R4 張祐銘 VS 彭聖曾醫師馬偕國泰病理討論會. General data Chart Number ： 0803472902 Name ：涂 X 治 Age ： 68 Gender: male Marriage Status: married Source of information: the.

Slides:

Advertisements

Similar presentations

General Data R.G. 2 years 4 months (May 22, 2008) Male Filipino Roman Catholic Sampaloc, Manila Informant: Mother Reliability: Good.

Advertisements

Case 1: Upper GI Bleeding

CASE REPORT CASE REPORT 洪嘉蔚醫師 / 吳維峰主任台北市立仁愛醫院小兒科.

Case Presentation Bianca Brif MD. Background  10 year old, previously healthy male  No PMH of hospitalizations/illness  NKDA  Vaccinations up to date.

Prepared by: Tristan Villanueva Arcibal BSN-RN Presented on: July 16, 2013 A CASE PRESENTATION OF A PATIENT WITH DIABETIC KETOACIDOCIS (DKA)

Case Presentation Linda White, PA-S. Chief Complaint n “ I am short winded and tired. Also when I eat it feels like the food sits in my chest.”

Case present By Intern 劉一璋. Patient data Name: 陳 ○ 富 Sex: 男 Age: 71 歲 Date of admission: 96/08/09 Chart No:

Case study Mr. Wang, a 64-year-old male, presented with nausea and coffee ground emesis in your department. In the past 1 month, he suffered from recurrent.

腎臟內科臨床個案探討徐邦治醫師. 介紹 A 47-year-old male patient suffered from conscious disturbance noted this morning and had a history of alcoholism with alcohol drinking.

Anemia Lab MHD I November 3, Case 1 A CBC is ordered on a 32-year old healthy man as part of a life-insurance policy evaluation.

Combine meeting 報告者 : NS R3 吳孟庭醫師. Case 姓名 : 廖 xx 年齡 : 16 y/o Admission date: 性別 : 男 ID: I.

風濕免疫科案例 -- SLE 案例簡介 Ms. Chang, a 24 y/o female, visited your clinic because of abdominal pain. Shortly before this visit, she ever called at a local hospital.

ER case conference 報告者：溫聖辰. Patient profile Chart No.: Name: 巫 X 緯 Gender: male Age: 18 Date of visiting: 19:04,May 3, 2007.

CASE REPORT Intern 呂佾欣. Profile Name: 劉ｘ珍 Name: 劉ｘ珍 Chart No.: Chart No.: Gender: female Gender: female Age: 49 y/o Age: 49 y/o Admission.

小港內科 Case presentation 98/05/05 Presented by Intern : 吳勝騰.

國泰馬偕聯合病例討論會Ｒ郭馨仁Ｖｓ吳志仁. Basic datas Name: 蔡ｘ峯 Age: 61 y/o Sex: female Chart no: Date of admission: Date of renal biopsy: (

報告者： fellow 1 陳筱惠.  Name: 江 O 君  Sex: female  Age: 39-year-old  Chart number:  Date of admission: 2011/12/20.

Case report By 馮文翰. Identity / Name: 崔 X 誠 / Sex: male / Age: 29 years old / Chart number: / 來急診的時間： / Name: 崔 X 誠 / Sex: male.

JCM OSCE Questions Caritas Medical Centre 3 June, 2015.

NYU Medical Grand Rounds Clinical Vignette Phillip Joseph, MD, PGY-2 September 25 th, 2013 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

心臟科案例 – Acute coronary syndrome 場景 (1): 病史 Mr. Chang, 65-year-old man, visited ER for severe chest pain on Saturday. According to his statement, he had.

Case discussion. Vs 李宜中,R1 林玫瑩. General data: Name: 賴錦 x Age:52 years old Occupation: 鐵工廠老闆 Admission date:2006/5/30.

腫瘤科案例 -- Hypercalcemia 案例簡介 Mrs. Lee, a 50-year-old female patient, was diagnosed with left breast cancer T2N1M1,ER(+),PR(+),HER2 (1+) with bone, liver.

Presented by F1 林立原 Instructed by Dr. 許景瑋 2011/11/11.

Patient History  TO  14 year old male  Lives in Palau  Right-handed  Informant: Patient, good reliability Chief Complaint: Wrist Injury.

NYU Medical Grand Rounds Clinical Vignette Maryann Kwa, MD PGY-3 March 20, 2012 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

Case Report 95/06/11 Intern 張偉德. Patient ’ s Profile  Name ：郭 ○ 玲  Age ： 40 y/o  Sex ： female  Chart no. ：  95/6/25, 12:04 入 ER.

CASE DISCUSSION 醫學六王家泰醫學六王家泰. History Name : 陳 XX Ward ： 11A 9-2 Date of Admission : 92/03/22 Age : 33 y/o Sex : Female.

Case presentation Intern 陳嘉夆 Personal Profile Name: 徐 X 祺 Age: 22 years old Gender: male Arrival date: :40 referred from 婦幼 Hospital.

Case Report Intern 謝旻翰. Status on Arrival Consciousness –Alert Vital sign –RR: –PR ： 70 –BT: 36.5 –BP: 162/102.

Red blood cell disorders / Anemia laboratory

Case Review Division of Gastroenterology Department of Pediatrics, YUMC R1 이 순 민.

CASE 경희 의료원 소화기 내과 황보 영. 방 O 극 (M/20) adm ; Epigastric discomfort o/s) remote; 수개월전 recent; 수일전 상기 환자는 anal bleeding 으로 국군대전병원 외래 내원 하여 anal hemorrhoids.

Echo conference R1 하 상 진 박 * 순 (F/69) Admission date Patient’s history Chief complaint : chest pain onset) 내원 30 분전 Character: sqeezing.

M G R Acute A viral hepatitis CASE 1 R2 이은정 / R4 박재현 / prof 김병호.

History and PE Fiona Javelosa. The Curious Case of John Dick Group 3 Clinical Clerk Batch 2012 SY

고혈압과 azotemia 를 동반한 68 세 남자 환자 Department of Nephrology Prof. 임천규 /R3 권성진.

우연히 발견된 폐결절환자 증례 호흡기내과 R1 최윤영/ Prof. 박명재

Case Conference 신장내과 R2 최소영 박 O 주 (M/82) adm : C.C) Fevero/s 1 weeks ago P.I ) M/82 30 년전 HTN, 3 년전 Old CVA, BPH Dx, 04 년 APN 으로 입원.

Case Conference Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea R2 임효석 / Prof. 장재영.

1 MGR 내분비 대사 내과 R2 황연희. 2 주소 전신적인 무기력증 발병시기 : 약 7 개월 전 현병력 특이 병력과 약물 복용력 없는 62 세 여자 환자로 7 개월 전부터 쉽게 지치고, 일상생활 유지 못할 정도로 전신 무기력감 지속되어 건강검진 시행 받았으며 당시 혈청.

Case Presentation Division of Gastroenterology R2 김 지 연.

건강 검진에서 발견된 위선종 73/M 소화기 내과 R 3 김혁 / Prof. 장영운 MGR.

Polygrandular Autoimmune Syndrome 내분비대사 내과 R1 권성진.

MGR - case R2. 유정선 / Prof. 정재헌. Case 송 O 섭 M/67 Adm date: Chief complaint Left neck mass o/s) 15 일전 Present illness 67/M, 2009.

Case Conference 신장내과 R2 우종신 한스 0 자 (F/69) adm : CC ) Poor oral intake (onset: 15days ago) P.I ) 2005 년 12 월 TKR Rt 받은 Hx 있는 자로, 당시 Cr.

CASE PRESENTATION 영동 세브란스 병원 응급의학과 R1 김민정 32/F Chief Complaint : 중화제를 먹었어요. Duration : 내원 30 분 전 Past History DM / HTN / Pul.Tbc / Hepatitis (-/-/-/-)

Case Conference Department of nephrology R2 우용식 유 O 형 (M/69) adm: C. C. : headache, fever o/s- 4 주전 P. I. :  M/69, 9 월초 headache,

Echo- Conference R2 조경민. History 강 O 은 (F/77) Chief Complaint Chief Complaint Chest pain o/s) On the day hospitalization Chest pain o/s) On the.

Echo-Conference R2 조경민. History 박 O 화 (F/31) Chief Complaint Chief Complaint Fever.chilling & Chest discomfort O/S) 10 days ago Fever.chilling.

Case I. Chief complain : dyspnea o/s) 2 days ago Present illness : a 67 years old man with hypertension, MVP and atrial fibrillation had taken medicine.

Case Presentation Jung Hyun Seo Department of Internal Medicine Catholic University of Daegu School of Medicine School of Medicine.

Hallym University Sacred Heart Hospital 한림대학교 성심병원 소화기내과 김 유 진 위암 치료를 위해 내원한 60 세 남자 제 83 회 내시경 집담회.

Case II. Chief complain : RUQ pain o/s) 2 days ago Present illness : a 45 years old woman with hypertension and ASD had taken medicine at local clinic.

Department of oncology. C/C Poor oral intake, abdominal distension (onset: 2 weeks ago) P/H DM (+): detection, medication 중 HTN/Hepatitis/Tuberculosis.

Echo-Conference R2 조경민. History 송 O 규 Chief Complaint Lt.side weakness O/S) Recent onset 3-4 days ago Present illness A 75 year old woman had.

R3 이정훈 Echo Conference. History 임 O 수 (M/45) adm. Via OPD Chief Complaint dyspnea of exertion o/s) 1yr ago dyspnea of exertion o/s)

Angio Conference 김 O 동 (M/50) Admission: Chief complaint - Chest Pain (recent o/s: 내원 2 주전, remote o/s: 내원 1 년전 ) squeezing type Ant.

Presented by Int. 楊為傑 Int. 吳建霆

GI-GS-RAD.-PATH. conference

Stevens-Johnson Syndrome

Living donor liver transplantation Pre-transplant report

Progressive Liver Failure following Gastric Bypass

Case presentation 경희의료원 내과 R2 조창현.

PED Case Presented by R1 常景棠.

Case Discussion R1 吳宗祐 VS 邱元佑 2016/12/07.

Clinical Pathology Conference 病史篇

Case Presentation R3 謝旻玲 / VS 王玠能.

By Dr khounelaphet Touphaythoune Savannakhet provincial hospiatl

Presentation transcript:

R4 張祐銘 VS 彭聖曾醫師馬偕國泰病理討論會

General data Chart Number ： Name ：涂 X 治 Age ： 68 Gender: male Marriage Status: married Source of information: the patient himself and his son, old medical history, reliable

Past history DM: denied Hypertension: 2 years with irregular control at 竹東榮民醫院. BPH for 2 years with irregular control at 竹東榮民醫院 Operation history: HIVD s/p op at 署立台北醫院 in 1999.

Chief complaint progressive general malaise for about 3-4 months

Present illness This 69 year-old man had a history of HTN and BPH for 2 years. His medications included: Harnalidge 1# hs, Tanatril 1#qd from 竹東榮民 H 97/11/17 Lasix 40mg 1#bid, Carvedilol 6.25mg 1# bid 97/11/19 Lasix 40mg, Trichlormethiazide 2mg 1# qd 97/11/26 Lasix 40mg, Nifedipine SR 30mg 1#bid, Bisoprolol 5mg 1#qd

Since 97/8, he got edematous status and soreness over bilateral legs. He became weakness so that he could not play tennis any more. His hypertension exacerbated. He took traditional Chinese herb once in 97/9. Due to soreness, NSAID was also prescribed from 竹東榮民 H.

In 97/10, there was exertional dyspnea. Palpitation, dizziness and cold sweating also occurred from time to time. No tarry stool, nausea, vomiting, poor appetite, body weight loss, chest tightness, chest pain, flank pain, tea-color urine or decreased urine amount was noted.

He went to 新竹國泰 OPD on 97/11/17 and renal failure (BUN/Cr : 37 / 2.87) was found. His clinical symptoms (aching, weakness) did not improve and his renal function kept on deterioration. Under the impression of acute renal failure with unknown origin,he was transferred to 台北國泰 for renal biopsy on 97/12/23.

Physical examination Body weight: 75.5 kg Body height: 175 cm Vital sign: BP 160/90 mmHg, BT 36.5 ℃, HR 60 BPM, RR 18 /min General appearance: chronic ill-looking Consciousness: clear HEENT: conjunctiva: mild pale, sclera: anicteric Neck: supple, JVE (-/-), LAP (-/-)

Chest: accessory muscle respiration (-), rales (-), rhonchi (-), wheezing (-) Heart: RHB, S3 (-), S4 (-), murmur (-) Abdomen: distension (-), tenderness (-), muscles guarding (-), rebounding pain (-), palpable mass (-), hepatosplenomegaly (-), shifting dullness (-), tympanic (-), knocking pain (-), normal active bowel sound Flank: knocking pain L/R (-/-), pressure sore (-) EXT: freely movable, pitting edema (+/+) Skin: rash (-), petechiae (-)

date97/811/1711/2611/2912/1812/2398/1/51/121/131/14 BUN Cr Uric acid Total protein albumin Cholesterol TG Ca P Na K GOT GPT Bilirubin T/D 0.8/ /0.1

11/1711/2612/1812/2312/24 Hb Hct MCV8788 WBC Platelet urine protein 56.8 Urine Cr36.8 RBC WBC Protein(-)30 SpGr PH55.5 Glucos e -- Cast--

11/2611/2812/23 Haptoglobin< 10 Reticulocyte1.75 ( ) 2.66 Fe34 TIBC205 Ferritin792 AC sugar88 LDH282 Stool O.B.(-)

12/23 RA: < 20 (0-30) ANA: 1:80, speckleAnti-cardiolipin IgM: 3.8 ASLO: 27.4 (0-116) Coomb’s test (D): ±Anti-cardiolipin IgG: 4.4 IgA: 197 ( ) Coomb’s test (I): -Anti-dsDNA: 1.18 (-) IgM: 89 (79-195) C-ANCA: -Anti-RNP Ab: 1.27 (-) IgG: 1430 ( ) P-ANCA: -Anti-SM Ab: 0.31 (-) C3: 84 ( ) C4: 22.4(16-32)HBsAg(-), Anti-HCV(-)

Renal echo

Renal biopsy was done on 97/12/23

date97/811/1711/2611/2912/1812/2398/1/51/121/131/14 BUN Cr Uric acid Total protein albumin Cholesterol TG Ca P Na K GOT GPT Bilirubin T/D0.8/0.10.3/0.1