18320 lines (18064 with data), 137.1 kB

Patient O
presents O
with O
glaucoma O
, O
characterized O
by O
a O
definitive O
diagnosis O
of O
pigmentary O
glaucoma O
. O
Intraocular O
pressure O
measures O
at O
15 O
mmHg O
, O
while O
the O
visual O
field O
remains O
normal O
. O
Visual O
acuity O
is O
recorded O
as O
20 O
50 O
. O
The O
patient O
has O
not O
undergone O
prior O
cataract B-PROCEDURE
surgery I-PROCEDURE
, O
but O
has O
had O
LASIK B-PROCEDURE
surgery I-PROCEDURE
. O
Additionally O
, O
comorbid O
ocular O
diseases O
include O
macular O
degeneration O
. O

Patient O
has O
been O
diagnosed O
with O
primary O
open O
angle O
glaucoma O
. O
The O
patient O
's O
intraocular O
pressure O
is O
a O
concern O
and O
needs O
monitoring O
. O
There O
is O
moderate O
damage O
observed O
in O
the O
patient O
's O
visual O
field O
. O
The O
visual O
acuity O
is O
recorded O
at O
0 O
. O
3 O
. O
The O
patient O
has O
not O
undergone O
prior O
cataract B-PROCEDURE
surgery I-PROCEDURE
or O
LASIK B-PROCEDURE
surgery I-PROCEDURE
. O
The O
presence O
of O
corneal O
edema O
, O
along O
with O
glaucoma O
, O
suggests O
comorbid O
ocular O
diseases O
. O
The O
definitive O
diagnosis O
is O
primary O
open O
angle O
glaucoma O
, O
and O
the O
patient O
's O
ocular O
health O
requires O
close O
attention O
due O
to O
the O
combination O
of O
factors O
mentioned O
. O

The O
patient O
has O
been O
diagnosed O
with O
glaucoma O
, O
specifically O
primary O
open O
angle O
glaucoma O
POAG O
. O
Their O
intraocular O
pressure O
measures O
at O
48 O
mmHg O
, O
indicating O
elevated O
pressure O
within O
the O
eye O
. O
The O
patient O
exhibits O
advanced O
glaucomatous O
field O
damage O
in O
their O
visual O
field O
, O
and O
their O
visual O
acuity O
is O
recorded O
at O
20 O
150 O
. O
Notably O
, O
the O
patient O
has O
undergone O
prior O
cataract B-PROCEDURE
surgery I-PROCEDURE
. O
However O
, O
they O
have O
not O
had O
LASIK B-PROCEDURE
surgery I-PROCEDURE
. O
In O
addition O
to O
glaucoma O
, O
the O
patient O
also O
presents O
with O
comorbid O
ocular O
diseases O
, O
including O
diabetic O
retinopathy O
. O

Patient O
presents O
with O
uveitic O
glaucoma O
as O
the O
definitive O
diagnosis O
. O
Intraocular O
pressure O
measures O
at O
28 O
mmHg O
. O
Visual O
field O
assessment O
indicates O
early O
field O
damage O
. O
Visual O
acuity O
is O
measured O
at O
20 O
30 O
. O
No O
prior O
history O
of O
cataract B-PROCEDURE
surgery I-PROCEDURE
or O
LASIK B-PROCEDURE
surgery I-PROCEDURE
. O
Notably O
, O
patient O
also O
presents O
with O
comorbid O
ocular O
disease O
, O
specifically O
macular O
edema O
. O


The O
patient O
presents O
with O
neovascular O
glaucoma O
, O
as O
evidenced O
by O
an O
intraocular O
pressure O
of O
22 O
mmHg O
. O
Visual O
field O
assessment O
indicates O
normal O
results O
, O
and O
the O
visual O
acuity O
is O
measured O
at O
0 O
. O
2 O
. O
The O
patient O
has O
undergone O
prior O
cataract B-PROCEDURE
surgery I-PROCEDURE
but O
has O
not O
had O
LASIK B-PROCEDURE
surgery I-PROCEDURE
. O
There O
is O
no O
information O
available O
about O
comorbid O
ocular O
diseases O
. O










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

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

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

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












The O
patient O
's O
definitive O
diagnosis O
is O
sickle O
cell O
anemia O
SS O
genotype O
. O
A O
blood B-PROCEDURE
transfusion I-PROCEDURE
was O
administered O
one O
week O
ago O
. O
The O
hemoglobin O
level O
is O
currently O
5 O
. O
8 O
g O
dL O
. O
The O
patient O
's O
last O
vaso O
occlusive O
crisis O
occurred O
two O
months O
ago O
. O
There O
is O
no O
history O
of O
stroke O
. O

The O
individual O
has O
been O
diagnosed O
with O
sickle O
cell O
anemia O
SC O
, O
a O
hereditary O
blood O
disorder O
. O
Their O
hemoglobin O
level O
is O
8 O
. O
7 O
g O
dl O
. O
They O
have O
experienced O
five O
vaso O
occlusive O
crises O
in O
the O
last O
12 O
months O
. O
Additionally O
, O
the O
patient O
has O
a O
history O
of O
stroke O
that O
occurred O
12 O
years O
ago O
. O
Blood B-PROCEDURE
transfusion I-PROCEDURE
has O
never O
been O
administered O
to O
this O
patient O
. O

The O
patient O
has O
been O
diagnosed O
with O
sickle O
cell O
anemia O
SB O
. O
Three O
weeks O
ago O
, O
the O
patient O
received O
a O
blood B-PROCEDURE
transfusion I-PROCEDURE
. O
Their O
current O
hemoglobin O
level O
is O
10 O
. O
5 O
. O
The O
patient O
's O
last O
vaso O
occlusive O
crisis O
occurred O
six O
months O
ago O
, O
and O
they O
have O
never O
had O
a O
history O
of O
stroke O
. O

Patient O
has O
been O
diagnosed O
with O
sickle O
cell O
anemia O
. O
Definitive O
diagnosis O
indicates O
the O
presence O
of O
SS O
. O
The O
patient O
received O
a O
blood B-PROCEDURE
transfusion I-PROCEDURE
six O
months O
ago O
. O
Hemoglobin O
level O
is O
recorded O
at O
9 O
. O
0 O
g O
DL O
. O
The O
patient O
's O
most O
recent O
vaso O
occlusive O
crisis O
occurred O
2 O
years O
ago O
, O
while O
their O
medical O
history O
includes O
an O
ischemic O
stroke O
that O
occurred O
2 O
years O
ago O
. O

This O
patient O
, O
diagnosed O
with O
sickle O
cell O
anemia O
, O
has O
a O
hemoglobin O
level O
of O
7 O
. O
5 O
g O
dL O
. O
They O
experienced O
a O
vaso O
occlusive O
crisis O
two O
weeks O
ago O
but O
have O
no O
history O
of O
stroke O
. O
Blood B-PROCEDURE
transfusions I-PROCEDURE
have O
not O
been O
required O
in O
their O
medical O
history O
. O







78 O
M O
transferred O
to O
nursing O
home O
for O
rehab O
after O
CABG B-PROCEDURE
. O
Reportedly O
readmitted O
with O
a O
small O
NQWMI O
. O
Yesterday O
, O
he O
was O
noted O
to O
have O
a O
melanotic O
stool O
and O
then O
today O
he O
had O
approximately O
9 O
loose O
BM O
w O
some O
melena O
and O
some O
frank O
blood O
just O
prior O
to O
transfer O
, O
unclear O
quantity O
. O

A O
75F O
with O
a O
PMHx O
significant O
for O
severe O
PVD O
, O
CAD O
, O
DM O
, O
and O
CKD O
presented O
after O
being O
found O
down O
unresponsive O
at O
home O
. O
She O
was O
found O
to O
be O
hypoglycemic O
to O
29 O
with O
hypotension O
and O
bradycardia O
. O
Her O
hypotension O
and O
confusion O
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA B-PROCEDURE
which O
eventually O
grew O
klebsiella O
. O
She O
had O
temp O
96 O
. O
3 O
, O
respiratory O
rate O
22 O
, O
BP O
102 O
26 O
, O
a O
leukocytosis O
to O
18 O
and O
a O
creatinine O
of O
6 O
baseline O
2 O
. O
Pt O
has O
blood O
cultures O
positive O
for O
group O
A O
streptococcus O
. O
On O
the O
day O
of O
transfer O
her O
blood O
pressure O
dropped O
to O
the O
60s O
. O
She O
was O
anuric O
throughout O
the O
day O
. O
She O
received O
80mg O
IV O
solumedrol O
this O
morning O
in O
the O
setting O
of O
low O
BPs O
and O
rare O
eos O
in O
urine O
. O
On O
arrival O
to O
the O
MICU O
pt O
was O
awake O
but O
drowsy O
. O
On O
ROS O
, O
pt O
denies O
pain O
, O
lightheadedness O
, O
headache O
, O
neck O
pain O
, O
sore O
throat O
, O
recent O
illness O
or O
sick O
contacts O
, O
cough O
, O
shortness O
of O
breath O
, O
chest O
discomfort O
, O
heartburn O
, O
abd O
pain O
, O
n O
v O
, O
diarrhea O
, O
constipation O
, O
dysuria O
. O
Is O
a O
poor O
historian O
regarding O
how O
long O
she O
has O
had O
a O
rash O
on O
her O
legs O
. O

An O
87 O
yo O
woman O
with O
h O
o O
osteoporosis O
, O
multiple O
recent O
falls O
, O
CAD O
, O
who O
presents O
from O
nursing O
home O
with O
C2 O
fracture O
. O
The O
patient O
was O
in O
her O
usual O
state O
of O
health O
at O
her O
nursing O
home O
until O
yesterday O
morning O
when O
she O
sustained O
a O
fall O
when O
trying O
to O
get O
up O
to O
go O
to O
the O
bathroom O
. O
The O
fall O
was O
not O
witnessed O
, O
but O
the O
patient O
reportedly O
did O
not O
lose O
consciousness O
. O
The O
patient O
complained O
of O
neck O
and O
rib O
pain O
. O
She O
was O
taken O
to O
OSH O
, O
where O
she O
was O
found O
to O
have O
a O
comminuted O
fracture O
of O
C2 O
. O
In O
the O
ED O
, O
the O
patient O
's O
VS O
were O
T O
99 O
. O
1 O
, O
BP O
106 O
42 O
, O
P O
101 O
, O
R O
24 O
. O
She O
had O
an O
ECG B-PROCEDURE
which O
showed O
sinus O
tachycardia O
and O
ST O
depressions O
in O
V3 O
and O
V4 O
. O
CT B-PROCEDURE
head I-PROCEDURE
was O
negative O
for O
ICH O
. O

An O
82 O
man O
with O
chronic O
obstructive O
pulmonary O
disease O
, O
status B-PROCEDURE
post I-PROCEDURE
bioprosthetic I-PROCEDURE
atrial I-PROCEDURE
valve I-PROCEDURE
replacement I-PROCEDURE
for O
atrial O
stenosis O
, O
atrial O
fibrillation O
with O
cardioversion B-PROCEDURE
, O
right O
nephrectomy B-PROCEDURE
for O
renal O
cell O
carcinoma O
, O
colon O
cancer O
status O
post O
colectomy B-PROCEDURE
, O
presents O
with O
9 O
day O
history O
of O
productive O
cough O
, O
fever O
and O
dyspnea O
. O

A O
94 O
year O
old O
female O
with O
hx O
recent O
PE O
DVT O
, O
atrial O
fibrillation O
, O
CAD O
presents O
with O
fever O
and O
abdominal O
pain O
. O
Earlier O
, O
she O
presented O
with O
back O
pain O
and O
shortness O
of O
breath O
. O
She O
was O
found O
to O
have O
bilateral O
PE O
's O
and O
new O
afib O
and O
started O
on O
coumadin O
. O
Her O
HCT O
dropped O
slightly O
, O
requiring O
blood B-PROCEDURE
transfusion I-PROCEDURE
, O
with O
guaic O
positive O
stools O
. O
She O
was O
discharged O
and O
returned O
with O
abdominal O
cramping O
and O
black O
stools O
. O
EGD B-PROCEDURE
showed O
a O
small O
gastric O
and O
duodenal O
ulcer O
healing O
, O
esophageal O
stricture O
, O
no O
active O
bleeding O
. O
She O
also O
had O
an O
abdominal B-PROCEDURE
CT I-PROCEDURE
demonstrating O
a O
distended O
gallbladder O
with O
gallstones O
and O
biliary O
obstruction O
with O
several O
CBD O
stones O
. O

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

A O
G2P0010 O
26 O
yo O
F O
, O
now O
estimated O
to O
10 O
weeks O
pregnant O
, O
with O
4yr O
hx O
of O
IDDM O
. O
Last O
menstrual O
period O
is O
not O
known O
but O
was O
sometime O
three O
months O
ago O
. O
Five O
days O
ago O
, O
the O
patient O
began O
feeling O
achy O
and O
congested O
. O
She O
had O
received O
a O
flu B-PROCEDURE
shot I-PROCEDURE
about O
1 O
week O
prior O
. O
She O
continued O
to O
feel O
poorly O
and O
developed O
hyperemesis O
. O
She O
was O
seen O
in O
the O
ED O
but O
not O
admitted O
, O
where O
she O
was O
given O
IVF O
, O
Reglan O
and O
Tylenol O
and O
she O
was O
found O
to O
have O
a O
positive O
pregnancy O
test O
. O
Today O
, O
she O
returned O
to O
the O
ED O
with O
worsening O
of O
symptoms O
. O
She O
was O
admitted O
to O
the O
OB O
service O
and O
given O
IVF O
and O
Reglan O
. O
Of O
note O
, O
her O
labwork O
demonstrates O
a O
blood O
glucose O
of O
160 O
, O
bicarbonate O
of O
11 O
, O
beta O
hCG O
of O
3373 O
and O
ketones O
in O
her O
urine O
. O
Her O
family O
noted O
that O
she O
was O
breathing O
rapidly O
and O
was O
quite O
somnolent O
. O
She O
appears O
to O
be O
in O
respiratory O
distress O
. O

This O
is O
a O
24 O
and O
2 O
7 O
weeks O
, O
678 O
gm O
male O
, O
born O
to O
a O
34 O
year O
old O
G2 O
, O
P0 O
to O
3 O
woman O
. O
Prenatal O
screens O
were O
O O
positive O
, O
antibody O
negative O
, O
hepatitis O
B O
surface O
antigen O
negative O
, O
RPR O
nonreactive O
, O
rubella O
immune O
, O
and O
GBS O
unknown O
. O
This O
was O
an O
IVF O
pregnancy O
, O
notable O
for O
bleeding O
in O
the O
first O
trimester O
. O
The O
mother O
presented O
to O
the O
Hospital O
on O
the O
morning O
of O
delivery O
with O
premature O
rupture O
of O
membranes O
. O
Betamethasone O
was O
given O
approximately O
18 O
hours O
prior O
to O
delivery O
. O
The O
mother O
was O
also O
started O
on O
ampicillin O
, O
gentamycin O
, O
and O
magnesium O
sulfate O
. O
Mother O
's O
labor O
progressed O
despite O
magnesium O
and O
she O
developed O
fever O
and O
chills O
. O
Maximum O
temperature O
was O
101 O
. O
2 O
degrees O
. O
Because O
of O
progressive O
labor O
and O
concerns O
for O
chorioamnionitis O
, O
the O
decision O
was O
made O
to O
deliver O
the O
infants O
. O
Delivery O
was O
by O
cesarean B-PROCEDURE
section I-PROCEDURE
. O
The O
infant O
was O
intubated O
in O
the O
Delivery O
Room O
and O
Apgars O
were O
5 O
at O
one O
and O
8 O
at O
five O
minutes O
. O
Examination O
was O
notable O
for O
an O
extreme O
pre O
term O
infant O
, O
intubated O
. O
Weight O
was O
678 O
gm O
. O
Chest O
x O
ray O
shows O
respiratory O
immaturity O
and O
diffuse O
bilateral O
opacities O
within O
the O
lungs O
, O
left O
greater O
than O
right O
, O
with O
increased O
lung O
volumes O
. O

A O
55y O
o O
F O
with O
sarcoidosis O
, O
COPD O
, O
idiopathic O
cardiomyopathy B-PROCEDURE
with O
EF O
40 O
and O
diastolic O
dysfunction O
, O
varices O
s O
p O
TIPS O
and O
hypothyroidism O
presenting O
today O
with O
confusion O
. O
She O
was O
brought O
to O
the O
ED O
by O
her O
husband O
for O
evaluation O
after O
he O
noted O
worsening O
asterixis O
. O
While O
in O
the O
waiting O
room O
the O
pt O
became O
more O
combative O
and O
then O
unresponsive O
. O
In O
the O
ED O
VS O
Temp O
97 O
. O
9F O
, O
HR O
115 O
, O
BP O
122 O
80 O
, O
R O
18 O
, O
O2 O
sat O
98 O
2L O
NC O
. O
She O
was O
unresponsive O
but O
able O
to O
protect O
her O
airway O
and O
so O
not O
intubated O
. O
She O
vomited O
x1 O
and O
received O
Zofran O
as O
well O
as O
1 O
. O
5 O
L O
NS O
. O
Labs O
were O
significant O
for O
K O
5 O
. O
5 O
, O
BUN O
46 O
, O
Cr O
2 O
. O
2 O
up O
from O
baseline O
of O
0 O
. O
8 O
, O
and O
ammonia O
of O
280 O
. O
Stool O
was O
Guaiac O
negative O
. O
A O
urinalysis B-PROCEDURE
and O
CXR B-PROCEDURE
were O
done O
and O
are O
pending O
, O
and O
a O
FAST B-PROCEDURE
revealed O
hepatosplenomegaly O
but O
no O
intraperitoneal O
fluid O
. O


66 O
yo O
female O
pedestrian O
struck O
by O
auto O
. O
Unconscious O
and O
unresponsive O
at O
scene O
. O
Multiple O
fractures O
and O
complication O
secondary O
to O
the O
primary O
injury O
. O
S O
p O
embolization O
of O
the O
avulsed O
second O
branch O
of O
brachial O
artery O
, O
complicated O
by O
exp O
lap O
secondary O
to O
suspicion O
of O
abdominal O
compartment O
syndrome O
. O
Not O
much O
of O
the O
response O
after O
weaning O
the O
sedation O
with O
CT B-PROCEDURE
of O
the O
head O
showing O
extensive O
interparenchymal O
hemorrhages O
throughout O
. O


A O
52 O
year O
old O
woman O
with O
chronic O
obstructive O
pulmonary O
disease O
and O
breast O
cancer O
who O
presented O
to O
an O
outside O
hospital O
with O
shortness O
of O
breath O
and O
back O
pain O
for O
several O
weeks O
. O
Had O
been O
seen O
by O
primary O
care O
provider O
for O
the O
back O
pain O
and O
treated O
with O
pain O
medications O
. O
Subsequently O
developed O
rash O
that O
was O
thought O
to O
be O
zoster O
. O
In O
the O
last O
few O
days O
, O
oxygen O
requirement O
increased O
and O
she O
had O
cough O
, O
fevers O
and O
sore O
throat O
. O
Noted O
oxygen O
saturation O
of O
79 O
with O
ambulation O
at O
home O
. O
At O
outside O
hospital O
she O
was O
diagnosed O
with O
" O
multi O
focal O
pneumonia O
. O
" O
In O
the O
process O
of O
obtaining O
a O
computerized O
tomography B-PROCEDURE
scan O
, O
contrast O
infiltrated O
her O
arm O
with O
skin O
blistering O
and O
swelling O
. O
She O
was O
treated O
with O
ceftriaxone O
and O
transferred O
to O
current O
hospital O
. O

A O
67 O
y O
. O
o O
. O
M O
with O
end O
stage O
COPD O
on O
home O
oxygen O
, O
tracheobronchomalacia O
s O
p O
Y O
stent O
, O
h O
o O
RUL B-PROCEDURE
resection I-PROCEDURE
for O
squamous O
cell O
carcinoma O
with O
Cyberknife O
treatment O
. O
Patient O
had O
Y O
stent O
placed O
complicated O
by O
cough O
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy B-PROCEDURE
was O
at O
OSH O
, O
where O
patient O
had O
copious O
secretions O
that O
were O
aspirated O
. O
Pt O
reports O
compliance O
with O
Mucomyst O
nebs O
and O
Mucinex O
. O
Patient O
reports O
decreaed O
appetitie O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
Smokes O
5 O
cig O
day O
. O
PET B-PROCEDURE
scan O
revealed O
FDG O
avid O
soft O
tissue O
mass O
adjacent O
to O
lung O
resection O
site O
with O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
On O
arrival O
, O
vitals O
were O
T98 O
. O
6 O
HR86 O
BP106 O
78 O
O289 O
. O
Pt O
denied O
chest O
pain O
, O
palpitations O
, O
trauma O
, O
F O
C O
, O
N O
V O
D O
. O
Pt O
. O
presents O
with O
worsening O
SOB O
with O
R O
shoulder O
pain O
and O
weakness O
. O



A O
40 O
year O
old O
woman O
with O
a O
history O
of O
alcoholism O
complicated O
by O
Delirium O
Tremens O
and O
seizures O
2 O
years O
ago O
, O
polysubstance O
abuse O
ncluding O
IV O
heroin O
, O
cocaine O
, O
crack O
last O
use O
2 O
years O
ago O
, O
heroin O
inhalation O
last O
use O
2 O
days O
ago O
, O
hep O
C O
, O
presents O
for O
voluntary O
admission O
for O
detox B-PROCEDURE
. O
The O
patient O
would O
like O
to O
undergo O
detoxification B-PROCEDURE
so O
she O
can O
take O
care O
of O
her O
children O
. O
She O
also O
complains O
of O
abdominal O
pain O
in O
lower O
quadrants O
, O
radiating O
to O
the O
back O
since O
yesterday O
. O
She O
says O
the O
pain O
has O
worsened O
since O
yesterday O
and O
is O
not O
related O
to O
food O
intake O
. O
She O
also O
complains O
of O
nausea O
, O
vomitting O
bilious O
but O
nonbloody O
, O
and O
diarrhea O
no O
black O
or O
red O
stools O
. O
She O
stopped O
her O
methadone O
1 O
week O
ago O
in O
an O
effort O
to O
quit O
drug O
abuse O
. O
She O
reports O
dyspnea O
on O
exertion O
, O
orthopnea O
. O
Also O
describes O
weight O
gain O
. O
Labs O
are O
significant O
for O
elevated O
lipase O
. O



94M O
with O
CAD O
s O
p O
4v O
CABG O
, O
CHF O
, O
CRI O
presented O
with O
vfib O
arrest O
. O
Initial O
labs O
significant O
for O
K O
2 O
. O
7 O
. O
EKG B-PROCEDURE
showed O
sinus O
rhythm O
, O
HR O
80 O
with O
LAD O
, O
prolonged O
PR O
, O
TD O
0 O
. O
5 O
to O
1mm O
in O
V4 O
V6 O
. O
Echo O
showed O
Mildly O
depressed O
global O
left O
ventricular O
function O
, O
mild O
to O
moderate O
aortic O
regurgitation O
and O
mild O
mitral O
regurgitation O
. O

A O
63 O
yo O
man O
with O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic B-PROCEDURE
SCT I-PROCEDURE
, O
who O
presents O
with O
one O
week O
of O
worsening O
SOB O
and O
two O
days O
of O
a O
clear O
productive O
cough O
. O
The O
patient O
states O
his O
SOB O
occured O
when O
lying O
flat O
, O
but O
not O
with O
activity O
. O
Also O
admitted O
to O
chest O
pressure O
which O
would O
come O
and O
go O
in O
his O
left O
chest O
no O
related O
to O
the O
SOB O
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND O
; O
admits O
to O
a O
slight O
increase O
in O
lower O
extremity O
edema O
. O
Admits O
to O
low O
grade O
fevers O
to O
the O
99 O
's O
and O
crampy O
abdominal O
pain O
. O
Denies O
chills O
, O
night O
sweats O
, O
vomiting O
, O
or O
diarrhea O
. O
Patient O
also O
has O
a O
history O
of O
CMV O
infection O
, O
aspergillus O
and O
Leggionare O
's O
disease O
and O
is O
on O
posaconazole O
. O
His O
CXR B-PROCEDURE
showed O
an O
opacification O
of O
the O
left O
basilar O
lobe O
and O
also O
right O
upper O
lobe O
concerning O
for O
pneumonia O
as O
well O
as O
a O
small O
loculated O
right O
pleural O
effusion O
. O

85M O
dementia O
, O
colon O
cancer O
and O
recent O
colectomy B-PROCEDURE
with O
primary O
reanastomosis B-PROCEDURE
p O
w O
melena O
. O
HCT O
30 O
to O
23 O
but O
hemodynamically O
stable O
. O
NGL O
negative O
. O
Exam O
notable O
for O
Tm O
99 O
BP O
128 O
50 O
HR O
70 O
RR O
16 O
with O
sat O
100 O
on O
RA O
. O
WD O
man O
, O
NAD O
. O
Chest O
clear O
, O
JVP O
8cm O
. O
RR O
s1s2 O
. O
Soft O
abdomen O
, O
well O
healed O
surgical O
scar O
. O
No O
edema O
or O
cord O
. O
Labs O
notable O
for O
WBC O
7K O
, O
HCT O
24 O
, O
K O
4 O
. O
0 O
, O
Cr O
0 O
. O
7 O
. O

51 O
year O
old O
man O
with O
multiple O
sclerosis O
, O
quadriparesis O
, O
hypertension O
, O
restrictive O
lung O
disease O
, O
chronic O
constipation O
and O
small O
bowel O
obstruction O
after O
ileostomy B-PROCEDURE
, O
multiple O
urinary O
tract O
infections O
also O
after O
placement O
of O
suprapubic O
tube O
, O
presents O
with O
small O
bowel O
obstruction O
and O
urinary O
tract O
infection O
. O
Admitted O
today O
as O
his O
home O
health O
aide O
noticed O
his O
urine O
output O
was O
low O
, O
75cc O
overnight O
when O
he O
usually O
has O
about O
1 O
liter O
overnight O
. O
Over O
the O
past O
two O
weeks O
he O
has O
had O
mild O
earaches O
, O
a O
sorethroat O
as O
well O
as O
some O
rhinorrhea O
. O
He O
denies O
any O
abdominal O
pain O
, O
has O
not O
sujectively O
noticed O
any O
change O
in O
abdominal O
distention O
. O
In O
the O
Emergency O
Department O
, O
he O
was O
noted O
to O
be O
severely O
dehydrated O
on O
exam O
, O
and O
creatinine O
level O
was O
1 O
. O
4 O
up O
from O
0 O
. O
6 O
. O

The O
patient O
is O
a O
79 O
yoF O
w O
a O
h O
o O
CAD O
s O
p O
RCA B-PROCEDURE
stenting I-PROCEDURE
, O
diastolic O
CHF O
, O
1 O
MR O
, O
HTN O
, O
Hyperlipidemia O
, O
previous O
smoking O
history O
, O
and O
atrial O
fibrillation O
who O
presents O
for O
direct O
admission O
from O
home O
for O
progressive O
shortness O
of O
breath O
. O
According O
to O
Pt O
, O
her O
primary O
complaint O
is O
not O
shortness O
of O
breath O
, O
but O
cough O
X O
1 O
week O
which O
has O
been O
rarely O
productive O
of O
white O
sputum O
. O
She O
denies O
associated O
fevers O
, O
chills O
, O
nausea O
, O
vomiting O
, O
pleuritic O
pain O
, O
weight O
gain O
, O
or O
dietary O
indiscretion O
. O
She O
also O
reports O
a O
sore O
throat O
over O
the O
past O
3 O
days O
. O
She O
recently O
underwent O
thoracentesis B-PROCEDURE
for O
a O
moderate O
size O
pleueral O
effusion O
. O
Cytology O
of O
the O
effusion O
was O
negative O
for O
malignant O
cells O
. O
Pt O
denies O
recent O
palpitations O
, O
and O
reports O
that O
she O
has O
been O
compliant O
with O
all O
medications O
. O
She O
admits O
to O
recent O
fatigue O
and O
2 O
pillow O
orthopnea O
which O
has O
been O
present O
for O
months O
. O
Current O
etiology O
considerations O
include O
CHF O
vs O
intrinsic O
pulmonary O
disease O
infiltrative O
vs O
embolic O
disease O
. O
In O
order O
to O
optimize O
cardic O
function O
with O
atrial O
kick O
, O
pt O
underwent O
cardioversion B-PROCEDURE
and O
became O
hypotensive O
with O
a O
junctional O
rhythm O
requiring O
intubation O
. O
She O
was O
placed O
on O
dobutamine O
. O
Off O
of O
dobutamine O
, O
cardiac O
monitoring O
demonstrated O
a O
long O
QTc O
of O
700 O
and O
an O
atrial O
escape O
rhythm O
. O

A O
64 O
yo O
female O
with O
with O
history O
of O
atrial O
fibrillation O
, O
Chronic O
Obstructive O
Pulmonary O
Disease O
, O
hypertension O
, O
hyperlipidemia O
, O
repair O
of O
an O
atrial O
septum O
defect O
which O
was O
complicated O
by O
sternal O
wound O
infection O
and O
post O
operative O
atrial O
fibrillation O
treated O
with O
amiodarone O
, O
was O
initially O
admitted O
through O
the O
Emergency O
Department O
with O
shortness O
of O
breath O
and O
back O
pain O
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
rapid O
ventricular O
response O
. O
A O
computed B-PROCEDURE
tomography I-PROCEDURE
angiography I-PROCEDURE
demonstrated O
diffuse O
left O
anterior O
descending O
artery O
and O
post O
obstructive O
pneumonia O
concerning O
for O
malignancy O
. O
For O
her O
atrial O
fibrillation O
, O
she O
was O
started O
on O
diltiazem O
. O
For O
the O
pneumonia O
, O
she O
was O
treated O
with O
antibiotics O
. O
She O
was O
then O
transferred O
to O
the O
floor O
later O
that O
same O
night O
on O
metoprolol O
50 O
mg O
tid O
. O
While O
on O
the O
floor O
, O
she O
had O
a O
bronchoscopy B-PROCEDURE
performed O
which O
showed O
external O
compression O
of O
her O
left O
mainstem O
bronchus O
, O
and O
she O
had O
a O
biopsy B-PROCEDURE
via O
fine O
needle O
aspiration O
, O
which O
showed O
large O
cell O
carcinoma O
. O
She O
denies O
chest O
pain O
, O
shortness O
of O
breath O
and O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations O
. O


A O
96 O
y O
o O
female O
found O
unresponsive O
on O
ground O
at O
nursing O
home O
. O
Pt O
was O
in O
dining O
room O
and O
found O
by O
staff O
. O
Unresponsive O
for O
1 O
min O
after O
found O
. O
Pt O
cannot O
recollect O
events O
preceding O
fall O
but O
with O
some O
c O
o O
HA O
and O
some O
neck O
shoulder O
discomfort O
. O
NCHCT O
showed O
9mm O
L O
parietal O
SDH O
. O
C O
spine O
negative O
. O
Imaging O
CT B-PROCEDURE
head I-PROCEDURE
w O
o O
contrast O
Acute O
left O
subdural O
hematoma O
measuring O
1 O
. O
5 O
cm O
maximal O
dimensions O
with O
leftward O
subfalcine O
herniation O
of O
8 O
mm O
, O
downward O
transtentorial O
herniation O
with O
obliteration O
of O
the O
left O
suprasellar O
cistern O
, O
and O
uncal O
herniation O
. O
No O
fx O
, O
destructive O
infiltrative O
lesion O
involving O
the O
skull O
base O
. O

85 O
y O
o O
F O
with O
PMHx O
of O
HTN O
, O
HL O
, O
h O
o O
breast O
CA O
and O
3cm O
renal O
pelvis O
transitional O
cell O
tumor O
who O
presented O
for O
nephrectomy B-PROCEDURE
. O
Her O
post O
op O
course O
was O
complicated O
by O
agitation O
thought O
due O
to O
narcotics O
. O
Today O
, O
she O
was O
restarted O
on O
her O
home O
meds O
and O
while O
on O
telemetry O
, O
pt O
was O
noted O
to O
be O
bradycardic O
to O
40s O
. O
Pt O
was O
triggered O
for O
SBP O
of O
70 O
and O
HR O
of O
40 O
during O
which O
she O
remained O
asymptomatic O
. O
She O
was O
given O
1L O
IVF O
and O
her O
HR O
BP O
trended O
back O
up O
to O
baseline O
. O
However O
, O
there O
was O
a O
second O
event O
an O
hour O
later O
when O
she O
sat O
up O
and O
became O
bradycardic O
in O
the O
30s O
with O
associated O
hypotension O
. O
Second O
episode O
occurred O
with O
position O
change O
and O
again O
, O
pt O
developped O
junctional O
rhythm O
in O
30s O
. O

This O
is O
a O
54 O
year O
old O
male O
patient O
with O
an O
idiopathic O
pulmonary O
fibrosis O
, O
who O
called O
today O
with O
worsening O
dyspnea O
for O
3 O
days O
. O
He O
had O
been O
in O
unusual O
state O
of O
good O
health O
at O
baseline O
respiratory O
status O
using O
4L O
nasal O
canula O
at O
rest O
and O
6L O
with O
exertion O
when O
3 O
days O
prior O
to O
admission O
, O
he O
hugged O
his O
cousin O
who O
has O
rats O
for O
pets O
and O
also O
the O
heat O
came O
up O
from O
the O
basement O
of O
his O
house O
. O
He O
feels O
that O
with O
these O
two O
events O
, O
his O
breathing O
became O
acutely O
worse O
and O
he O
is O
concerned O
for O
allergen O
exposure O
. O
He O
denies O
any O
sick O
contacts O
, O
fevers O
, O
chills O
, O
rhinorrhea O
. O
He O
did O
receive O
flu O
and O
pneumovax O
vaccines O
. O
He O
has O
had O
a O
recent O
admission O
last O
month O
with O
progressive O
dyspnea O
on O
exertion O
. O
The O
computed B-PROCEDURE
tomography I-PROCEDURE
revealed O
increased O
ground O
glass O
opacity O
in O
lower O
lobes O
superimposed O
on O
pulmonary O
fibrosis O
with O
elevated O
eosinophils O
peripherally O
12 O
. O
A O
bronchoalveolar O
lavage O
was O
also O
positive O
for O
eosinophils O
. O
He O
was O
started O
on O
high O
dose O
steroids O
prednisone O
60mg O
with O
plan O
for O
close O
outpatient O
follow O
up O
for O
eosinophilic O
lung O
disease O
. O
He O
was O
discharged O
on O
2 O
3L O
nasal O
canula O
. O
He O
then O
represented O
to O
the O
emergency O
department O
for O
spontaneous O
pneumomediastinum O
of O
unclear O
etiology O
. O
On O
day O
of O
current O
admission O
, O
the O
patient O
called O
his O
pulmonologist O
complaining O
of O
worsening O
shortness O
of O
breath O
since O
Saturday O
. O
Yesterday O
he O
was O
at O
pulmonary O
rehab O
and O
desaturated O
to O
the O
70s O
on O
6L O
with O
minimal O
exertion O
, O
and O
he O
is O
currently O
on O
4L O
nasal O
canula O
at O
rest O
. O
No O
sick O
contacts O
recently O
. O
He O
was O
asked O
to O
go O
to O
ED O
. O
In O
the O
ED O
, O
initial O
vs O
were O
98 O
. O
3 O
, O
96 O
, O
144 O
97 O
, O
24 O
, O
97 O
6L O
NC O
. O




The O
patient O
is O
an O
87 O
yo O
woman O
with O
h O
o O
osteoporosis O
, O
multiple O
recent O
falls O
, O
CAD O
, O
who O
presents O
from O
nursing O
home O
with O
C2 O
fracture O
and O
evidence O
of O
pulmonary O
emoblus O
. O
The O
patient O
was O
in O
her O
usual O
state O
of O
health O
at O
her O
nursing O
home O
until O
yesterday O
morning O
when O
she O
sustained O
a O
fall O
when O
trying O
to O
get O
up O
to O
go O
to O
the O
bathroom O
. O
The O
fall O
was O
not O
witnessed O
, O
but O
the O
patient O
reportedly O
did O
not O
lose O
consciousness O
. O
At O
3 O
30 O
that O
afternoon O
, O
the O
patient O
complained O
of O
neck O
and O
rib O
pain O
. O
She O
was O
taken O
to O
OSH O
, O
where O
she O
was O
found O
to O
have O
a O
comminuted O
fracture O
of O
C2 O
. O
She O
was O
transferred O
to O
Hospital1 O
1 O
for O
further O
evaluation O
. O
Of O
note O
, O
the O
patient O
was O
recently O
treated O
for O
CDiff O
infection O
at O
her O
nursing O
facility O
, O
per O
discussion O
with O
her O
daughter O
. O
. O
In O
the O
ED O
, O
the O
patient O
's O
VS O
were O
T O
99 O
. O
1 O
, O
BP O
106 O
42 O
, O
P O
101 O
, O
R O
24 O
. O
She O
had O
an O
ECG B-PROCEDURE
which O
showed O
sinus O
tachycardia O
and O
ST O
depressions O
in O
V3 O
and O
V4 O
. O
CT B-PROCEDURE
head I-PROCEDURE
was O
negative O
for O
ICH O
. O
She O
was O
seen O
by O
Trauma O
surgery O
, O
who O
recommended O
stabalization O
with O
a O
cervical O
collar O
for O
the O
next O
six O
to O
eight O
weeks O
, O
but O
they O
deemed O
that O
she O
is O
not O
an O
operable O
candidate O
. O

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

This O
is O
a O
Age O
over O
90 O
year O
old O
female O
with O
hx O
recent O
PE O
DVT O
, O
atrial O
fibrillation O
, O
CAD O
who O
is O
transfered O
from O
Hospital3 O
915 O
Hospital O
for O
ERCP B-PROCEDURE
. O
She O
has O
had O
multiple O
admissions O
to O
Hospital3 O
915 O
this O
past O
month O
, O
most O
recently O
on O
2963 O
11 O
24 O
. O
In O
early O
Month O
only O
776 O
, O
she O
presented O
with O
back O
pain O
and O
shortness O
of O
breath O
. O
She O
was O
found O
to O
have O
bilateral O
PE O
's O
and O
new O
afib O
and O
started O
on O
coumadin O
. O
Her O
HCT O
dropped O
slightly O
, O
requiring O
blood O
transfusion O
, O
with O
guaic O
positive O
stools O
. O
She O
was O
discharged O
and O
returned O
with O
abdominal O
cramping O
and O
black O
stools O
. O
She O
was O
found O
to O
have O
a O
HCT O
drop O
from O
32 O
to O
21 O
. O
She O
was O
given O
vit O
K O
, O
given O
a O
blood O
transfusion O
and O
started O
on O
protonix O
. O
She O
received O
an O
IVF O
filter O
and O
EGD O
. O
EGD O
showed O
a O
small O
gastric O
and O
duodenal O
ulcer O
healing O
, O
esophageal O
stricture O
, O
no O
active O
bleeding O
. O
She O
also O
had O
an O
abdominal O
CT B-PROCEDURE
demonstrating O
a O
distended O
gallbladder O
with O
gallstones O
and O
biliary O
obstruction O
with O
several O
CBD O
stones O
. O
Since O
12 O
AM O
Tmax O
38 O
C O
100 O
. O
4 O
Tcurrent O
37 O
. O
4 O
C O
99 O
. O
4 O
HR O
92 O
83 O
94 O
bpm O
BP O
89 O
32 O
54 O
89 O
32 O
54 O
94 O
37 O
60 O
mmHg O
RR O
23 O
23 O
33 O
insp O
min O
SpO2 O
100 O
Heart O
rhythm O
SR O
Sinus O
Rhythm O

Ms O
. O
Known O
patient O
lastname O
is O
a O
G2P0010 O
26 O
yo O
F O
, O
now O
estimated O
to O
10 O
weeks O
pregnant O
. O
Pt O
has O
4yr O
hx O
of O
IDDM O
. O
LMP O
is O
not O
known O
but O
was O
sometime O
in O
Month O
only O
. O
On O
3243 O
11 O
10 O
, O
the O
patient O
began O
feeling O
achy O
and O
congested O
. O
She O
had O
received O
a O
flu O
shot O
about O
1 O
week O
prior O
. O
She O
continued O
to O
feel O
poorly O
on O
3243 O
11 O
11 O
, O
and O
developed O
hyperemesis O
. O
She O
was O
seen O
in O
the O
ED O
but O
not O
admitted O
at O
Hospital3 O
, O
where O
she O
was O
given O
IVF O
, O
Reglan O
and O
Tylenol O
and O
she O
was O
found O
to O
have O
a O
positive O
pregnancy O
test O
. O
Today O
, O
she O
returned O
to O
the O
ED O
with O
worsening O
of O
symptoms O
. O
She O
was O
admitted O
to O
the O
OB O
service O
and O
given O
IVF O
and O
Reglan O
. O
Of O
note O
, O
her O
labwork O
demonstrates O
a O
blood O
glucose O
of O
160 O
, O
bicarbonate O
of O
11 O
, O
beta O
hCG O
of O
3373 O
and O
ketones O
in O
her O
urine O
. O
Her O
family O
noted O
that O
she O
was O
breathing O
rapidly O
and O
was O
quite O
somnolent O
. O
She O
appears O
to O
be O
in O
respiratory O
distress O
. O
. O
The O
falling O
beta O
HCG O
and O
trans B-PROCEDURE
abdominal I-PROCEDURE
ultrasound I-PROCEDURE
indicate O
intra O
uterine O
fetal O
demise O
. O
Medications O
on O
Admission O
Lantus O
65 O
units O
qAM O
Novolog O
SSI O
Cortef O
3mg O
qAM O
, O
1mg O
qHS O
. O
Meds O
on O
Transfer O
Levophed O
Dopamine O
Solumedrol O
80mg O
IV O
Amiodarone O
load O
Insulin O
in O
D10 O

Mr O
. O
Known O
patient O
lastname O
7952 O
is O
a O
41 O
yo O
M O
with O
PMH O
ETOH O
abuse O
, O
cholelithiasis O
, O
HTN O
, O
obesity O
who O
presented O
to O
Hospital3 O
with O
hematemasis O
. O
He O
reports O
that O
for O
the O
past O
6 O
years O
he O
has O
been O
drinking O
2 O
9 O
of O
a O
1 O
. O
7L O
bottle O
of O
vodka O
daily O
. O
On O
Friday O
evening O
he O
had O
several O
episodes O
of O
vomiting O
of O
bright O
and O
dark O
red O
material O
for O
which O
he O
presented O
to O
Hospital1 O
. O
He O
had O
an O
NG O
tube O
which O
reportedly O
failed O
to O
clear O
with O
lavage O
and O
patient O
self O
d O
c O
' O
d O
the O
NGT O
because O
he O
was O
vomiting O
around O
the O
tube O
. O
He O
was O
given O
4mg O
IV O
morphine O
for O
abdominal O
pain O
, O
ativan O
2mg O
IV O
for O
withdrawal O
, O
protonix O
40mg O
IV O
, O
zofran O
8mg O
IV O
, O
octreotide O
50mcg O
IV O
, O
and O
1 O
unit O
of O
platelets O
. O
In O
the O
ED O
, O
initial O
vs O
were O
T O
98 O
. O
6 O
P66 O
BP145 O
89 O
R16 O
O2 O
sat O
98 O
RA O
. O
He O
was O
started O
on O
a O
protonix O
gtt O
and O
octreotide O
gtt O
given O
his O
elevated O
LFT O
's O
. O
He O
was O
also O
given O
a O
bananna O
bag O
. O
He O
had O
a O
RUQ B-PROCEDURE
ultrasound I-PROCEDURE
which O
demonstrated O
gallstones O
and O
sludge O
and O
per O
ED O
resident O
report O
ascites O
. O
As O
such O
given O
new O
ascites O
and O
abdominal O
pain O
he O
was O
given O
levofloxacin O
750mg O
IV O
and O
flagyl O
500mg O
IV O
reportedly O
for O
SBP O
prophylaxis O
. O
He O
was O
evaluted O
by O
GI O
in O
the O
ED O
. O
. O
On O
the O
floor O
, O
he O
reports O
that O
he O
had O
two O
episodes O
of O
vomiting O
of O
dark O
red O
emesis O
. O
Per O
his O
nurse O
it O
was O
about O
75ml O
and O
was O
gastrocult O
positive O
. O
He O
otherwise O
endorese O
RUQ O
pain O
radiating O
to O
his O
back O
. O
He O
also O
reports O
slow O
increase O
in O
abdominal O
girth O
with O
more O
acute O
distention O
and O
lower O
extremity O
swelling O
over O
the O
two O
days O
prior O
to O
admission O
. O
Physical O
Examination O
Vitals O
BP O
153 O
92 O
P O
64 O
R O
20 O
O2 O
97 O
RA O
General O
Alert O
, O
oriented O
, O
no O
acute O
distress O
, O
no O
asterixis O
HEENT O
Sclera O
icteric O
, O
dry O
mucous O
membranes O
Neck O
supple O
, O
obese O
, O
JVP O
not O
elevated O
Lungs O
bibasilar O
crackles O
, O
no O
wheezes O
CV O
Regular O
rate O
and O
rhythm O
, O
3 O
16 O
soft O
nonradiating O
systolic O
murmur O
Abdomen O
obese O
distended O
, O
RUQ O
and O
epigastric O
tenderness O
to O
palpation O
, O
normoactive O
bowel O
sounds O
, O
no O
rebound O
or O
guarding O
. O
Ext O
warm O
, O
well O
perfused O
, O
1 O
pitting O
edema O
bilaterally O
, O
2 O
pulses O
Labs O
WBC O
2 O
. O
5 O
Hct O
36 O
. O
2 O
Plt O
28 O
Cr O
0 O
. O
5 O
Glucose O
111 O
Other O
labs O
PT O
PTT O
INR O
19 O
. O
1 O
31 O
. O
6 O
1 O
. O
7 O
, O
ALT O
AST O
37 O
165 O
, O
Alk O
Phos O
T O
Bili O
130 O
6 O
. O
9 O
, O
Amylase O
Lipase O
145 O
288 O
, O
Albumin O
2 O
. O
5 O
g O
dL O
, O
LDH O
278 O
IU O
L O
, O
Ca O
7 O
. O
9 O
mg O
dL O
, O
Mg O
1 O
. O
7 O
mg O
dL O
, O
PO4 O
3 O
. O
0 O
mg O
dL O

Infant O
is O
a O
24 O
1 O
31 O
week O
, O
678 O
gm O
male O
triplet O
II O
who O
was O
admitted O
to O
the O
NICU O
for O
management O
of O
extreme O
prematurity O
. O
Infant O
was O
born O
to O
a O
34 O
y O
. O
o O
. O
G2P0 O
now O
3 O
mother O
. O
Prenatal O
screens O
O O
, O
antibody O
negative O
, O
HBsAg O
negative O
, O
RPR O
NR O
, O
RI O
, O
GBS O
unknown O
. O
IVF O
pregnancy O
notable O
for O
bleeding O
in O
the O
first O
trimester O
, O
cerclage O
placement O
at O
19 O
weeks O
, O
and O
premature O
rupture O
of O
membranes O
on O
3435 O
11 O
28 O
am O
. O
Mother O
presented O
to O
Hospital1 O
53 O
. O
Betamethasone O
given O
11 O
28 O
at O
0640 O
. O
Also O
started O
on O
ampicillin O
, O
gentamicin O
, O
and O
magnesium O
sulfate O
. O
Mother O
's O
labor O
progressed O
despite O
magnesium O
and O
she O
developed O
chills O
and O
a O
fever O
Tm O
101 O
. O
2 O
. O
Due O
to O
progressive O
labor O
and O
concerns O
for O
infection O
, O
decision O
made O
to O
deliver O
infants O
. O
Delivery O
by O
Cesarean B-PROCEDURE
section I-PROCEDURE
. O
Infant O
intubated O
in O
the O
Delivery O
Room O
and O
Apgars O
were O
5 O
at O
one O
and O
8 O
at O
five O
minutes O
. O
Infant O
transported O
to O
NICU O
. O
Exam O
VS O
per O
CareView O
, O
of O
note O
has O
required O
several O
boluses O
of O
NS O
for O
low O
BP O
. O
Exam O
notes O
recorded O
on O
newborn O
examination O
form O
. O
Growth O
measurements O
Wt O
678 O
25 O
. O
Resp O
Infant O
placed O
on O
SIMV O
. O
Rec O
' O
d O
1 O
dose O
of O
surfactant O
. O
CXR O
FINDINGS O
There O
are O
diffuse O
bilateral O
opacities O
within O
the O
lungs O
, O
left O
greater O
than O
right O
, O
with O
increased O
lung O
volumes O
. O
No O
pleural O
effusion O
or O
pneumothorax O
. O
An O
endotracheal O
tube O
is O
seen O
with O
tip O
approximately O
one O
vertebral O
body O
above O
the O
carina O
. O
An O
umbilical O
vein O
catheter O
is O
seen O
with O
tip O
in O
the O
superior O
vena O
cava O
and O
an O
umbilical O
artery O
catheter O
is O
seen O
with O
tip O
in O
the O
mid O
thoracic O
region O
. O
The O
imaged O
portions O
of O
the O
abdomen O
show O
a O
few O
Last O
Name O
un O
36399 O
filled O
loops O
of O
bowel O
within O
the O
left O
abdomen O
. O
No O
abnormal O
soft O
tissue O
mass O
or O
calcifications O
. O
No O
free O
interperitoneal O
air O
. O
The O
imaged O
bony O
structures O
are O
unremarkable O
. O

The O
patient O
is O
a O
55 O
year O
old O
woman O
with O
hepatic O
sarcoidosis O
and O
regenerative O
hyperplasia O
s O
p O
TIPS B-PROCEDURE
10 O
3245 O
placed O
1 O
27 O
variceal O
bleeding O
and O
portal O
hypertensive O
gastropathy O
s O
p O
TIPS B-PROCEDURE
re O
do O
with O
angioplasty B-PROCEDURE
and O
portal B-PROCEDURE
vein I-PROCEDURE
embolectomy I-PROCEDURE
, O
who O
was O
brought O
to O
the O
ED O
by O
her O
husband O
for O
evaluation O
after O
he O
noted O
worsening O
asterixis O
. O
While O
in O
the O
waiting O
room O
the O
pt O
became O
more O
combative O
and O
then O
unresponsive O
. O
In O
the O
ED O
VS O
Temp O
97 O
. O
9F O
, O
HR O
115 O
, O
BP O
122 O
80 O
, O
R O
18 O
, O
O2 O
sat O
98 O
2L O
NC O
. O
She O
was O
unresponsive O
but O
able O
to O
protect O
her O
airway O
and O
so O
not O
intubated O
. O
She O
vomited O
x1 O
and O
received O
Zofran O
as O
well O
as O
1 O
. O
5 O
L O
NS O
. O
Labs O
were O
significant O
for O
K O
5 O
. O
5 O
, O
BUN O
46 O
, O
Cr O
2 O
. O
2 O
up O
from O
baseline O
of O
0 O
. O
8 O
, O
and O
ammonia O
of O
280 O
. O
Stool O
was O
Guaiac O
negative O
. O
A O
urinalysis O
and O
CXR O
were O
done O
and O
are O
pending O
, O
and O
a O
FAST B-PROCEDURE
revealed O
hepatosplenomegaly O
but O
no O
intraperitoneal O
fluid O
. O
On O
arrival O
to O
the O
ICU O
the O
pt O
had O
another O
episode O
of O
emesis O
. O
NGT O
was O
placed O
to O
suction O
and O
1 O
. O
5L O
bilious O
material O
was O
drained O
. O
Allergies O
Cipro O
Oral O
Ciprofloxacin O
Hcl O
Hives O
; O
Doxycycline O
Hives O
; O
hallucin O
Paxil O
Oral O
Paroxetine O
Hcl O
hair O
loss O
; O
Quinine O
Rash O
; O
Compazine O
Injection O
Prochlorperazine O
Edisylate O
muscle O
spasm O
; O
Levaquin O
Oral O
Levofloxacin O
tendinitis O
of O
t O
Lithium O
Hives O
; O

Mr O
. O
Name13 O
STitle O
5827 O
is O
an O
80yo O
M O
with O
dementia O
, O
CAD O
s O
p O
CABG B-PROCEDURE
in O
3420 O
LIMA O
LAD O
, O
SVG O
to O
OM2 O
, O
SVG O
to O
RPDA O
, O
then O
s O
p O
CABG B-PROCEDURE
redo O
in O
3426 O
, O
then O
s O
p O
2 O
caths O
this O
year O
with O
patent O
LIMA O
, O
totally O
occluded O
SVG O
to O
RPDA O
, O
SVG O
to O
OM2 O
, O
s O
p O
BMS O
to O
LCX O
on O
1 O
26 O
who O
presented O
to O
Hospital3 O
53 O
Hospital O
with O
increasing O
chest O
pain O
and O
nausea O
over O
the O
past O
few O
days O
. O
Per O
report O
, O
patient O
has O
presented O
several O
times O
since O
last O
cathed O
for O
recurrent O
angina O
. O
Admitted O
to O
Hospital3 O
on O
3436 O
4 O
2 O
with O
recurrent O
chest O
pain O
. O
Ruled O
out O
for O
MI O
. O
Last O
episode O
of O
chest O
pressure O
was O
the O
morning O
of O
transfer O
, O
associated O
with O
dry O
heaves O
and O
belching O
relieved O
with O
morphine O
. O
Pt O
was O
continued O
on O
ASA O
, O
Plavix O
, O
Statin O
, O
BBker O
, O
Imdur O
and O
placed O
on O
Heparin O
gtt O
. O
Cath O
last O
Month O
only O
here O
at O
Hospital1 O
5 O
showed O
a O
patent O
BMS O
in O
LCX O
and O
no O
new O
lesions O
. O
According O
to O
the O
family O
he O
usually O
has O
angina O
once O
every O
day O
or O
two O
, O
but O
for O
the O
past O
2 O
weeks O
he O
has O
been O
having O
angina O
with O
any O
minimal O
exertion O
eg O
putting O
on O
his O
shirt O
, O
and O
waking O
him O
several O
times O
per O
night O
. O




Mr O
. O
Known O
patient O
lastname O
3887 O
is O
a O
67 O
y O
. O
o O
. O
M O
with O
end O
stage O
COPD O
on O
home O
O2 O
3 O
L O
NC O
, O
tracheobronchomalacia O
s O
p O
Y B-PROCEDURE
stent I-PROCEDURE
, O
s O
p O
RUL B-PROCEDURE
resection I-PROCEDURE
for O
squamous O
cell O
carcinoma O
with O
Cyberknife O
treatment O
in O
2764 O
. O
Patient O
had O
Y O
stent O
placed O
in O
2769 O
1 O
1 O
complicated O
by O
cough O
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy B-PROCEDURE
was O
5 O
2769 O
at O
OSH O
, O
where O
patient O
had O
copious O
secretions O
that O
were O
aspirated O
. O
Pt O
reports O
compliance O
with O
Mucomyst O
nebs O
and O
Mucinex O
. O
He O
wears O
O2 O
" O
almost O
" O
24 O
hours O
day O
, O
but O
always O
at O
night O
. O
He O
does O
not O
wear O
his O
CPAP O
. O
Endorses O
inability O
to O
expectorate O
secretions O
and O
having O
" O
full O
feeling O
" O
for O
1 O
7 O
weeks O
. O
Decreaed O
appetitie O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
Smokes O
5 O
cig O
day O
. O
PET O
scan O
in O
6 O
12 O
revealed O
FDG O
avid O
soft O
tissue O
mass O
adjacent O
to O
RUL O
resection O
site O
with O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
On O
arrival O
to O
Hospital1 O
17 O
, O
vitals O
were O
T98 O
. O
6 O
HR86 O
BP106 O
78 O
O289 O
. O
Pt O
denied O
chest O
pain O
, O
palpitations O
, O
trauma O
, O
F O
C O
, O
N O
V O
D O
. O
R O
shoulder O
full O
PROM O
, O
limited O
abduction O
on O
active O
ROM O
. O






Mr O
. O
Known O
patient O
lastname O
4075 O
is O
a O
63 O
yo O
man O
with O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic B-PROCEDURE
SCT I-PROCEDURE
, O
who O
presents O
to O
clinc O
with O
one O
week O
of O
worsening O
SOB O
and O
two O
days O
of O
a O
clear O
productive O
cough O
. O
The O
patient O
states O
his O
SOB O
occured O
when O
lying O
flat O
, O
but O
not O
with O
activity O
. O
Also O
admitted O
to O
chest O
pressure O
which O
would O
come O
and O
go O
in O
his O
left O
chest O
no O
related O
to O
the O
SOB O
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND O
; O
admits O
to O
a O
slight O
increase O
in O
lower O
extremity O
edema O
. O
Admits O
to O
low O
grade O
fevers O
to O
the O
99 O
's O
and O
crampy O
abdominal O
pain O
. O
Denies O
chills O
, O
night O
sweats O
, O
vomiting O
, O
or O
diarrhea O
. O
Assessment O
and O
Plan O
Assesment O
This O
is O
a O
63 O
year O
old O
male O
with O
a O
history O
of O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic B-PROCEDURE
SCT I-PROCEDURE
, O
who O
presents O
with O
hypoxia O
, O
one O
week O
of O
worsening O
SOB O
, O
and O
two O
days O
of O
productive O
cough O
. O
Plan O
Hypoxia O
The O
patient O
developed O
acute O
onset O
of O
hypoxia O
accompanied O
by O
fever O
and O
a O
one O
day O
cough O
with O
sputum O
production O
. O
Given O
that O
the O
patient O
is O
about O
1 O
month O
s O
p O
allogenic B-PROCEDURE
SCT I-PROCEDURE
the O
differential O
is O
broad O
and O
would O
include O
bacterial O
pneumonia O
, O
viral O
pneumonia O
CMV O
, O
flu O
, O
and O
opportunistic O
infections O
including O
fungal O
infections O
. O
Patient O
also O
has O
a O
history O
of O
CMV O
infection O
, O
aspergillus O
and O
Leggionare O
's O
disease O
and O
is O
on O
posaconazole O
. O
His O
CXR O
showed O
an O
opacification O
of O
the O
left O
basilar O
lobe O
and O
also O
right O
upper O
lobe O
concerning O
for O
pneumonia O
as O
well O
as O
a O
small O
loculated O
right O
pleural O
effusion O
. O
Also O
in O
the O
differential O
is O
noninfectious O
causes O
such O
as O
PE O
, O
CHF O
, O
or O
MI O
. O
US O
were O
negative O
for O
clot O
and O
his O
first O
set O
of O
CE O
were O
negative O
. O

94 O
M O
with O
CAD O
s O
p O
4V B-PROCEDURE
CABG I-PROCEDURE
3420 O
and O
CRI O
had O
been O
doing O
well O
until O
this O
AM O
when O
he O
was O
out O
walking O
with O
his O
wife O
. O
Name O
NI O
abruptly O
syncopized O
and O
a O
bystander O
started O
CPR B-PROCEDURE
quickly O
. O
The O
local O
fire O
department O
delivered O
two O
shocks O
without O
success O
. O
Then O
EMS O
came O
and O
gave O
two O
more O
shocks O
and O
he O
went O
back O
into O
sinus O
. O
It O
is O
unclear O
whether O
he O
regained O
consciousness O
. O
He O
was O
intubated O
then O
brought O
to O
Hospital1 O
5 O
ED O
. O
. O
In O
the O
ED O
, O
his O
intial O
SBP O
was O
reported O
to O
be O
110 O
. O
Labs O
show O
K O
2 O
. O
7 O
and O
Hct O
25 O
. O
He O
was O
given O
40mEq O
of O
KCL O
. O
On O
repeat O
labs O
, O
his O
K O
normalized O
and O
his O
Hct O
was O
33 O
without O
any O
blood O
. O
It O
is O
unclear O
whether O
one O
of O
the O
labs O
was O
erroneous O
. O
the O
vitals O
were O
recorded O
as O
T O
34 O
. O
8 O
, O
HR O
62 O
, O
132 O
74 O
, O
18 O
, O
100 O
on O
AC O
18x500 O
, O
FiO2 O
100 O
. O
EKG O
Sinus O
at O
80 O
BPM O
with O
LAD O
, O
prolonged O
PR O
, O
TD O
0 O
. O
5 O
to O
1mm O
in O
V4 O
V6 O
. O
ECHO O
The O
left O
atrium O
and O
right O
atrium O
are O
normal O
in O
cavity O
size O
. O
There O
is O
mild O
symmetric O
left O
ventricular O
hypertrophy O
with O
normal O
cavity O
size O
. O
There O
is O
mild O
global O
left O
ventricular O
hypokinesis O
LVEF O
45 O
50 O
. O
The O
right O
ventricular O
free O
wall O
is O
hypertrophied O
. O
Right O
ventricular O
chamber O
size O
is O
normal O
. O
with O
normal O
free O
wall O
contractility O
. O
The O
aortic O
root O
is O
mildly O
dilated O
at O
the O
sinus O
level O
. O
The O
ascending O
aorta O
is O
moderately O
dilated O
. O
The O
aortic O
valve O
leaflets O
3 O
are O
mildly O
thickened O
but O
aortic O
stenosis O
is O
not O
present O
. O
Mild O
to O
moderate O
1 O
13 O
aortic O
regurgitation O
is O
seen O
. O
The O
mitral O
valve O
leaflets O
are O
mildly O
thickened O
. O
There O
is O
no O
mitral O
valve O
prolapse O
. O
Mild O
1 O
mitral O
regurgitation O
is O
seen O
. O
The O
tricuspid O
valve O
leaflets O
are O
mildly O
thickened O
. O
The O
estimated O
pulmonary O
artery O
systolic O
pressure O
is O
normal O
. O
There O
is O
a O
trivial O
physiologic O
pericardial O
effusion O
. O
IMPRESSION O
Mildly O
depressed O
global O
left O
ventricular O
function O
. O
Mild O
to O
moderate O
aortic O
regurgitation O
. O
Mild O
mitral O
regurgitation O
. O

85y O
o O
m O
w O
hx O
AD O
, O
diverticulosis O
, O
recently O
dx O
colon O
ca O
s O
. O
p O
hemicolectomy B-PROCEDURE
p O
w O
dark O
stools O
and O
dropping O
Hct O
30 O
26 O
23 O
. O
NG O
lavage O
was O
negative O
in O
ED O
, O
however O
, O
pt O
with O
duodenal O
ulcer O
on O
EGD B-PROCEDURE
7 O
2 O
. O
Possibly O
recent O
PUD O
vs O
anastomotic O
site O
vs O
1 O
26 O
colon O
ca O
vs O
diverticulosis O
. O
Review O
of O
systems O
Constitutional O
No O
t O
Fever O
Cardiovascular O
No O
t O
Chest O
pain O
, O
No O
t O
Palpitations O
Respiratory O
No O
t O
Cough O
, O
No O
t O
Dyspnea O
Gastrointestinal O
No O
t O
Abdominal O
pain O
, O
No O
t O
Nausea O
, O
No O
t O
Emesis O
, O
No O
t O
Diarrhea O
, O
No O
t O
Constipation O
Since O
12 O
AM O
Tmax O
37 O
. O
3 O
C O
99 O
. O
2 O
Tcurrent O
37 O
. O
3 O
C O
99 O
. O
2 O
HR O
69 O
64 O
78 O
bpm O
BP O
150 O
73 O
91 O
128 O
39 O
65 O
150 O
99 O
103 O
mmHg O
RR O
16 O
16 O
24 O
insp O
min O
SpO2 O
100 O
Heart O
rhythm O
SR O
Sinus O
Rhythm O
O2 O
Delivery O
Device O
None O
SpO2 O
100 O
ABG O
Physical O
Examination O
General O
Appearance O
No O
acute O
distress O
, O
Thin O
Eyes O
Conjunctiva O
PERRL O
, O
No O
t O
Conjunctiva O
pale O
Head O
, O
Ears O
, O
Nose O
, O
Throat O
Normocephalic O
Lymphatic O
Cervical O
WNL O
, O
Supraclavicular O
WNL O
Cardiovascular O
S1 O
Normal O
, O
S2 O
Normal O
, O
RRR O
Peripheral O
Vascular O
Right O
radial O
pulse O
Present O
, O
Left O
radial O
pulse O
Present O
, O
Right O
DP O
pulse O
Present O
, O
Left O
DP O
pulse O
Present O
Respiratory O
Chest O
Expansion O
Symmetric O
, O
Breath O
Sounds O
Clear O
Abdominal O
Soft O
, O
Non O
tender O
, O
Bowel O
sounds O
present O
, O
No O
t O
Tender O
, O
healing O
colectomy O
scar O
, O
no O
erythema O
, O
tenderness O
, O
bleeding O
, O
oozing O
. O
Extremities O
Right O
Absent O
, O
Left O
Absent O
Skin O
Not O
assessed O
Neurologic O
Attentive O
, O
Follows O
simple O
commands O
, O
Responds O
to O
Verbal O
stimuli O
, O
Oriented O
to O
only O
new O
year O
and O
thought O
he O
was O
at O
Hospital1 O
947 O
, O
Alzheimer O
's O
pt O
with O
baseline O
dementia O
. O
Pt O
oriented O
to O
self O
, O
but O
not O
time O
or O
place O
. O
Movement O
Purposeful O
, O
Tone O
Normal O
Labs O
Radiology O
WBC O
9 O
. O
7 O
Hct O
24 O
. O
0 O
Plt O
593 O
Other O
labs O
PT O
PTT O
INR O
14 O
. O
4 O
27 O
. O
2 O
1 O
. O
3 O
" O

This O
is O
a O
51 O
year O
old O
M O
w O
a O
h O
o O
MS O
, O
quadraparesis O
, O
HTN O
, O
restrictive O
lung O
disease O
, O
chronic O
constipation O
and O
SBOs O
s O
p O
ileostomy B-PROCEDURE
, O
multiple O
UTIs O
also O
s O
p O
suprapubic O
tube O
presents O
with O
SBO O
and O
UTI O
. O
Of O
note O
he O
was O
just O
recently O
discharged O
from O
the O
Hospital1 O
52 O
on O
10 O
2 O
for O
an O
admission O
for O
a O
UTI O
negative O
cultures O
treated O
with O
cipro O
, O
shingles O
treated O
w O
acyclovir O
and O
SBO O
evaluated O
by O
surgery B-PROCEDURE
but O
managed O
conservatively O
. O
He O
returns O
today O
as O
his O
home O
health O
aide O
had O
noticed O
his O
Urine O
output O
was O
low O
, O
75cc O
overnight O
when O
he O
usually O
has O
about O
1 O
liter O
of O
UOP O
overnight O
. O
His O
ostomy O
output O
has O
been O
high O
. O
He O
has O
not O
noticed O
any O
symptoms O
. O
Over O
the O
past O
two O
weeks O
he O
has O
had O
mild O
earaches O
, O
a O
sorethroat O
as O
well O
as O
some O
rhinorrhea O
. O
He O
has O
not O
noticed O
any O
watery O
itchy O
eyes O
. O
He O
has O
not O
sure O
if O
he O
has O
had O
a O
change O
in O
his O
ostomy O
output O
or O
suprapubic O
output O
. O
He O
has O
not O
noticed O
any O
visual O
changes O
, O
he O
has O
not O
noticed O
any O
new O
neurologic O
si O
sx O
. O
He O
denies O
any O
abdominal O
pain O
, O
has O
not O
sujectively O
noticed O
any O
change O
in O
abdominal O
distention O
. O
He O
denies O
any O
pain O
in O
regards O
to O
his O
zoster O
now O
or O
when O
diagnosed O
. O
Denies O
CP O
, O
has O
an O
occasional O
cough O
that O
is O
not O
worsening O
. O
. O
In O
the O
ED O
, O
he O
was O
noted O
to O
be O
severely O
dehydrated O
on O
exam O
. O
His O
BP O
nadir O
was O
79 O
43 O
and O
HR O
peak O
was O
97 O
. O
T O
99 O
he O
usually O
" O
runs O
low O
" O
, O
new O
ARF O
1 O
. O
4 O
up O
from O
0 O
. O
6 O
. O

A O
64 O
yo O
F O
w O
PMHx O
sx O
for O
AF O
, O
COPD O
, O
HTN O
, O
hyperlipidemia O
who O
initially O
had O
an O
open B-PROCEDURE
ASD I-PROCEDURE
repair I-PROCEDURE
c O
b O
sternal O
wound O
infection O
and O
post O
operative O
AF O
in O
11 O
15 O
treated O
with O
amiodarone O
. O
On O
2 O
20 O
, O
she O
was O
initially O
admitted O
through O
the O
ED O
with O
SOB O
and O
back O
pain O
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
RVR O
. O
A O
CTA B-PROCEDURE
demonstrating O
diffuse O
LAD O
and O
post O
obstructive O
PNA O
concerning O
for O
malignancy O
. O
For O
her O
atrial O
fibrillation O
, O
she O
was O
started O
on O
diltiazem O
gtt O
, O
for O
which O
she O
was O
transferred O
to O
the O
Hospital O
Unit O
Name O
42 O
for O
monitoring O
. O
The O
atrial O
fibrillation O
was O
thought O
to O
be O
in O
the O
setting O
of O
a O
post O
obstructive O
pneumonia O
, O
for O
which O
she O
was O
treated O
with O
antibiotics O
. O
She O
was O
then O
transferred O
to O
the O
floor O
later O
that O
same O
night O
on O
metoprolol O
50 O
mg O
tid O
. O
While O
on O
the O
floor O
, O
she O
had O
a O
bronchoscopy B-PROCEDURE
performed O
which O
showed O
external O
compression O
of O
her O
left O
mainstem O
bronchus O
, O
and O
she O
had O
a O
biopsy B-PROCEDURE
FNA I-PROCEDURE
performed O
, O
which O
showed O
large O
cell O
carcinoma O
. O
She O
was O
then O
readmitted O
to O
the O
Hospital O
Unit O
Name O
42 O
yesterday O
with O
atrial O
fibrillation O
with O
HR O
130s O
, O
and O
was O
started O
on O
a O
diltiazem O
gtt O
. O
. O
In O
the O
Hospital O
Unit O
Name O
42 O
, O
she O
was O
started O
on O
po O
diltiazem O
, O
which O
was O
rapidly O
uptitrated O
to O
60 O
mg O
qid O
. O
She O
was O
called O
out O
this O
morning O
. O
Tonight O
, O
at O
8 O
30 O
pm O
, O
she O
was O
noted O
to O
have O
HR O
160s O
, O
w O
EKG O
c O
w O
AF O
with O
RVR O
, O
for O
which O
she O
received O
metoprolol O
5 O
mg O
IV O
x2 O
, O
followed O
by O
diltiazem O
10 O
mg O
IV O
x2 O
without O
conversion O
. O
She O
denies O
chest O
pain O
, O
SOB O
, O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations O
. O

Briefly O
79 O
yo O
F O
w O
a O
h O
o O
CAD O
s O
p O
RCA O
stenting O
BMS O
to O
mRCA O
3421 O
and O
pLAD O
3423 O
, O
diastolic O
CHF O
2 O
pillow O
orthopnea O
, O
1 O
MR O
, O
HTN O
, O
Hyperlipidemia O
, O
previous O
smoking O
history O
, O
and O
atrial O
fibrillation O
initially O
p O
w O
cough O
, O
dyspnea O
. O
. O
Briefly O
, O
pt O
's O
symptoms O
began O
Month O
only O
760 O
. O
At O
that O
time O
pt O
was O
admitted O
with O
GI O
bleed O
, O
transfused O
and O
discharged O
without O
resolution O
of O
symptoms O
. O
Furthur O
workup O
noted O
bilateral O
atrial O
thrombi O
and O
anticoagulation O
was O
reinitiated O
. O
CTA O
did O
not O
show O
PE O
but O
was O
concern O
for O
small O
peripheral O
emboli O
as O
cause O
of O
dyspnea O
. O
Pt O
was O
had O
multiple O
PFTs O
, O
echos O
, O
CT O
scans O
and O
CXRs O
without O
definitive O
cause O
of O
dyspnea O
. O
Most O
recent O
PFTs O
on O
3432 O
12 O
27 O
c O
w O
restrictive O
ventilatory O
defect O
and O
low O
DLCO O
suspicious O
for O
interstitial O
pulmonary O
process O
worsening O
. O
She O
has O
been O
followed O
by O
cardiology B-PROCEDURE
and O
pulmonology B-PROCEDURE
and O
is O
being O
treated O
for O
dCHF O
and O
reactive O
airway O
disease O
. O
. O
On O
current O
admission O
pt O
presented O
with O
cough O
, O
thought O
to O
be O
URI O
, O
rather O
than O
worsening O
of O
chronic O
dyspnea O
. O
Current O
etiology O
considerations O
include O
CHF O
vs O
intrinsic O
pulmonary O
disease O
infiltrative O
vs O
embolic O
disease O
. O
In O
order O
to O
optimize O
cardic O
function O
with O
atrial O
kick O
, O
pt O
was O
pretreated O
with O
Sotolol B-PROCEDURE
and O
underwent O
TEE B-PROCEDURE
and O
cardioversion B-PROCEDURE
of O
afib O
on O
3433 O
1 O
11 O
. O
After O
cardioversion B-PROCEDURE
, O
patient O
developed O
junctional O
HR O
to O
45bpm O
with O
SBPs O
in O
80s O
. O
She O
was O
placed O
on O
dobutamine O
and O
HR O
increased O
to O
80s O
sinus O
vs O
antrial O
escape O
rhythm O
. O
Off O
of O
dobutamine O
, O
HR O
and O
BP O
decreased O
with O
EKG O
demonstrated O
QTc O
of O
700 O
. O


84 O
year O
old O
man O
with O
CAD O
s O
p O
CABG B-PROCEDURE
, O
DM O
, O
HTN O
, O
presented O
with O
2 O
days O
of O
black O
stools O
and O
coffee O
ground O
emesis O
. O
Pt O
reports O
of O
woke O
up O
2am O
on O
10 O
19 O
and O
had O
black O
soft O
loose O
BM O
, O
followed O
by O
nausea O
and O
and O
vomiting O
blackish O
liquid O
. O
He O
felt O
better O
but O
continued O
to O
have O
three O
more O
black O
stools O
over O
the O
next O
two O
days O
. O
He O
vomited O
a O
total O
of O
1 O
20 O
times O
before O
presenting O
to O
the O
hospital O
. O
He O
has O
been O
feeling O
lethargic O
and O
lightheaded O
and O
called O
the O
ambulence O
at O
the O
advice O
of O
his O
son O
. O
His O
stools O
were O
lightening O
in O
color O
prior O
arriving O
. O
He O
has O
not O
been O
using O
any O
new O
medications O
and O
has O
not O
had O
a O
prior O
GIB O
. O
. O
In O
the O
ED O
, O
initial O
VS O
98 O
. O
7 O
88 O
65 O
47 O
98 O
RA O
. O
He O
was O
BIBEMS O
with O
SBPs O
110 O
120s O
and O
has O
had O
similarly O
stable O
blood O
pressures O
since O
arrival O
. O
He O
had O
an O
NG O
lavage O
with O
coffee O
ground O
emesis O
that O
cleared O
with O
600 O
cc O
of O
flushing O
. O
During O
the O
lavage O
he O
had O
chest O
pressure O
and O
an O
EKG O
showed O
STD O
in O
V2 O
4 O
. O
He O
did O
not O
have O
radiation O
, O
pain O
, O
or O
diaphoresis O
. O
Home O
medications O
ALLOPURINOL O
300 O
mg O
Tablet O
by O
mouth O
daily O
GLIPIZIDE O
5 O
mg O
Extended O
Rel O
by O
mouth O
daily O
LOSARTAN O
COZAAR O
100 O
mg O
by O
mouth O
daily O
METFORMIN O
500 O
mg O
by O
mouth O
daily O
METOPROLOL O
TARTRATE O
50 O
mg O
by O
mouth O
daily O
PIOGLITAZONE O
ACTOS O
15 O
mg O
by O
mouth O
daily O
SIMVASTATIN O
80 O
mg O
Tablet O
by O
mouth O
daily O
ASPIRIN O
81 O
mg O
Tablet O
by O
mouth O
daily O
Past O
medical O
history O
Coronary O
artery O
disease O
s O
p O
triple O
vessel O
coronary O
artery O
bypass O
in O
7 O
2899 O
Hypertension O
Peripheral O
arterial O
disease O
Hypercholesterolemia O
Diabetes O
Osteoarthritis O
Gout O
Anemia O
Baseline O
32 O
35 O
with O
unrevealing O
w O
u O
by O
heme O
Right O
hernia O
repair O
in O
2877 O
Appendectomy O
in O
2841 O
Prostate O
disease O
N O
C O
Occupation O
Retired O
trial O
lawyer O
Drugs O
Denies O
Tobacco O
Denies O
Alcohol O
Occasional O


85 O
y O
o O
F O
with O
PMHx O
of O
HTN O
, O
HL O
, O
h O
o O
breast O
CA O
and O
3cm O
renal O
pelvis O
transitional O
cell O
tumor O
who O
presented O
for O
nephrectomy B-PROCEDURE
on O
2575 O
8 O
15 O
. O
Her O
post O
op O
course O
was O
complicated O
by O
agitation O
thought O
due O
to O
narcotics O
. O
Today O
, O
she O
was O
restarted O
on O
her O
home O
meds O
and O
while O
on O
telemetry O
, O
pt O
was O
noted O
to O
be O
bradycardic O
to O
40s O
. O
Pt O
was O
triggered O
for O
SBP O
of O
70 O
and O
HR O
of O
40 O
during O
which O
she O
remained O
asymptomatic O
. O
She O
was O
given O
1L O
IVF O
and O
her O
HR O
BP O
trended O
back O
up O
to O
baseline O
. O
However O
, O
there O
was O
a O
second O
event O
an O
hour O
later O
when O
she O
sat O
up O
and O
became O
bradycardic O
in O
the O
30s O
with O
associated O
hypotension O
. O
Second O
episode O
occurred O
with O
position O
change O
and O
again O
, O
pt O
developped O
junctional O
rhythm O
in O
30s O
. O
home O
meds O
Verapamil O
240mg O
daily O
Lisinopril O
5mg O
Rosuvastatin O
10mg O
Meclizine O
25 O
TID O
PRN O
Imipramine O
25 O
QHS O
Colace O
100mg O
Loratidine O
10mg O
daily O
Physical O
Examination O
T O
98 O
BP O
111 O
47 O
P O
74 O
R O
16 O
O2 O
98 O
on O
2L O
NC O
General O
oriented O
to O
person O
only O
, O
NAD O
, O
comfortable O
HEENT O
Sclera O
anicteric O
, O
dry O
MM O
, O
oropharynx O
clear O
Neck O
supple O
, O
unable O
to O
appreciate O
JVP O
due O
to O
habitus O
Lungs O
poor O
effort O
but O
Month O
only O
199 O
BS O
at O
bases O
and O
some O
audible O
airway O
secretion O
in O
upper O
airways O
CV O
Regular O
rate O
and O
rhythm O
, O
no O
m O
r O
g O
, O
diff O
to O
auscult O
2 O
13 O
habitus O
Abdomen O
diffusely O
tender O
, O
bowel O
sounds O
present O
, O
multiple O
surgical O
incisions O
, O
clean O
dry O
and O
intact O
, O
abd O
binder O
in O
place O
GU O
foley O
in O
place O
Ext O
cool O
, O
no O
edema O
, O
1 O
pulses O
, O
pneumoboots O
in O
place O





An O
82 O
man O
with O
multiple O
chronic O
conditions O
and O
previous O
surgeries B-PROCEDURE
presents O
with O
9 O
day O
history O
of O
productive O
cough O
, O
fever O
and O
dyspnea O
. O










67 O
y O
. O
o O
. O
male O
smoker O
with O
end O
stage O
COPD O
on O
home O
oxygen O
, O
tracheobronchomalacia O
, O
s O
p O
RUL B-PROCEDURE
resection I-PROCEDURE
for O
squamous O
cell O
carcinoma O
. O
Y O
stent O
placement O
was O
complicated O
by O
cough O
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Patient O
reports O
decreased O
appetite O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
PET O
scan O
revealed O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
Pt O
. O
presents O
with O
worsening O
SOB O
with O
R O
shoulder O
pain O
and O
weakness O
. O






94 O
M O
with O
CAD O
s O
p O
4v B-PROCEDURE
CABG I-PROCEDURE
, O
CHF O
, O
CRI O
presented O
with O
vfib O
arrest O
. O


85 O
yo O
M O
with O
PMH O
of O
colon O
CA O
s O
p O
resection B-PROCEDURE
now O
presenting O
with O
black O
stools O
and O
HCT O
drop O
. O


An O
elderly O
female O
with O
history O
of O
atrial O
fibrillation O
, O
Chronic O
Obstructive O
Pulmonary O
Disease O
, O
hypertension O
, O
hyperlipidemia O
and O
previous O
repair B-PROCEDURE
of I-PROCEDURE
atrial I-PROCEDURE
septum I-PROCEDURE
defect I-PROCEDURE
, O
presenting O
with O
shortness O
of O
breath O
and O
atrial O
fibrillation O
resistant O
to O
medication O
. O

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






A O
40 O
year O
old O
woman O
comes O
to O
the O
clinic O
complaining O
of O
gritty O
sensation O
in O
her O
eyes O
. O
She O
also O
has O
difficulty O
swallowing O
dry O
foods O
with O
no O
pain O
or O
heartburn O
. O
The O
patient O
is O
a O
schoolteacher O
and O
must O
drink O
water O
frequently O
during O
lectures O
due O
to O
her O
mouth O
dryness O
. O
She O
also O
reports O
occasional O
joint O
pain O
. O
Medical O
history O
is O
not O
significant O
other O
than O
the O
confirmed O
Sjogren O
disease O
with O
no O
other O
rheumatologic O
disease O
. O
She O
is O
sexually O
active O
with O
her O
husband O
and O
has O
2 O
children O
both O
delivered O
by O
natural O
vaginal O
delivery O
. O
She O
has O
no O
history O
of O
any O
kind O
of O
surgery B-PROCEDURE
. O
Physical O
examination O
shows O
conjunctival O
erythema O
and O
cracking O
of O
the O
lips O
. O
The O
remainder O
of O
the O
examination O
and O
history O
is O
normal O
. O
Her O
lab O
result O
shows O
elevated O
ESR O
50 O
mm O
h O

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



A O
30 O
year O
old O
man O
who O
is O
a O
computer O
scientist O
came O
to O
the O
clinic O
with O
the O
lab O
result O
stating O
azoospermia O
. O
The O
patient O
is O
sexually O
active O
with O
his O
wife O
and O
does O
not O
use O
any O
contraception O
methods O
. O
They O
have O
been O
trying O
to O
conceive O
for O
the O
past O
year O
with O
no O
success O
. O
The O
patient O
has O
a O
past O
medical O
history O
of O
recurrent O
pneumonia O
, O
shortness O
of O
breath O
, O
and O
persistent O
cough O
that O
produces O
large O
amounts O
of O
thick O
sputum O
. O
The O
patient O
had O
multiple O
lung O
infections O
during O
childhood O
. O
He O
does O
not O
smoke O
, O
use O
illicit O
drugs O
or O
alcohol O
. O
The O
patient O
has O
no O
history O
of O
other O
medical O
conditions O
including O
allergies O
or O
any O
kind O
of O
surgery B-PROCEDURE
. O
On O
physical O
examination O
, O
the O
digits O
show O
clubbing O
. O
An O
ultrasound O
shows O
bilateral O
absence O
of O
the O
vas O
deferens O
, O
and O
FEV1 O
was O
75 O
on O
the O
respiratory O
function O
test O
. O






A O
27 O
year O
old O
woman O
comes O
to O
the O
dermatology O
clinic O
with O
skin O
rash O
and O
oral O
ulcers O
. O
The O
rashes O
are O
mildly O
itchy O
. O
The O
patient O
has O
no O
other O
medical O
conditions O
and O
takes O
no O
medications O
. O
Vital O
signs O
are O
normal O
. O
On O
examination O
, O
there O
are O
pink O
papules O
symmetrically O
distributed O
over O
the O
anterior O
surfaces O
of O
the O
shins O
and O
ankles O
. O
There O
are O
some O
white O
ulcerated O
papules O
on O
her O
buccal O
mucosa O
. O
She O
is O
in O
relationship O
with O
her O
boyfriend O
and O
has O
only O
one O
sexual O
partner O
. O
Her O
boyfriend O
uses O
condoms O
. O
She O
smokes O
1 O
to O
2 O
cigarettes O
a O
day O
and O
drinks O
a O
beer O
daily O
. O
Biopsy B-PROCEDURE
reveals O
prominent O
hyperkeratosis O
with O
a O
thickened O
granular O
layer O
. O
There O
is O
an O
infiltration O
of O
mononuclear O
cells O
in O
the O
superficial O
dermis O
that O
involves O
the O
overlying O
epidermis O
. O
The O
rete O
ridges O
have O
a O
sawtooth O
appearance O
. O



A O
50 O
year O
old O
woman O
comes O
to O
the O
clinic O
complaining O
of O
difficulty O
swallowing O
both O
liquids O
and O
solid O
foods O
, O
as O
well O
as O
occasional O
cough O
while O
eating O
. O
She O
also O
has O
difficulty O
lifting O
her O
arms O
above O
her O
head O
and O
getting O
up O
from O
a O
chair O
. O
The O
weakness O
seems O
to O
get O
worse O
gradually O
. O
The O
patient O
has O
no O
prior O
medical O
problems O
and O
takes O
no O
medications O
. O
Vital O
signs O
are O
normal O
. O
Physical O
examination O
shows O
an O
erythematous O
rash O
on O
the O
upper O
eyelids O
. O
There O
are O
some O
red O
papules O
over O
joints O
of O
her O
hands O
. O
The O
rest O
of O
the O
physical O
examination O
is O
unremarkable O
. O
Antinuclear O
antibodies O
, O
anti O
Jo O
1 O
antibodies O
and O
anti O
MDA5 O
antibody O
are O
positive O
. O
Muscle B-PROCEDURE
biopsy I-PROCEDURE
shows O
perifascicular O
inflammation O
and O
atrophy O
of O
the O
fascicle O
and O
surrounding O
blood O
vessels O
. O


A O
32 O
year O
old O
woman O
comes O
to O
the O
hospital O
with O
vaginal O
spotting O
. O
Her O
last O
menstrual O
period O
was O
10 O
weeks O
ago O
. O
She O
has O
regular O
menses O
lasting O
for O
6 O
days O
and O
repeating O
every O
29 O
days O
. O
Medical O
history O
is O
significant O
for O
appendectomy B-PROCEDURE
and O
several O
complicated O
UTIs O
. O
She O
has O
multiple O
male O
partners O
, O
and O
she O
is O
inconsistent O
with O
using O
barrier O
contraceptives O
. O
Vital O
signs O
are O
normal O
. O
Serum O
β O
hCG O
level O
is O
1800 O
mIU O
mL O
, O
and O
a O
repeat O
level O
after O
2 O
days O
shows O
an O
abnormal O
rise O
to O
2100 O
mIU O
mL O
. O
Pelvic O
ultrasound O
reveals O
a O
thin O
endometrium O
with O
no O
gestational O
sac O
in O
the O
uterus O
. O


A O
61 O
year O
old O
man O
comes O
to O
the O
clinic O
due O
to O
nonproductive O
cough O
and O
progressive O
dyspnea O
. O
The O
patient O
's O
medical O
conditions O
include O
hypertension O
, O
hypercholesteremia O
and O
peptic O
ulcer O
disease O
. O
He O
smokes O
2 O
packs O
of O
cigarettes O
daily O
for O
the O
past O
30 O
years O
. O
On O
examination O
, O
there O
are O
decreased O
breath O
sounds O
and O
percussive O
dullness O
at O
the O
base O
of O
the O
left O
lung O
. O
Other O
vital O
signs O
are O
normal O
. O
Abdomen O
is O
soft O
without O
tenderness O
. O
CT O
scan O
shows O
a O
left O
sided O
pleural O
effusion O
and O
nodular O
thickening O
of O
the O
pleura O
. O
The O
plural O
fluid O
was O
bloody O
on O
thoracentesis O
. O
Biopsy B-PROCEDURE
shows O
proliferation O
of O
epithelioid O
type O
cells O
with O
very O
long O
microvilli O
. O

A O
7 O
month O
old O
boy O
is O
brought O
to O
emergency O
by O
his O
parents O
due O
to O
irritability O
and O
inability O
to O
defecate O
for O
the O
past O
3 O
days O
. O
The O
patient O
has O
had O
constipation O
and O
discomfort O
with O
bowel O
movements O
since O
birth O
. O
His O
symptoms O
worsened O
after O
eating O
semi O
solid O
foods O
. O
Vital O
signs O
are O
normal O
. O
Abdominal O
examination O
shows O
distension O
and O
tenderness O
to O
palpation O
with O
presence O
of O
bowel O
sounds O
. O
Xray O
with O
barium O
shows O
a O
narrow O
rectum O
and O
rectosigmoid O
area O
. O
The O
rest O
of O
the O
colon O
proximal O
to O
this O
segment O
is O
dilated O
. O
Digital O
rectal O
exam O
revealed O
burst O
of O
feces O
out O
of O
the O
anus O
. O
The O
biopsy B-PROCEDURE
showed O
absence O
of O
submucosal O
ganglia O
in O
the O
last O
segment O
of O
the O
large O
intestine O
. O






A O
7 O
year O
old O
girl O
is O
brought O
to O
the O
emergency O
department O
by O
her O
parents O
for O
generalized O
rash O
. O
The O
mother O
reports O
that O
she O
was O
playing O
outside O
wearing O
a O
skirt O
and O
felt O
a O
sharp O
pain O
in O
her O
arm O
while O
seating O
on O
a O
mat O
, O
plying O
with O
her O
doll O
. O
Her O
mother O
suspects O
that O
something O
had O
stung O
her O
. O
The O
patient O
's O
blood O
pressure O
is O
75 O
55 O
mm O
Hg O
and O
her O
heart O
rate O
is O
122 O
min O
. O
Physical O
examination O
shows O
erythematous O
, O
raised O
plaques O
over O
the O
trunk O
, O
extremities O
, O
and O
face O
. O
Lung B-PROCEDURE
auscultation I-PROCEDURE
reveals O
bilateral O
expiratory O
wheezes O
. O

A O
15 O
year O
old O
boy O
with O
mild O
intellectual O
disability O
is O
brought O
to O
the O
office O
by O
his O
parents O
for O
a O
routine O
physical O
examination O
. O
The O
boy O
is O
going O
to O
a O
school O
for O
students O
with O
learning O
disabilities O
. O
The O
patient O
was O
adopted O
, O
and O
his O
immunizations O
are O
up O
to O
date O
. O
Review O
of O
the O
patient O
's O
medical O
records O
is O
notable O
for O
cytogenetic B-PROCEDURE
studies I-PROCEDURE
that O
showed O
a O
small O
gap O
near O
the O
tip O
of O
the O
long O
arm O
of O
the O
X O
chromosome O
, O
which O
is O
consistent O
with O
fragile O
X O
syndrome O
, O
an O
X O
linked O
disorder O
. O
The O
defect O
is O
an O
unstable O
expansion O
of O
trinucleotide O
repeats O
CGG O
in O
the O
fragile O
X O
mental O
retardation O
1 O
FMR1 O
gene O
, O
located O
on O
the O
long O
arm O
of O
the O
X O
chromosome O
. O
He O
is O
not O
using O
any O
medications O
and O
vital O
signs O
are O
within O
normal O
levels O
. O
His O
blood O
chemistry O
analysis O
as O
bellow O
Blood O
Chemistry O
Value O
Normal O
Range O
Patient O
Value O
Glucose O
90 O
120 O
mg O
dl O
95 O
mg O
dl O
BUN O
Blood O
Urea O
Nitrogen O
7 O
24 O
mg O
dl O
10 O
mg O
dl O
Creatinine O
0 O
. O
7 O
1 O
. O
4 O
mg O
dl O
0 O
. O
8 O
mg O
dl O
Calcium O
8 O
. O
5 O
10 O
. O
5 O
mg O
dl O
9 O
mg O
dl O
Sodium O
134 O
143 O
mEq O
L O
135 O
mEq O
L O
Potassium O
3 O
. O
5 O
4 O
. O
5 O
mEq O
L O
3 O
. O
7 O
mEq O
L O
Chloride O
95 O
108 O
mEq O
L O
98 O
mEq O
L O
CO2 O
20 O
30 O
mEq O
L O
25 O
mEq O
L O
Blood O
pH O
7 O
. O
38 O
7 O
. O
42 O
7 O
. O
39 O


A O
23 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
following O
an O
episode O
of O
syncope O
. O
He O
was O
working O
out O
when O
he O
felt O
dizzy O
and O
passed O
out O
without O
head O
injury O
. O
He O
has O
had O
3 O
other O
episodes O
of O
light O
headedness O
over O
the O
last O
year O
, O
all O
happening O
during O
physical O
activity O
. O
He O
never O
had O
this O
experience O
while O
resting O
. O
He O
has O
no O
other O
medical O
conditions O
. O
The O
patient O
does O
not O
use O
tobacco O
, O
alcohol O
, O
or O
illicit O
drugs O
. O
His O
father O
died O
suddenly O
at O
age O
35 O
. O
Vital O
signs O
are O
within O
normal O
limits O
. O
On O
physical O
examination O
, O
the O
patient O
has O
a O
harsh O
systolic O
murmur O
. O
The O
lungs O
are O
clear O
with O
no O
peripheral O
edema O
. O
Echocardiography B-PROCEDURE
shows O
asymmetric O
interventricular O
septal O
hypertrophy O
. O



A O
63 O
year O
old O
man O
comes O
to O
the O
clinic O
for O
recent O
unintentional O
weight O
loss O
. O
The O
patient O
also O
has O
epigastric O
discomfort O
after O
meals O
. O
He O
has O
no O
known O
medical O
problems O
and O
takes O
no O
medications O
. O
His O
blood O
pressure O
is O
130 O
75 O
and O
pulse O
rate O
is O
88 O
min O
. O
He O
is O
not O
febrile O
. O
Upper O
endoscopy B-PROCEDURE
shows O
a O
lesion O
in O
the O
stomach O
that O
shows O
typical O
features O
of O
diffuse O
type O
adenocarcinoma O
presenting O
with O
signet O
ring O
cells O
that O
do O
not O
form O
glands O
. O


An O
8 O
year O
old O
boy O
is O
brought O
to O
the O
clinic O
by O
his O
parents O
because O
of O
weakness O
and O
difficulty O
of O
standing O
up O
from O
a O
sitting O
position O
. O
The O
mother O
is O
healthy O
but O
had O
a O
brother O
who O
died O
in O
his O
20th O
after O
being O
disabled O
and O
using O
wheelchairs O
in O
the O
last O
few O
years O
of O
his O
life O
. O
Physical O
examination O
shows O
3 O
5 O
lower O
extremity O
muscle O
strength O
and O
enlarged O
calf O
muscles O
. O
The O
other O
physical O
examination O
and O
vital O
signs O
are O
unremarkable O
. O
Muscle B-PROCEDURE
biopsy I-PROCEDURE
showed O
absence O
of O
dystrophin O
protein O
. O
The O
patient O
is O
diagnosed O
with O
DMD O
. O


A O
49 O
year O
old O
man O
comes O
to O
the O
office O
because O
of O
the O
bulging O
in O
his O
groin O
. O
Physical O
examination O
shows O
a O
swelling O
above O
the O
inguinal O
ligament O
. O
When O
the O
patient O
is O
asked O
to O
cough O
, O
the O
size O
of O
the O
bulge O
increases O
. O
His O
medical O
history O
is O
significant O
for O
mild O
dyslipidemia O
, O
which O
is O
under O
control O
by O
lifestyle O
modifications O
. O
He O
does O
not O
smoke O
, O
but O
drinks O
alcohol O
occasionally O
. O
His O
vital O
signs O
and O
other O
physical O
examinations O
are O
unremarkable O
. O
He O
is O
referred O
to O
a O
surgeon O
and O
scheduled O
to O
undergo O
elective B-PROCEDURE
laparoscopic I-PROCEDURE
hernia I-PROCEDURE
repair I-PROCEDURE
. O



A O
23 O
year O
old O
woman O
comes O
to O
the O
emergency O
department O
with O
a O
history O
of O
nosebleeds O
lasting O
for O
1 O
hour O
. O
She O
has O
a O
history O
of O
heavy O
menses O
as O
well O
as O
occasional O
gum O
bleeding O
following O
dental B-PROCEDURE
procedures I-PROCEDURE
. O
Her O
mother O
also O
has O
a O
history O
of O
menorrhagia O
. O
Laboratory O
tests O
reveal O
increased O
bleeding O
time O
and O
slightly O
increased O
partial O
thromboplastin O
time O
. O
She O
has O
no O
other O
medical O
conditions O
and O
is O
otherwise O
healthy O
. O
Her O
coagulation O
study O
shows O
CB O
0 O
. O
30 O
IU O
mL O
and O
FVIII O
C O
0 O
. O
37 O
IU O
mL O
. O
She O
is O
not O
smoking O
or O
using O
any O
kind O
of O
illicit O
drugs O
. O
She O
uses O
alcohol O
occasionally O
and O
is O
in O
ra O
elationship O
with O
her O
boyfriend O
for O
the O
past O
2 O
years O
. O





A O
60 O
year O
old O
man O
comes O
to O
the O
clinic O
complaining O
of O
hand O
tremor O
that O
started O
few O
months O
ago O
. O
It O
is O
most O
bothering O
when O
he O
wants O
to O
drink O
from O
a O
glass O
or O
pour O
from O
a O
bottle O
. O
He O
does O
not O
smoke O
, O
but O
drinks O
occasionally O
. O
He O
recently O
started O
consuming O
more O
alcohol O
as O
his O
tremor O
subsides O
somewhat O
when O
he O
drinks O
small O
amounts O
of O
alcohol O
. O
Family O
history O
is O
significant O
for O
similar O
problems O
in O
his O
mother O
. O
Vital O
signs O
are O
normal O
and O
the O
patient O
has O
no O
other O
medical O
conditions O
. O
Neurologic B-PROCEDURE
examination I-PROCEDURE
shows O
bilateral O
tremor O
in O
the O
upper O
extremities O
. O
The O
diagnosis O
of O
essential O
tremor O
is O
confirmed O
. O



A O
48 O
year O
old O
man O
comes O
to O
the O
office O
complaining O
of O
heartburn O
and O
acid O
reflux O
. O
He O
has O
taken O
over O
the O
counter O
antacids O
but O
sees O
no O
relief O
. O
Other O
medical O
history O
is O
unremarkable O
. O
The O
patient O
does O
not O
use O
tobacco O
, O
alcohol O
, O
or O
illicit O
drugs O
. O
Vital O
signs O
are O
within O
normal O
limits O
. O
BMI O
is O
31 O
kg O
m2 O
. O
Physical O
examination O
is O
positive O
for O
mild O
tenderness O
in O
upper O
stomach O
. O
Chest O
x O
ray O
shows O
an O
air O
fluid O
opacity O
behind O
the O
heart O
. O
A O
barium B-PROCEDURE
swallow I-PROCEDURE
study I-PROCEDURE
reveals O
approximately O
1 O
3 O
of O
the O
stomach O
herniating O
through O
the O
esophageal O
hiatus O
. O


A O
20 O
year O
old O
man O
comes O
to O
the O
emergency O
due O
to O
bleeding O
after O
a O
tooth B-PROCEDURE
extraction I-PROCEDURE
. O
The O
bleeding O
has O
persisted O
for O
approximately O
30 O
minutes O
despite O
constant O
direct O
pressure O
. O
He O
is O
a O
known O
case O
of O
Hemophilia O
type O
A O
treated O
with O
FVIII O
. O
Blood O
pressure O
is O
95 O
60 O
mm O
Hg O
and O
pulse O
is O
105 O
min O
. O
His O
weight O
is O
70 O
Kg O
. O
Family O
history O
is O
positive O
for O
Hemophilia O
type O
A O
in O
his O
maternal O
uncle O
. O
He O
also O
has O
a O
lipoma O
on O
his O
left O
arm O
which O
he O
plans O
to O
remove O
surgically O
. O
His O
FVIII O
activity O
is O
40 O
. O


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

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

A O
32 O
yo O
woman O
who O
presents O
following O
a O
severe O
' O
exploding O
' O
headache O
. O
She O
and O
her O
husband O
report O
that O
yesterday O
she O
was O
in O
the O
kitchen O
and O
stood O
up O
and O
hit O
her O
head O
on O
the O
corner O
of O
a O
cabinet O
. O
The O
next O
morning O
she O
developed O
a O
sudden O
' O
exploding O
' O
headache O
. O
She O
came O
to O
the O
hospital O
where O
head O
CT B-PROCEDURE
showed O
a O
significant O
amount O
of O
blood O
in O
her O
right O
ventricle O
. O
NSGY B-PROCEDURE
evaluated O
her O
for O
spontaneous O
intraventricular O
hemorrhage O
with O
a O
concern O
for O
an O
underlying O
vascular O
malformation O
. O
Cerebral B-PROCEDURE
angiogram I-PROCEDURE
was O
done O
which O
showed O
abnormal O
vasculature O
with O
a O
draining O
vein O
from O
L O
temporal O
lobe O
penetrating O
deep O
white O
matter O
consistent O
with O
AVM O
. O
The O
patient O
did O
continue O
to O
have O
a O
headaches O
but O
they O
were O
improving O
with O
pain O
medication O
. O
The O
patient O
refused O
PT O
evaluation O
but O
was O
ambulating O
independently O
without O
difficulty O
. O
She O
was O
discharged O
to O
home O
with O
her O
husband O
on O
2155 O
12 O
6 O
. O

This O
is O
a O
44 O
year O
old O
female O
with O
PMH O
of O
PCOS O
, O
Obesity O
, O
HTN O
who O
presented O
with O
symptoms O
of O
cholecystitis O
and O
was O
found O
incidentally O
to O
have O
a O
large O
pericardial O
effusion O
. O
A O
pericardiocentesis B-PROCEDURE
was O
performed O
and O
the O
fluid B-PROCEDURE
analysis I-PROCEDURE
was O
consistent O
with O
Burkitt O
's O
lymphoma O
. O
Pericardial O
fluid O
was O
kappa O
light O
chain O
restricted O
CD10 O
positive O
monotypic O
B O
cells O
expressing O
FMC O
7 O
, O
CD19 O
, O
CD20 O
, O
and O
myc O
rearrangement O
consistent O
with O
Burkitt O
's O
Lymphoma O
. O
A O
subsequent O
lumbar O
puncture O
and O
bone O
marrow O
biopsy B-PROCEDURE
were O
negative O
for O
any O
involvement O
which O
made O
this O
a O
primary O
cardiac O
lymphoma O
. O
A O
cardiac O
MRI B-PROCEDURE
showed O
a O
mass O
that O
was O
3cm O
x O
1cm O
on O
the O
lateral O
wall O
of O
the O
right O
atrium O
adjacent O
to O
the O
AV O
junction O
. O
Past O
Medical O
History O
1 O
. O
Rare O
migraines O
2 O
. O
HTN O
3 O
. O
Obesity O
4 O
. O
PCOS O
infertility O
5 O
. O
Viral O
encephalitis O
meningitis O
ICH O
seizure O
stroke O
2137 O
from O
severe O
sinus O
infxn O
, O
caused O
mild O
non O
focal O
residual O
deficits O
6 O
. O
CSF O
leak O
w O
meningitis O
s O
p O
lumbar O
drain O
placement O
7 O
. O
R O
LE O
DVT O
s O
p O
IVC B-PROCEDURE
filter I-PROCEDURE
placement I-PROCEDURE
8 O
. O
Knee B-PROCEDURE
surgery I-PROCEDURE

74M O
hx O
of O
CAD O
s O
p O
CABG O
, O
EF O
60 O
prior O
CVA O
no O
residual O
deficits O
, O
HTN O
, O
HL O
, O
DMII O
, O
Moderate O
to O
Severe O
PVD O
was O
referred O
to O
cardiology O
for O
evaluation O
of O
PVD O
, O
and O
on O
examination O
patient O
was O
found O
to O
have O
carotid O
bruits O
. O
Upon O
further O
review O
of O
symptoms O
the O
pt O
reports O
Occasional O
dizziness O
, O
no O
prior O
syncope O
occasional O
HA O
, O
Denies O
CP O
SOB O
. O
No O
sensory O
or O
motor O
defects O
. O
He O
recalls O
that O
he O
might O
have O
had O
a O
stroke O
10 O
15 O
years O
ago O
without O
any O
residual O
deficit O
. O
Prior O
to O
CABG B-PROCEDURE
he O
only O
had O
diaphoresis O
. O
Further O
review O
of O
systems O
is O
notable O
for O
absence O
of O
chest O
pain O
, O
dyspnea O
on O
exertion O
, O
paroxysmal O
nocturnal O
dyspnea O
, O
orthopnea O
, O
palpitations O
, O
syncope O
or O
presyncope O
. O
He O
underwent O
Carotid B-PROCEDURE
U O
S O
that O
showed O
significant O
bilateral O
carotid O
stenosis O
, O
L O
R O
. O
Angiography B-PROCEDURE
revealed O
an O
80 O
stenosis O
of O
the O
R O
ICA O
and O
a O
90 O
L O
ICA O
stenosis O
. O
Cerebral B-PROCEDURE
angiography I-PROCEDURE
further O
revealed O
patent O
right O
ACA O
and O
MCA O
and O
patent O
left O
ACA O
and O
left O
MCA O
. O
Past O
Medical O
History O
CAD O
s O
p O
CABG B-PROCEDURE
in O
2154 O
Hospital1 O
112 O
Prior O
CVA O
Bilateral O
carotid O
artery O
disease O
Anemia O
PVD O
Hypertension O
Diabetes O
c O
b O
retinopathy B-PROCEDURE
and O
peripheral B-PROCEDURE
neuropathy I-PROCEDURE
Cataracts O
s O
p O
surgery B-PROCEDURE
Thyroid O
nodule O
Colon O
polyps O
s O
p O
resection B-PROCEDURE
Intermittent O
Lower O
back O
pain O
Proteinuria O
s O
p O
right O
elbow O
fracture O
as O
a O
child O
Arthritis O


60 O
yo O
M O
with O
Hep O
C O
cirrhosis O
, O
grade O
II O
esophageal O
varices O
, O
recent O
admission O
for O
UGIB O
2 O
9 O
NSAID O
gastritis O
, O
referred O
for O
admission O
throught O
the O
ED O
by O
hepatology O
clinic O
for O
new O
slurred O
speech O
and O
tangential O
thought O
process O
. O
Patient O
also O
describes O
new O
imbalance O
leading O
to O
a O
fall O
during O
which O
he O
may O
have O
hit O
his O
head O
on O
. O
Per O
last O
liver O
clinic O
note O
has O
been O
off O
ETOH O
for O
a O
year O
corroborated O
with O
pt O
, O
utox O
was O
negative O
for O
alocohol O
. O
CT B-PROCEDURE
was O
within O
normal O
limits O
, O
and O
neuro O
evaluation O
determined O
this O
was O
not O
ischemic O
infart O
. O
Patient O
was O
given O
a O
presumptive O
diagnosis O
of O
hepatic O
encephalopathy O
and O
started O
on O
lactulose O
. O
Liver B-PROCEDURE
function I-PROCEDURE
tests I-PROCEDURE
showed O
a O
striking O
increase O
in O
his O
total O
and O
direct O
bilirubin O
since O
last O
visit O
. O
Another O
worrisome O
feature O
was O
the O
increase O
in O
the O
patient O
's O
AFP O
. O
This O
could O
be O
progression O
of O
cirrhosis O
as O
he O
failed O
interferon O
twice O
. O
He O
is O
to O
follow O
up O
as O
an O
outpatient O
to O
work O
this O
up O
. O
Past O
Medical O
History O
HCV O
Cirrhosis O
tx O
with O
interferon O
x2 O
with O
no O
response O
Portal O
Gastropathy O
Grade O
II O
Esophageal O
varices O
HTN O
Recent O
admission O
4 O
2150 O
UGIB O
2 O
9 O
non O
steroidal O
induced O
gastritis O


41 O
year O
old O
man O
with O
history O
of O
severe O
intellectual O
disability O
, O
CHF O
, O
epilepsy O
presenting O
with O
facial O
twitching O
on O
the O
right O
and O
generalized O
shaking O
in O
at O
his O
NH O
which O
required O
20 O
mg O
valium O
to O
cease O
seizure O
activity O
. O
Per O
outside O
medical O
patient O
was O
felt O
to O
have O
focal O
epilepsy O
with O
secondary O
generalization O
, O
likely O
due O
to O
anoxic O
brain O
injury O
at O
birth O
, O
and O
probably O
related O
to O
the O
atrophic O
changes O
seen O
on O
MRI B-PROCEDURE
, O
particularly O
in O
the O
left O
temporal O
lobe O
. O
The O
patient O
first O
developed O
seizures O
at O
age O
13 O
found O
by O
family O
to O
have O
a O
generalized O
convulsion O
. O
He O
had O
a O
second O
seizure O
two O
years O
after O
his O
first O
episode O
. O
He O
was O
maintained O
on O
Dilantin O
and O
phenobarbital O
. O
The O
patient O
went O
20 O
years O
without O
another O
seizure O
. O
He O
was O
recently O
tapered O
off O
Dilantin O
, O
and O
it O
was O
felt O
that O
perhaps O
this O
medication O
was O
necessary O
to O
maintain O
him O
seizure O
free O
. O
The O
patient O
had O
no O
further O
events O
during O
the O
hospital O
course O
and O
was O
back O
at O
his O
baseline O
at O
the O
time O
of O
discharge O
. O
Full O
EEG B-PROCEDURE
reports O
are O
pending O
at O
the O
time O
of O
dictation O
. O
Past O
Medical O
History O
Epilepsy O
as O
above O
, O
CHF O
, O
depression O


A O
75 O
yo O
M O
w O
metastatic O
papillary O
thyroid O
cancer O
s O
p O
XRT B-PROCEDURE
19 O
sessions O
who O
presented O
with O
2 O
days O
of O
worsening O
dysphagia O
for O
solids O
, O
poor O
oral O
intake O
, O
weight O
loss O
20 O
pounds O
over O
last O
several O
weeks O
and O
some O
lethargy O
. O
Papillary O
thyroid O
cancer O
dx O
w O
right O
neck O
mass O
s O
p O
neck O
mass O
resection O
; O
unable O
to O
perform O
thyroidectomy O
high O
bleed O
risk O
, O
proximity O
to O
trachea O
and O
recurrent O
laryngeal O
nerve O
and O
large O
tumor O
size O
s O
p O
XRT B-PROCEDURE
to O
neck O
s O
p O
RAI B-PROCEDURE
ablation I-PROCEDURE
Metastatic O
to O
lymph O
nodes O
and O
adrenal O
glands O
s O
p O
hernia B-PROCEDURE
repair I-PROCEDURE
s O
p O
tonsillectomy B-PROCEDURE

34 O
year O
old O
woman O
with O
Marfan O
's O
syndrome O
and O
known O
severe O
mitral O
valve O
prolapse O
with O
regurgitation O
, O
who O
was O
planned O
for O
a O
MV B-PROCEDURE
repair I-PROCEDURE
but O
was O
lost O
to O
follow O
up O
. O
She O
remains O
symptomatic O
and O
is O
now O
prepared O
to O
undergo O
mitral B-PROCEDURE
valve I-PROCEDURE
repair I-PROCEDURE
replacement B-PROCEDURE
surgery I-PROCEDURE
. O
EF O
of O
65 O
on O
TTE O
. O
Past O
Medical O
History O
Marfans O
Syndrome O
MVP O
with O
severe O
mitral O
regurgitation O
Gastric O
reflux O
disease O
History O
of O
gestational O
diabetes O
mellitus O
Hypertension O
with O
pregnancy O
Obesity O
c B-PROCEDURE
section I-PROCEDURE
x O
2 O
laser B-PROCEDURE
eye I-PROCEDURE
surgery I-PROCEDURE
cataract B-PROCEDURE
surgery I-PROCEDURE
foot B-PROCEDURE
surgery I-PROCEDURE
shorten O
bone O
length O

70 O
y O
o O
with O
COPD O
on O
2 O
. O
5 O
3 O
. O
5L O
O2 O
at O
baseline O
, O
OSA O
and O
obesity O
hypoventilation O
syndrome O
, O
dCHF O
, O
discharged O
2132 O
8 O
24 O
now O
presents O
with O
agitation O
and O
altered O
mental O
status O
with O
hypoxia O
and O
O2 O
sats O
70s O
on O
BipAp O
with O
5L O
. O
Pt O
agitated O
then O
somnolent O
at O
initial O
presentation O
. O
Daughter O
reported O
increased O
agitation O
and O
altered O
mental O
status O
x O
2 O
3 O
days O
with O
O2 O
sats O
60s O
70s O
at O
home O
. O
Daughter O
has O
also O
noted O
increased O
LE O
edema O
and O
weight O
gain O
which O
prompted O
a O
phone O
call O
to O
her O
PCP O
and O
increased O
lasix O
dose O
from O
80daily O
to O
100mg O
daily O
with O
some O
mild O
improvement O
in O
edema O
. O
She O
has O
had O
decreased O
appetite O
, O
PO O
intake O
, O
energy O
level O
at O
home O
with O
difficulty O
with O
ADLs O
. O
No O
recent O
history O
of O
fever O
, O
cough O
, O
chills O
, O
sputum O
production O
, O
CP O
, O
abd O
pain O
, O
or O
other O
complaints O
other O
than O
chronic O
right O
thigh O
pain O
last O
1 O
2 O
months O
. O
Daughter O
also O
reports O
med O
compliance O
and O
compliance O
with O
BiPap O
at O
night O
. O
Past O
Medical O
History O
CAD O
; O
s O
p O
4 O
vessel O
CABG B-PROCEDURE
in O
2119 O
CHF O
; O
EF O
55 O
, O
mild O
AS O
obesity O
hypoventilation O
syndrome O
obstructive O
sleep O
apnea O
DM2 O
ventricular O
tachycardia O
; O
s O
p O
ICD B-PROCEDURE
in O
2127 O
hypothyroidism O
schizophrenia O
COPD O
Pneumona O
treated O
in O
4 O
7 O
at O
Hospital1 O

62 O
yo O
male O
with O
hx O
of O
CVA O
, O
neurogenic O
bladder O
with O
indwelling O
suprapubic B-PROCEDURE
catheter I-PROCEDURE
with O
multiple O
prior O
admissions O
for O
UTIs O
, O
altered O
mental O
status O
, O
and O
urosepsis O
presents O
to O
the O
hospital O
in O
urosepsis O
now O
resolved O
after O
treatment O
with O
vanc O
meropenem O
. O
Per O
CT B-PROCEDURE
there O
is O
a O
non O
obstructing O
stone O
in O
the O
L O
ureter O
, O
no O
evidence O
of O
urethral O
strictures O
. O
Significant O
leaking O
around O
suprapubic O
cath O
site O
. O
Started O
on O
ditropan O
changed O
over O
to O
detrol O
. O
Urologist O
not O
concerned O
with O
leaking O
and O
will O
f O
u O
with O
pt O
next O
week O
. O
s O
p O
CVA B-PROCEDURE
Neurogenic O
bladder O
s O
p O
suprapubic B-PROCEDURE
cath I-PROCEDURE
Recurrent O
UTIs O
with O
Klebsiella O
Pseudomonas O
Non O
hodgkins O
Marginal O
Zone O
Lymphoma O
of O
the O
left O
orbit O
Dx O
in O
03 O
s O
p O
R O
CHOP O
x O
6 O
cycles O
Bells O
Palsy O
BPH O
Hypertension O
Partial O
Bowel O
obstruction O
s O
p O
colostomy B-PROCEDURE
Hepatitis O
C O
Cryoglobulinemia O
SLE O
with O
transverse O
myelitis O
, O
anti O
dsDNA O
Ab O
Insulin O
Dependant O
Diabetic O
Fungal O
Esophagitis O
Stage O
IV O
? O
Urinary O
Tract O
Infections O
pseudomonas O
enterococcus O

70 O
year O
old O
woman O
with O
a O
history O
of O
CAD O
recently O
noted O
abdominal O
mass O
who O
presents O
with O
fevers O
rigors O
and O
bandemia O
. O
Over O
the O
last O
few O
weeks O
leading O
up O
to O
admission O
, O
she O
has O
been O
experiencing O
mid O
abdominal O
pain O
, O
radiating O
to O
the O
left O
flank O
. O
It O
lasts O
throughout O
the O
day O
is O
not O
increased O
by O
eating O
though O
there O
is O
associated O
vomiting O
and O
is O
worsened O
with O
coughing O
. O
CT O
abdomen O
without O
contrast O
was O
then O
performed O
on O
4 O
20 O
showing O
a O
large O
9 O
. O
5 O
x O
7 O
. O
5 O
x O
6 O
. O
0 O
cm O
heterogeneous O
left O
upper O
abdominal O
mass O
. O
Patient O
underwent O
a O
EUS O
with O
biopsy B-PROCEDURE
. O
The O
results O
of O
the O
biopsy B-PROCEDURE
were O
consistent O
with O
pancreatic O
adenocarcinoma O
at O
the O
head O
of O
pancreas O
. O
Splenic O
flecture O
pancreatic O
tail O
mass O
was O
also O
seen O
on O
CT O
, B-PROCEDURE
likely O
diverticular O
abscess O
given O
the O
patients O
recent O
likely O
history O
of O
diverticulitis O
this O
was O
thought O
to O
be O
an O
infected O
fluid O
collection O
or O
abscess O
. O
She O
was O
treated O
with O
IV O
antibiotics O
Zosyn O
, O
then O
ceftriaxone O
and O
flagyl O
and O
will O
continue O
on O
them O
until O
seen O
by O
ID O
as O
an O
outpatient O
. O
Past O
Medical O
History O
1 O
. O
Coronary O
artery O
disease O
with O
history O
of O
angioplasty O
in O
State O
108 O
one O
year O
ago O
2 O
. O
Mitral O
valve O
prolapse O
3 O
. O
Atrial O
fibrillation O
4 O
. O
Hyperlipemia O
5 O
. O
Hypertension O
6 O
. O
Chronic O
kidney O
disease O
SCr O
2 O
. O
1 O
in O
3 O
17 O
7 O
. O
Hypothyroidism O
? O
TSH O
10 O
in O
3 O
17 O
8 O
. O
Anemia O
HCT O
30 O
. O
7 O
in O
3 O
17 O

79 O
yo O
F O
with O
multifactorial O
chronic O
hypoxemia O
and O
dyspnea O
thought O
due O
to O
diastolic O
CHF O
, O
pulmonary O
hypertension O
thought O
secondary O
to O
a O
chronic O
ASD O
and O
COPD O
on O
5L O
home O
oxygen O
admitted O
with O
complaints O
of O
worsening O
shortness O
of O
breath O
. O
Cardiology O
consult O
recommended O
a O
right O
heart O
cath O
for O
evaluation O
of O
response O
to O
sildenafil O
but O
the O
patient O
refused O
. O
Pulmonary O
consult O
recommended O
an O
empiric O
, O
compassionate O
sildenafil O
trial O
due O
to O
severe O
dyspneic O
symptomology O
preventing O
outpatient O
living O
, O
and O
the O
patient O
tolerated O
an O
inpatient O
trial O
without O
hypotension O
. O
Patient O
to O
f O
u O
with O
pulmonology O
to O
start O
sildenifil O
chronically O
as O
outpatient O
as O
prior O
authorization O
is O
obtained O
. O
Past O
Medical O
History O
Atrial O
septal O
defect O
repair O
6 O
17 O
complicated O
by O
sinus O
arrest O
with O
PPM B-PROCEDURE
placement I-PROCEDURE
. O
Diastolic O
CHF O
, O
estimated O
dry O
weight O
of O
94kg O
Pulm O
HTN O
RSVP O
75 O
in O
11 O
24 O
thought O
secondary O
to O
longstanding O
ASD O
COPD O
on O
home O
O2 O
5L O
NC O
with O
baseline O
saturation O
high O
80 O
's O
to O
low O
90 O
's O
on O
this O
therapy O
. O
OSA O
, O
not O
CPAP O
compliant O
Mild O
mitral O
regurgitation O
Microcytic O
anemia O
Hypothyroidism O
S O
p O
APPY O
, O
s O
p O
CCY O
' O
33 O
Gallstone O
pancreatitis O
s O
p O
ERCP B-PROCEDURE
, O
sphincterotomy B-PROCEDURE
Elevated O
alk O
phos O
secondary O
to O
amiodarone O

64yo O
woman O
with O
multiple O
myeloma O
, O
s O
p O
allogeneic B-PROCEDURE
transplant I-PROCEDURE
with O
recurrent O
disease O
and O
with O
systemic O
amyloidosis O
involvement O
of O
lungs O
, O
tongue O
, O
bladder O
, O
heart O
, O
on O
hemodialysis B-PROCEDURE
for O
ESRD O
who O
represents O
for O
malaise O
, O
weakness O
, O
and O
generalized O
body O
aching O
x O
2 O
days O
. O
She O
was O
admitted O
last O
week O
with O
hypercalcemia O
and O
treated O
with O
pamidronate O
30mg O
, O
calcitonin O
, O
and O
dialysis O
. O
Patient O
was O
Initially O
treated O
with O
melphalan O
and O
prednisone O
, O
followed O
by O
VAD O
regimen O
, O
and O
autologous B-PROCEDURE
stem I-PROCEDURE
cell I-PROCEDURE
transplant I-PROCEDURE
. O
With O
relapse O
of O
her O
myeloma O
, O
she O
received O
thalidomide O
velcade O
and O
thalidomide O
, O
which O
were O
eventually O
also O
held O
due O
to O
worsening O
edema O
and O
kidney O
function O
. O

This O
is O
a O
78 O
year O
old O
male O
with O
h O
o O
BPH O
s O
p O
multiple O
urological B-PROCEDURE
procedures I-PROCEDURE
, O
including O
s O
p O
Suprapubic B-PROCEDURE
prostatectomy I-PROCEDURE
. O
He O
was O
noted O
to O
have O
low O
urine O
output O
and O
bladder O
scan O
showed O
360cc O
residual O
. O
It O
was O
impossible O
for O
staff O
to O
pass O
a O
foley O
. O
Urology O
was O
consulted O
, O
performed O
a O
flexible O
cystoscopy B-PROCEDURE
in O
the O
ICU O
and O
found O
severe O
2cm O
bulbar O
urethral O
stricture O
. O
They O
were O
able O
to O
pass O
small O
catheter O
through O
and O
left O
in O
place O
. O
The O
patient O
leaked O
around O
the O
catheter O
, O
the O
catheter O
eventually O
came O
out O
but O
he O
continued O
to O
have O
good O
urine O
output O
and O
post O
void O
bladder O
scans O
were O
performed O
q4h O
to O
ensure O
he O
did O
not O
have O
high O
residual O
volume O
. O
Urology O
suggested O
that O
when O
patient O
is O
stable O
he O
will O
have O
to O
be O
taken O
to O
the O
OR O
to O
have O
the O
stricture O
surgically O
fixed O
. O

65 O
yo O
man O
with O
history O
of O
CAD O
and O
prior O
MI O
, O
HLD O
, O
HTN O
, O
ventricular O
tachycardia O
, O
and O
syncope O
was O
admitted O
earlier O
today O
evaluation O
of O
syncope O
and O
ventricular O
arrhythmias O
. O
He O
was O
recently O
discharged O
after O
a O
negative O
work O
up O
for O
syncope O
which O
included O
the O
implantation B-PROCEDURE
of I-PROCEDURE
a I-PROCEDURE
cardiac I-PROCEDURE
monitoring I-PROCEDURE
device I-PROCEDURE
. O
It O
was O
interrogated O
at O
the O
OSH O
and O
per O
report O
the O
monitor O
read O
from O
yesterday O
40 O
seconds O
of O
VT O
and O
then O
bradycardia O
with O
a O
rate O
of O
39 O
shortly O
thereafter O
corresponding O
with O
his O
symptoms O
. O
Overnight O
, O
the O
patient O
went O
into O
monomorphic O
VT O
on O
telemetry O
. O
The O
patient O
was O
found O
to O
be O
unresponsive O
. O
CPR B-PROCEDURE
was O
initiated O
, O
unclear O
if O
the O
patient O
had O
a O
pulse O
. O
Within O
one O
minute O
the O
patient O
returned O
to O
sinus O
rhythm O
. O
The O
patient O
does O
not O
report O
any O
symptoms O
prior O
to O
this O
episode O
. O
Currently O
, O
the O
patient O
feels O
presyncope O
and O
nausea O
, O
but O
denies O
chest O
pain O
. O
Patient O
is O
to O
be O
transferred O
to O
the O
CCU O
for O
catheterization B-PROCEDURE
and O
EPS B-PROCEDURE
. O



The O
patient O
is O
a O
31 O
year O
old O
woman O
complaining O
of O
abdominal O
pain O
. O
The O
pain O
started O
last O
night O
as O
diffuse O
abdominal O
discomfort O
. O
She O
had O
poor O
appetite O
as O
well O
as O
malaise O
. O
The O
pain O
worsened O
in O
intensity O
and O
became O
sharp O
in O
the O
morning O
. O
The O
pain O
became O
localized O
to O
the O
right O
lower O
quadrant O
in O
the O
morning O
. O
The O
temperature O
is O
within O
the O
normal O
limits O
with O
normal O
vital O
signs O
. O
Focal O
tenderness O
and O
guarding O
were O
observed O
during O
palpation O
of O
the O
right O
lower O
quadrant O
. O
Palpation O
of O
the O
left O
lower O
quadrant O
causes O
pain O
on O
the O
right O
. O
Her O
lab O
work O
is O
remarkable O
for O
leukocytosis O
. O
Computed O
Tomography O
of O
the O
abdomen O
with O
contrast O
shows O
the O
presence O
of O
a O
distended O
appendix O
with O
thickened O
appendiceal O
wall O
without O
perforation O
, O
abscess O
or O
gangrene O
. O
She O
is O
a O
candidate O
for O
laparoscopic B-PROCEDURE
appendectomy I-PROCEDURE
under O
general O
anesthesia O
. O

A O
39 O
year O
old O
man O
came O
to O
the O
clinic O
with O
cough O
and O
shortness O
of O
breath O
that O
was O
not O
relieved O
by O
his O
inhaler O
. O
He O
had O
these O
symptoms O
for O
5 O
days O
during O
the O
past O
2 O
weeks O
. O
He O
doubled O
his O
oral O
corticosteroids O
in O
the O
past O
week O
. O
He O
is O
a O
chef O
with O
a O
history O
of O
asthma O
for O
3 O
years O
, O
suffering O
from O
frequent O
cough O
, O
wheezing O
, O
and O
shortness O
of O
breath O
and O
chest O
tightness O
. O
The O
symptoms O
become O
more O
bothersome O
within O
1 O
2 O
hours O
of O
starting O
work O
every O
day O
and O
worsen O
throughout O
the O
work O
week O
. O
His O
symptoms O
improve O
within O
1 O
2 O
hours O
outside O
the O
workplace O
. O
Spirometry B-PROCEDURE
was O
performed O
revealing O
a O
forced O
expiratory O
volume O
in O
the O
first O
second O
FEV1 O
of O
63 O
of O
the O
predicted O
. O
His O
past O
medical O
history O
is O
significant O
for O
seasonal O
allergic O
rhinitis O
in O
the O
summer O
. O
He O
doesn O
' O
t O
smoke O
or O
use O
illicit O
drugs O
. O
His O
family O
history O
is O
significant O
for O
asthma O
in O
his O
father O
and O
sister O
. O
He O
currently O
uses O
inhaled O
corticosteroid O
ICS O
and O
fluticasone O
500 O
mcg O
salmeterol O
50 O
mcg O
, O
one O
puff O
twice O
daily O
. O


The O
patient O
is O
a O
42 O
year O
old O
postmenopausal O
woman O
who O
had O
a O
screening O
sonogram B-PROCEDURE
which O
revealed O
an O
abnormality O
in O
the O
right O
breast O
. O
She O
had O
no O
palpable O
masses O
on O
breast O
exam O
. O
Core B-PROCEDURE
biopsy I-PROCEDURE
was O
done O
and O
revealed O
a O
1 O
. O
8 O
cm O
infiltrating O
ductal O
breast O
carcinoma O
in O
the O
left O
upper O
outer O
quadrant O
. O
Lumpectomy B-PROCEDURE
was O
done O
and O
the O
surgical O
margins O
were O
clear O
. O
The O
tumor O
was O
HER2 O
positive O
and O
ER O
PR O
negative O
. O
Axillary O
sampling O
revealed O
1 O
positive O
lymph O
node O
out O
of O
12 O
sampled O
. O
CXR O
was O
unremarkable O
. O
She O
is O
using O
well O
women O
multivitamins O
daily O
and O
no O
other O
medication O
. O
She O
smokes O
frequently O
and O
consumes O
alcohol O
occasionally O
. O
She O
is O
in O
a O
relation O
with O
only O
one O
partner O
and O
has O
a O
history O
of O
3 O
pregnancies O
and O
live O
births O
. O
She O
breastfed O
all O
three O
children O
. O

A O
45 O
year O
old O
woman O
was O
referred O
to O
the O
emergency O
department O
with O
abdominal O
pain O
lasting O
about O
4 O
days O
accompanied O
by O
nausea O
and O
2 O
episodes O
of O
vomiting O
. O
The O
pain O
is O
localized O
to O
the O
epigastric O
region O
and O
radiates O
to O
the O
right O
upper O
quadrant O
. O
The O
pain O
is O
worsening O
after O
eating O
fatty O
food O
. O
The O
patient O
experienced O
similar O
pain O
twice O
in O
the O
past O
year O
. O
Her O
past O
medical O
history O
is O
remarkable O
for O
hypercholesterolemia O
and O
two O
C B-PROCEDURE
sections I-PROCEDURE
. O
She O
has O
2 O
children O
, O
and O
she O
is O
menopausal O
. O
She O
doesn O
' O
t O
smoke O
, O
drink O
alcohol O
, O
or O
use O
illicit O
drugs O
. O
She O
is O
mildly O
febrile O
. O
Her O
BP O
is O
150 O
85 O
, O
HR O
115 O
, O
RR O
15 O
, O
T O
38 O
. O
2 O
, O
SpO2 O
98 O
on O
RA O
. O
On O
palpation O
, O
she O
experiences O
epigastric O
tenderness O
and O
tenderness O
in O
the O
right O
upper O
quadrant O
without O
rebound O
. O
Bowel O
sounds O
are O
normal O
. O
Laboratory O
analysis O
is O
remarkable O
for O
elevated O
ESR O
and O
leukocytosis O
with O
a O
left O
shift O
. O
The O
ultrasound B-PROCEDURE
revealed O
several O
gallstones O
and O
biliary O
sludge O
. O
The O
largest O
gallstone O
is O
0 O
. O
7cm O
. O
Surgery O
consultation O
recommends O
elective O
cholecystectomy O
. O

A O
53 O
year O
old O
man O
presents O
with O
chronic O
HCV O
infection O
for O
the O
past O
2 O
years O
. O
His O
past O
medical O
history O
is O
only O
significant O
for O
inguinal B-PROCEDURE
hernia I-PROCEDURE
surgery I-PROCEDURE
when O
he O
was O
20 O
years O
old O
. O
He O
is O
on O
IFN O
100 O
mg O
week O
plus O
RBV O
400 O
mg O
day O
combination O
therapy O
for O
the O
past O
9 O
months O
. O
Direct O
antiviral O
drugs O
were O
added O
to O
his O
treatment O
6 O
months O
ago O
. O
His O
medical O
record O
shows O
previous O
positive O
HCV O
RNA O
tests O
as O
well O
as O
positive O
enzyme O
immunoassay O
for O
anti O
HCV O
antibodies O
. O
The O
recent O
biopsy B-PROCEDURE
was O
negative O
for O
hepatocellular O
carcinoma O
and O
was O
only O
remarkable O
for O
chronic O
inflammation O
compatible O
with O
a O
chronic O
viral O
hepatitis O
. O
There O
is O
no O
evidence O
of O
alcoholic O
liver O
disease O
, O
bleeding O
from O
esophageal O
varices O
, O
hemochromatosis O
, O
autoimmune O
hepatitis O
or O
metabolic O
liver O
disease O
. O
He O
is O
an O
alert O
male O
with O
no O
acute O
distress O
. O
His O
BP O
130 O
75 O
, O
HR O
90 O
min O
and O
BMI O
27 O
. O
His O
abdomen O
is O
soft O
with O
no O
ascites O
or O
tenderness O
. O
The O
lower O
extremities O
are O
normal O
with O
no O
edema O
. O




The O
patient O
is O
a O
37 O
year O
old O
woman O
who O
came O
to O
the O
clinic O
for O
a O
routine O
Pap O
smear O
. O
The O
test O
revealed O
stage O
1B O
of O
cervical O
cancer O
. O
The O
patient O
tested O
positive O
for O
HPV O
16 O
. O
She O
has O
three O
sexual O
partners O
and O
four O
children O
. O
She O
underwent O
tubal O
ligation O
. O
She O
smokes O
30 O
packs O
year O
and O
drinks O
alcohol O
frequently O
. O
She O
is O
otherwise O
healthy O
. O
She O
was O
offered O
a O
radical O
hysterectomy B-PROCEDURE
. O

The O
patient O
is O
a O
47 O
year O
old O
Asian O
woman O
complaining O
of O
persistent O
feelings O
of O
sadness O
. O
She O
lost O
interest O
in O
activities O
she O
used O
to O
enjoy O
. O
She O
states O
that O
her O
mood O
is O
mostly O
depressed O
for O
the O
past O
3 O
weeks O
. O
She O
also O
lost O
her O
appetite O
, O
which O
led O
to O
about O
5kg O
weight O
loss O
. O
She O
complains O
of O
loss O
of O
energy O
and O
feelings O
of O
worthlessness O
nearly O
every O
day O
. O
She O
is O
not O
using O
any O
drugs O
and O
she O
does O
not O
smoke O
. O
She O
doesn O
' O
t O
drink O
alcohol O
. O
She O
used O
to O
exercise O
every O
day O
for O
at O
least O
30 O
min O
. O
But O
she O
doesn O
' O
t O
have O
enough O
energy O
to O
do O
so O
for O
the O
past O
3 O
weeks O
. O
She O
also O
has O
some O
digestive O
issues O
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
. O
Her O
husband O
was O
recently O
diagnosed O
with O
colon O
cancer O
and O
he O
is O
starting O
his O
chemotherapy B-PROCEDURE
. O
There O
is O
nothing O
remarkable O
in O
her O
past O
medical O
history O
and O
her O
drug O
history O
is O
only O
positive O
for O
Vit O
D3 O
1000 O
units O
daily O
. O
Her O
family O
history O
is O
negative O
for O
any O
psychologic O
problems O
. O
Her O
HAM O
D O
score O
is O
20 O
. O


The O
patient O
is O
a O
35 O
year O
old O
woman O
with O
myasthenia O
gravis O
, O
class O
IIa O
. O
She O
complains O
of O
diplopia O
and O
fatigue O
and O
weakness O
that O
affects O
mainly O
her O
upper O
limbs O
. O
She O
had O
a O
positive O
anti O
AChR O
antibody O
test O
, O
and O
her O
single B-PROCEDURE
fiber I-PROCEDURE
electromyography I-PROCEDURE
SFEMG B-PROCEDURE
was O
positive O
. O
She O
takes O
pyridostigmine O
60 O
mg O
three O
times O
a O
day O
. O
But O
she O
still O
has O
some O
symptoms O
that O
interfere O
with O
her O
job O
. O
She O
is O
a O
research O
coordinator O
and O
has O
3 O
children O
. O
Her O
70 O
year O
old O
father O
has O
hypertension O
. O
She O
does O
not O
smoke O
or O
use O
illicit O
drugs O
. O
She O
drinks O
alcohol O
occasionally O
at O
social O
events O
. O
Her O
physical O
exam O
and O
lab O
studies O
were O
not O
remarkable O
for O
any O
other O
abnormalities O
. O
BP O
110 O
75 O
Hgb O
11 O
g O
dl O
WBC O
8000 O
mm3 O
Plt O
300000 O
ml O
Creatinine O
0 O
. O
5 O
mg O
dl O
BUN O
10 O
mg O
dl O
Beta O
hcg O
negative O
for O
pregnancy O

A O
3 O
day O
old O
Asian O
female O
infant O
presents O
with O
jaundice O
that O
started O
a O
day O
ago O
. O
She O
was O
born O
at O
38w3d O
of O
gestation O
, O
after O
an O
uncomplicated O
pregnancy O
. O
The O
family O
history O
is O
unremarkable O
. O
The O
baby O
is O
breastfed O
. O
Vital O
signs O
are O
reported O
as O
axillary O
temperature O
36 O
. O
3 O
C O
, O
heart O
rate O
154 O
beats O
min O
, O
respiratory O
rate O
37 O
breaths O
min O
, O
and O
blood O
pressure O
65 O
33 O
mm O
Hg O
. O
Her O
weight O
is O
3 O
. O
2 O
kg O
, O
length O
is O
53 O
cm O
, O
and O
head O
circumference O
36 O
cm O
. O
Her O
sclera O
are O
yellow O
and O
her O
body O
is O
icteric O
. O
No O
murmurs O
or O
any O
other O
abnormalities O
are O
detected O
in O
the O
heart O
and O
lung O
auscultation O
. O
Her O
liver O
and O
spleen O
are O
normal O
on O
palpation O
. O
Laboratory O
results O
are O
as O
follows O
Serum O
total O
bilirubin O
21 O
. O
02 O
mg O
dL O
Direct O
bilirubin O
of O
2 O
. O
04 O
mg O
dL O
AST O
37 O
U O
L O
ALT O
20 O
U O
L O
GGT O
745 O
U O
L O
Alkaline O
phosphatase O
531 O
U O
L O
Creatinine O
0 O
. O
3 O
mg O
dL O
Urea O
29 O
mg O
dL O
Na O
147 O
mEq O
L O
K O
4 O
. O
5 O
mEq O
L O
CRP O
3 O
mg O
L O
Complete O
blood O
cell O
count O
within O
the O
normal O
range O
. O
She O
is O
diagnosed O
with O
uncomplicated O
neonatal O
jaundice O
that O
may O
require O
phototherapy B-PROCEDURE
. O


The O
patient O
is O
a O
14 O
year O
old O
boy O
complaining O
of O
scoliosis O
and O
back O
pain O
. O
He O
has O
no O
other O
medical O
condition O
. O
He O
used O
to O
be O
able O
to O
play O
routine O
activities O
such O
as O
basketball O
and O
soccer O
, O
however O
, O
he O
recently O
has O
problem O
doing O
them O
. O
The O
pain O
is O
in O
his O
leg O
and O
back O
and O
aggravated O
by O
physical O
activities O
. O
He O
prefer O
lying O
down O
most O
of O
the O
time O
. O
He O
is O
not O
happy O
with O
his O
body O
gesture O
and O
complaints O
of O
shoulder O
imbalance O
and O
shifting O
his O
head O
to O
right O
. O
Patient O
is O
a O
well O
dressed O
and O
well O
nourished O
adolescent O
who O
is O
alert O
and O
cooperative O
. O
The O
left O
shoulder O
is O
slightly O
higher O
than O
the O
right O
shoulder O
. O
The O
scoliotic O
curve O
is O
measured O
as O
45 O
degree O
. O
The O
patients O
is O
candidate O
for O
scoliosis B-PROCEDURE
surgery I-PROCEDURE
according O
to O
perioperative O
MEP O
monitoring O


A O
62 O
year O
old O
African O
American O
man O
presented O
with O
left O
upper O
and O
lower O
extremity O
weakness O
, O
associated O
with O
dark O
visual O
spot O
in O
right O
eye O
, O
right O
facial O
numbness O
, O
facial O
drop O
and O
slurred O
speech O
. O
He O
denied O
dyspnea O
, O
headache O
, O
palpitations O
, O
chest O
pain O
, O
fever O
, O
dizziness O
, O
bowel O
or O
urinary O
incontinence O
, O
loss O
of O
consciousness O
. O
His O
medical O
history O
was O
significant O
for O
hypertension O
, O
hyperlipidemia O
and O
hypothyroidism O
. O
He O
smokes O
cigarette O
1 O
pack O
per O
day O
for O
40 O
years O
and O
alcohol O
consumption O
of O
5 O
to O
6 O
beers O
per O
week O
. O
He O
is O
not O
aware O
about O
his O
family O
history O
. O
He O
is O
using O
Levothyroxine O
, O
Atorvastatin O
and O
HTCZ O
. O
His O
vital O
signs O
were O
stable O
in O
the O
primary O
evaluation O
. O
Left O
sided O
facial O
droop O
, O
dysarthria O
, O
and O
left O
sided O
hemiplegia O
were O
seen O
in O
the O
physical O
exam O
. O
His O
National O
Institutes O
of O
Health O
Stroke O
Scale O
NIHSS O
score O
was O
calculated O
as O
7 O
. O
Initial O
CT B-PROCEDURE
angiogram I-PROCEDURE
of O
head O
and O
neck O
reported O
no O
acute O
intracranial O
findings O
. O
Intravenous O
recombinant O
tissue O
plasminogen O
activator O
t O
PA O
was O
administered O
as O
well O
as O
high O
dose O
statin O
therapy O
. O
The O
patient O
was O
admitted O
to O
the O
intensive O
care O
unit O
to O
be O
monitored O
for O
24 O
hours O
. O
MRI B-PROCEDURE
of O
the O
head O
revealed O
an O
acute O
1 O
. O
7 O
cm O
infarct O
of O
the O
right O
periventricular O
white O
matter O
and O
posterior O
right O
basal O
ganglia O
. O



A O
57 O
year O
old O
man O
was O
admitted O
to O
the O
clinic O
because O
of O
weight O
loss O
and O
persistent O
dry O
cough O
4 O
months O
ago O
. O
Chest B-PROCEDURE
computed I-PROCEDURE
topography I-PROCEDURE
showed O
bilateral O
multiple O
infiltrates O
in O
the O
upper O
lobes O
and O
thickened O
bronchial O
walls O
. O
There O
is O
a O
documented O
positive O
serum O
MPO O
ANCA O
in O
his O
medical O
record O
. O
Transbronchial B-PROCEDURE
biopsy I-PROCEDURE
revealed O
necrotic O
granulomas O
with O
multinucleated O
giant O
cells O
and O
the O
Wegener O
's O
granulomatosis O
was O
diagnosed O
for O
him O
. O
He O
is O
treating O
with O
corticosteroid O
and O
cyclophosphamides O
since O
4 O
months O
ago O
. O
His O
Birmingham O
Vasculitis O
Activity O
Score O
BVAS O
is O
above O
4 O
since O
the O
beginning O
of O
his O
disease O
. O
His O
last O
physical O
exam O
and O
lab O
study O
was O
performed O
yesterday O
and O
showed O
the O
results O
bellow O
A O
wellbeing O
, O
well O
nourished O
man O
, O
non O
icteric O
, O
cooperative O
and O
alert O
Weight O
73 O
kg O
Height O
177 O
BP O
120 O
80 O
HR O
90 O
min O
RR O
22 O
min O
Hgb O
13 O
g O
dl O
WBC O
8000 O
mm3 O
Neutrophil O
2700 O
mm3 O
Plt O
300000 O
ml O
AST O
40 O
U O
L O
ALT O
56 O
U O
L O
Alk O
P O
147 O
U O
L O
Bill O
total O
1 O
. O
2 O
mg O
dl O
ESR O
120 O
mm O
hr O
MPO O
ANCA O
153 O
EU O

The O
patient O
is O
a O
41 O
year O
old O
man O
and O
a O
known O
case O
of O
Acromegaly O
who O
underwent O
transsphenoidal O
surgery O
4 O
months O
ago O
. O
He O
came O
to O
the O
clinic O
for O
the O
follow O
up O
lab O
studies O
after O
his O
primary O
resection O
surgery O
. O
His O
lab O
study O
shows O
the O
IGF O
1 O
level O
of O
4 O
. O
5 O
ULN O
adjusted O
by O
sex O
and O
age O
. O
His O
random O
GH O
level O
is O
4 O
ug O
L O
. O
The O
recent O
brain O
MRI B-PROCEDURE
confirmed O
the O
residual O
pituitary O
tumor O
. O
His O
past O
medical O
history O
is O
only O
significant O
for O
acromegaly O
due O
to O
pituitary O
adenoma O
and O
the O
recent O
surgery O
. O
After O
his O
surgery O
he O
takes O
only O
vitamin O
D O
and O
multivitamins O
. O

The O
patient O
is O
a O
17 O
year O
old O
boy O
complaining O
of O
severe O
migratory O
pain O
in O
the O
right O
lower O
quadrant O
of O
his O
abdomen O
that O
started O
four O
days O
ago O
. O
The O
pain O
is O
accompanied O
by O
nausea O
and O
vomiting O
. O
He O
was O
febrile O
with O
tenderness O
, O
rebound O
tenderness O
and O
guarding O
on O
palpation O
. O
His O
WBC O
was O
elevated O
with O
dominant O
neutrophils O
. O
CT B-PROCEDURE
scan O
showed O
evidence O
of O
acute O
perforated O
appendicitis O
with O
free O
fluid O
in O
the O
pelvis O
. O
Diagnostic B-PROCEDURE
laparoscopy I-PROCEDURE
revealed O
phlegmon O
with O
no O
other O
abdominal O
abnormalities O
. O
He O
is O
now O
a O
candidate O
for O
emergent B-PROCEDURE
laparoscopic I-PROCEDURE
appendectomy I-PROCEDURE
under O
general O
anesthesia O
. O


A O
42 O
year O
old O
healthy O
woman O
came O
to O
the O
clinic O
to O
have O
her O
flu O
shot O
in O
early O
October O
. O
She O
works O
in O
a O
rehab O
center O
and O
has O
no O
underlying O
disease O
. O
It O
's O
her O
first O
time O
getting O
the O
vaccine O
this O
year O
. O
She O
is O
married O
for O
5 O
years O
and O
uses O
barrier O
methods O
of O
contraception O
. O
Her O
menstrual O
cycle O
is O
irregular O
. O
She O
does O
not O
smoke O
. O
She O
is O
not O
on O
any O
medications O
. O
She O
exercises O
regularly O
for O
30 O
minutes O
a O
day O
at O
least O
5 O
days O
a O
week O
. O
She O
has O
no O
history O
of O
allergies O
to O
any O
food O
or O
drugs O
. O
Her O
past O
surgical O
history O
is O
significant O
for O
tonsillectomy B-PROCEDURE
and O
she O
is O
otherwise O
healthy O
. O


The O
patient O
is O
a O
20 O
year O
old O
Caucasian O
female O
presents O
to O
the O
clinic O
with O
one O
sided O
vision O
lost O
and O
facial O
weakness O
, O
dysarthria O
and O
numbness O
lasting O
for O
1 O
day O
. O
She O
visited O
her O
PCP O
and O
underwent O
brain B-PROCEDURE
MRI I-PROCEDURE
which O
revealed O
a O
single O
plaque O
in O
the O
brainstem O
. O
After O
few O
months O
, O
she O
experienced O
lower O
extremities O
weakness O
led O
to O
balance O
problem O
. O
The O
second O
MRI B-PROCEDURE
revealed O
another O
lesion O
in O
the O
left O
cerebral O
hemisphere O
. O
The O
diagnosis O
of O
Relapsing O
Remitting O
Multiple O
Sclerosis O
RRMS O
is O
confirmed O
after O
the O
second O
MRI O
. O
Her O
past O
surgical O
history O
is O
significant O
for O
a O
C B-PROCEDURE
section I-PROCEDURE
2 O
years O
ago O
and O
she O
has O
a O
one O
child O
. O
She O
is O
divorced O
and O
is O
not O
currently O
in O
any O
sexual O
relationship O
. O
She O
smokes O
10 O
cigarettes O
per O
day O
and O
drinks O
alcohol O
occasionally O
. O
She O
is O
working O
as O
an O
editor O
in O
a O
publisher O
company O
and O
she O
is O
happy O
that O
she O
can O
keep O
working O
from O
home O
most O
of O
the O
time O
. O
She O
is O
under O
the O
treatment O
of O
RRMS O
from O
7 O
months O
ago O
. O









A O
22 O
year O
old O
Caucasian O
man O
came O
to O
the O
Clinic O
with O
a O
history O
of O
tremors O
since O
a O
year O
ago O
. O
The O
tremor O
was O
first O
in O
his O
right O
hand O
while O
holding O
something O
. O
Later O
the O
tremor O
became O
continuous O
and O
extended O
to O
both O
hands O
and O
legs O
and O
even O
at O
rest O
. O
The O
Kayser O
Fleischer O
' O
ring O
was O
detected O
in O
the O
ophthalmologic B-PROCEDURE
exam I-PROCEDURE
. O
The O
physical O
exam O
revealed O
jaundice O
, O
hepatosplenomegaly O
and O
hypotonia O
of O
the O
upper O
limbs O
. O
He O
had O
a O
constant O
smile O
on O
his O
face O
, O
however O
, O
he O
has O
aggressive O
behavior O
according O
to O
his O
parents O
' O
explanation O
. O
His O
laboratory O
study O
was O
significant O
for O
a O
low O
serum O
caeruloplasmin O
0 O
. O
05 O
g O
l O
, O
and O
a O
raised O
24 O
hour O
urine O
copper O
excretion O
120 O
μg O
24 O
h O
. O
Wilson O
disease O
was O
confirmed O
by O
high O
liver O
copper O
concentration O
305 O
μg O
g O
dry O
weight O
of O
liver O
. O


The O
patient O
is O
a O
15 O
year O
old O
boy O
with O
asthma O
diagnosed O
a O
year O
ago O
. O
He O
presents O
with O
shortness O
of O
breath O
, O
chest O
tightening O
and O
cough O
. O
According O
to O
his O
mother O
, O
he O
didn O
' O
t O
respond O
to O
the O
usual O
corticosteroid O
inhaler O
. O
He O
was O
admitted O
to O
the O
emergency O
department O
with O
diagnosis O
of O
severe O
asthma O
exacerbation O
. O
He O
is O
a O
candidate O
for O
general O
corticosteroid O
therapy O
. O
Spirometry B-PROCEDURE
revealed O
a O
forced O
expiratory O
volume O
in O
the O
first O
second O
FEV1 O
of O
60 O
of O
the O
predicted O
. O
His O
past O
medical O
history O
is O
non O
significant O
. O
His O
family O
history O
is O
significant O
for O
asthma O
in O
his O
mother O
and O
his O
uncle O
. O
He O
used O
to O
be O
treated O
with O
combination O
of O
inhaled O
corticosteroids O
and O
Zafirlukast O
. O

The O
patient O
is O
a O
63 O
year O
old O
man O
presenting O
to O
the O
Emergency O
Department O
with O
a O
history O
of O
acute O
urinary O
retention O
in O
the O
past O
2 O
days O
. O
Abdominopelvic B-PROCEDURE
CT I-PROCEDURE
scan O
revealed O
a O
large O
prostate O
and O
a O
bladder O
filled O
with O
urine O
. O
He O
is O
a O
candidate O
for O
urethral B-PROCEDURE
catheterization I-PROCEDURE
and O
TURP B-PROCEDURE
. O
Further O
evaluation O
revealed O
Post O
void O
residual O
71 O
mL O
Prostate O
volume O
TRUS O
63 O
mL O
Prostate O
specific O
antigen O
PSA O
level O
3 O
. O
5 O
ng O
mL O
His O
recent O
blood O
chemistry O
3 O
days O
ago O
was O
normal O
Hgb O
13 O
. O
6 O
g O
dl O
WBC O
133000 O
mm3 O
Plt O
370000 O
ml O
PT O
12 O
second O
PTT O
34 O
second O
INR O
0 O
. O
9 O
Creatinine O
0 O
. O
5 O
mg O
dl O
BUN O
10 O
mg O
dl O
U O
A O
Color O
yellow O
Appearance O
cloudy O
PH O
5 O
. O
3 O
Specific O
gravity O
1 O
. O
010 O
Glc O
100 O
Nitrite O
negative O
Ketone O
none O
Leukocyte O
esterase O
negative O
RBC O
negative O
WBC O
2 O
WBCs O
hpf O
U O
C O
negative O

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

A O
46 O
year O
old O
man O
presents O
with O
dizziness O
and O
frequent O
headaches O
. O
He O
has O
a O
family O
history O
of O
CAD O
, O
but O
no O
other O
cardiovascular O
risk O
factors O
such O
as O
smoking O
, O
high O
blood O
pressure O
, O
and O
diabetes O
mellitus O
and O
is O
physically O
active O
. O
The O
patient O
's O
LDL O
C O
and O
HDL O
C O
levels O
were O
545 O
and O
53 O
mg O
dL O
, O
respectively O
. O
His O
fasting O
glucose O
and O
triglyceride O
levels O
85 O
and O
158 O
mg O
dL O
, O
resp O
. O
were O
within O
normal O
limits O
. O
The O
patient O
reported O
no O
use O
of O
lipid O
lowering O
medications O
. O
Neck B-PROCEDURE
auscultation I-PROCEDURE
revealed O
a O
systolic O
murmur O
3 O
6 O
in O
the O
neck O
, O
radiating O
to O
the O
skull O
. O
Ultrasonography B-PROCEDURE
of O
the O
carotid O
arteries O
, O
revealed O
severe O
stenosis O
in O
the O
left O
internal O
carotid O
artery O
LICA O
, O
as O
well O
as O
moderate O
stenosis O
in O
the O
right O
internal O
carotid O
artery O
RICA O
estimated O
between O
40 O
and O
50 O
. O
For O
the O
LICA O
, O
the O
peak O
systolic O
PSV O
and O
end O
diastolic O
velocity O
EDV O
cutoff O
values O
were O
208 O
. O
5 O
cm O
s O
and O
54 O
. O
5 O
cm O
s O
, O
respectively O
; O
RICA O
PSV O
was O
91 O
. O
72 O
cm O
s O
and O
RICA O
EDV O
was O
37 O
. O
37 O
cm O
s O
. O
Plaque O
was O
observed O
in O
the O
anterior O
and O
posterior O
walls O
of O
the O
internal O
carotid O
artery O
and O
common O
carotid O
artery O
, O
which O
were O
characterized O
as O
bulky O
plates O
extending O
to O
the O
middle O
third O
of O
the O
internal O
coronary O
arteries O
ICAs O
and O
as O
predominantly O
echogenic O
and O
hyperechoic O
, O
with O
less O
than O
50 O
of O
the O
area O
being O
echolucent O
with O
uneven O
surfaces O
. O


The O
patient O
is O
a O
55 O
year O
old O
man O
diagnosed O
with O
HCV O
2 O
years O
ago O
and O
the O
recent O
coinfection O
with O
HBV O
. O
His O
past O
medical O
history O
is O
non O
significant O
. O
He O
is O
on O
IFN O
, O
RBV O
and O
direct O
antiviral O
drugs O
for O
the O
past O
6 O
months O
. O
The O
patient O
takes O
no O
other O
medications O
. O
His O
medical O
records O
show O
previous O
positive O
HCV O
RNA O
tests O
and O
a O
positive O
enzyme O
immunoassay O
for O
anti O
HCV O
antibodies O
. O
The O
recent O
biopsy B-PROCEDURE
was O
negative O
for O
hepatocellular O
carcinoma O
and O
was O
only O
remarkable O
for O
chronic O
inflammation O
compatible O
with O
a O
chronic O
viral O
hepatitis O
. O
There O
is O
no O
evidence O
of O
alcoholic O
liver O
disease O
, O
bleeding O
from O
esophageal O
varices O
, O
hemochromatosis O
, O
autoimmune O
hepatitis O
, O
or O
metabolic O
liver O
disease O
. O
He O
is O
an O
alert O
male O
with O
no O
acute O
distress O
. O
His O
BP O
130 O
75 O
, O
HR O
90 O
min O
and O
BMI O
27 O
. O
His O
abdomen O
is O
soft O
with O
no O
ascites O
or O
tenderness O
. O
The O
lower O
extremities O
are O
normal O
with O
no O
edema O
. O

The O
patient O
is O
a O
25 O
year O
old O
man O
with O
type O
1 O
diabetes O
confirmed O
with O
molecular B-PROCEDURE
analysis I-PROCEDURE
7 O
years O
ago O
. O
He O
presents O
to O
the O
clinic O
with O
shortness O
of O
breath O
and O
fatigue O
during O
activities O
. O
He O
claims O
mild O
dyspnea O
after O
climbing O
3 O
floors O
, O
no O
dyspnea O
at O
rest O
and O
no O
angina O
New O
York O
Heart O
Association O
class O
2 O
. O
He O
is O
diagnosed O
with O
cardiomyopathy O
that O
will O
be O
treated O
with O
ACE O
inhibitors O
and O
Beta O
blockers O
. O
His O
takes O
70 O
30 O
Insulin O
and O
vitamin O
D O
supplements O
. O
His O
past O
medical O
history O
is O
not O
significant O
for O
any O
other O
medical O
issues O
. O
His O
family O
history O
is O
positive O
for O
DM O
type O
1 O
in O
his O
uncle O
and O
his O
grandfather O
. O
His O
lab O
study O
is O
as O
bellow O
FBS O
100 O
mg O
dl O
HbA1c O
6 O
. O
5 O
Cholesterol O
190 O
mg O
dl O
TG O
140 O
mg O
dl O
LDL O
125 O
mg O
dl O
HDL O
40 O
mg O
dl O


A O
Pap O
smear O
in O
a O
54 O
year O
old O
woman O
revealed O
abnormal O
cervical O
squamous O
intraepithelial O
glandular O
lesion O
. O
She O
tested O
positive O
for O
HPV O
16 O
. O
She O
is O
sexually O
active O
with O
her O
husband O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
and O
uses O
no O
contraception O
. O
She O
smokes O
and O
drinks O
alcohol O
frequently O
. O
She O
is O
otherwise O
healthy O
. O
She O
was O
offered O
conization B-PROCEDURE
. O

The O
patient O
is O
a O
23 O
year O
old O
man O
who O
came O
to O
the O
hospital O
with O
high O
blood O
pressure O
175 O
95 O
mmHg O
and O
signs O
of O
septicemia O
. O
He O
developed O
respiratory O
failure O
requiring O
mechanical O
ventilation O
and O
renal O
failure O
requiring O
hemodialysis B-PROCEDURE
. O
His O
blood O
smear O
showed O
microangiopathic O
hemolytic O
anemia O
and O
thrombocytopenia O
. O
His O
blood O
tests O
revealed O
elevated O
lactate O
dehydrogenase O
and O
reduced O
human O
complement O
C3 O
levels O
with O
a O
normal O
coagulation O
profile O
. O
He O
was O
diagnosed O
with O
atypical O
hemolytic O
uremic O
syndrome O
. O
He O
was O
treated O
with O
plasma O
exchange O
and O
corticosteroids O
. O
He O
has O
been O
previously O
vaccinated O
with O
meningococcal O
group O
ACWY O
conjugate O
vaccine O
and O
meningococcal O
group O
B O
vaccine O
. O
The O
genetic O
survey O
revealed O
ADAMTS13 O
10 O
. O


A O
46 O
year O
old O
Asian O
woman O
with O
MDD O
complains O
of O
persistent O
feelings O
of O
sadness O
and O
loss O
of O
interest O
in O
daily O
activities O
. O
She O
states O
that O
her O
mood O
is O
still O
depressed O
most O
of O
the O
days O
. O
She O
complains O
of O
loss O
of O
energy O
and O
feelings O
of O
worthlessness O
nearly O
every O
day O
. O
She O
is O
on O
anti O
depressants O
for O
the O
past O
6 O
months O
, O
but O
the O
symptoms O
are O
still O
present O
. O
She O
does O
not O
drink O
alcohol O
or O
smoke O
. O
She O
used O
to O
exercise O
every O
day O
for O
at O
least O
30 O
min O
. O
, O
but O
she O
doesn O
' O
t O
have O
enough O
energy O
to O
do O
so O
for O
the O
past O
3 O
weeks O
. O
She O
also O
has O
some O
digestive O
issues O
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
. O
Her O
husband O
was O
diagnosed O
with O
colon O
cancer O
a O
year O
ago O
and O
is O
undergoing O
chemotherapy B-PROCEDURE
. O
Her O
past O
medical O
history O
is O
unremarkable O
. O
Her O
family O
history O
is O
negative O
for O
any O
psychologic O
problems O
. O
Her O
HAM O
D O
score O
is O
20 O
. O




The O
patient O
is O
a O
3 O
day O
old O
female O
infant O
with O
jaundice O
that O
started O
one O
day O
ago O
. O
She O
was O
born O
at O
34w O
of O
gestation O
and O
kept O
in O
an O
incubator O
due O
to O
her O
gestational O
age O
. O
Vital O
signs O
were O
reported O
as O
axillary O
temperature O
36 O
. O
3 O
C O
, O
heart O
rate O
154 O
beats O
min O
, O
respiratory O
rate O
37 O
breaths O
min O
, O
and O
blood O
pressure O
65 O
33 O
mm O
Hg O
. O
Her O
weight O
is O
2 O
. O
1 O
kg O
, O
length O
is O
45 O
cm O
, O
and O
head O
circumference O
32 O
cm O
. O
She O
presents O
with O
yellow O
sclera O
and O
icteric O
body O
. O
Her O
liver O
and O
spleen O
are O
normal O
to O
palpation O
. O
Laboratory O
results O
are O
as O
follows O
Serum O
total O
bilirubin O
21 O
. O
02 O
mg O
dL O
Direct O
bilirubin O
of O
2 O
. O
04 O
mg O
dL O
AST O
37 O
U O
L O
ALT O
20 O
U O
L O
GGT O
745 O
U O
L O
Alkaline O
phosphatase O
531 O
U O
L O
Creatinine O
0 O
. O
3 O
mg O
dL O
Urea O
29 O
mg O
dL O
Na O
147 O
mEq O
L O
K O
4 O
. O
5 O
mEq O
L O
CRP O
3 O
mg O
L O
Complete O
blood O
cell O
count O
within O
the O
normal O
range O
. O
She O
is O
diagnosed O
with O
neonatal O
jaundice O
that O
may O
require O
phototherapy B-PROCEDURE
. O