1. John Leffert,MPAS, PA-C Grand Rounds

2. Case 1 46 year old black male is seen in the ER for a yellow productive cough and wheezing 24 hours ago. He was seen by the you. He denied any chills, fever, hemoptysis or N/V/D. He smoked ½ a day for 20 years. His exam revealed diffuse wheezing in all lung fields but no rales or rhonchi. V/S at that visit: B/P 130-80, P-78, R-16, T-98.6 Labs WBC- 8.0, H/H 15/38, MCV 90 Dx- Acute Bronchitis Treatment: Septra DS and Albuterol inhaler.

3. 18 hours later Patient returns with family. He C/O being weak and lightheaded just before he collapsed. He is stuperous and incoherent Admission V/S- B/P 75/40, P-120, R-20 and shallow, T-98.8 What do you do?

4. Now what?

5. Differential Diagnosis

6. What caused his hemolysis?

7. Significance of (+) blood in Urine without RBS on Micro?

8. Treatment

9. Case 2 A 64-year-old postmenopausal mother of three presents to her primary physician with the complaint of fatigue and abdominal swelling over the last 5 months.

10. HPI PMH FMH Social Meds/Allergies ROS PE Differential Plan Management