O
daily O
activities O
. O
She O
states O
that O
her O
mood O
is O
still O
depressed O
most O
of O
the O
days O
. O
She O
complains O
of O
loss O
of O
energy O
and O
feelings O
of O
worthlessness O
nearly O
every O
day O
. O
She O
is O
on O
anti B-MEDICATION
depressants I-MEDICATION
for O
the O
past O
6 O
months O
, O
but O
the O
symptoms O
are O
still O
present O
. O
She O
does O
not O
drink O
alcohol O
or O
smoke O
. O
She O
used O
to O
exercise O
every O
day O
for O
at O
least O
30 O
min O
. O
, O
but O
she O
doesn O
' O
t O
have O
enough O
energy O
to O
do O
so O
for O
the O
past O
3 O
weeks O
. O
She O
also O
has O
some O
digestive O
issues O
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
. O
Her O
husband O
was O
diagnosed O
with O
colon O
cancer O
a O
year O
ago O
and O
is O
undergoing O
chemotherapy 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
34 O
year O
old O
obese O
woman O
who O
comes O
to O
the O
clinic O
with O
weight O
concerns O
. O
She O
is O
165 O
cm O
tall O
, O
and O
her O
weight O
is O
113 O
kg O
BMI O
41 O
. O
5 O
. O
In O
the O
past O
, O
she O
unsuccessfully O
used O
antiobesity B-MEDICATION
agents I-MEDICATION
and O
appetite B-MEDICATION
suppressants I-MEDICATION
. O
She O
is O
complaining O
of O
sleep B-MEDICATION
apnea I-MEDICATION
, O
PCO O
and O
dissatisfaction B-MEDICATION
with O
her O
body O
shape O
. O
She O
is O
a O
high O
school O
teacher O
. O
She O
is 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
rarely O
exercises O
and O
movement O
seems O
to O
be O
hard O
for O
her O
. O
She O
is O
not O
able O
to O
complete O
the O
four O
square O
step O
test O
in O
less O
than O
15 O
seconds O
. O
She O
does O
not O
smoke O
or O
use O
any O
drugs 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
lab O
results 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
She O
is O
considering O
a O
laparoscopic O
gastric O
bypass 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 O
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 B-MEDICATION
inhibitor I-MEDICATION
treatment I-MEDICATION
combined O
with O
immunosuppressants B-MEDICATION
. 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 O
, O
generalized O
bone O
pain O
and O
difficulty O
chewing O
that O
started O
6 O
years O
ago O
and O
is O
getting O
worse O
. O
Examination O
shows O
bilateral O
swellings O
around O
the O
molars O
. O
The O
swellings O
have O
increased O
since O
his O
last O
examination O
. O
Several O
extraoral O
lesions O
of O
the O
head O
and O
face O
are O
detected O
. O
The O
swellings O
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 B-MEDICATION
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 O
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 O
and O
slow O
movement O
. 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 B-MEDICATION
and O
Trihexyphenidyl B-MEDICATION
. 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