[情報] 明天的內科 Medical Challenge

[cosmo (irreversible)]

※ [本文轉錄自 NTUmed87 看板]

作者: cosmo (irreversible) 看板: NTUmed87
標題: [情報] 明天的內科 Medical Challenge
時間: Tue Mar 29 21:31:48 2005


  剛剛在內科主任室前面抄下來的...

  Medical Challenge  by R4 林建助

  General History:
  - 汪XX, 75y/o male
  - Occupation: retired teacher

  Chief Complaint:
  - Sudden onset of epigastralgia after eating dinner last night

  Past History:
  - Denied DM, Denied HTN
  - BPH, Cataract s/p operation
  - Smoking: denied
  - Drinking: denied

  Question 1: What do you want to ask from the chief complaint?

  Brief History
  - Sudden onset of epigastralgia after eating dinner last night
  - Vomiting with food
  - Fever (+), Chills (+); no diarrhea

  Question 2: What physical examinations will you do in this patient?

  Physical Examination (1)
  - Consciousness: clear
  - Vital sign: T/P/R 38.2/103/20, SpO2: 91% with room air
  - HEENT: conj not pale, sclera anicteric
  - Chest: symmetric expansion
  - Breathing Sound: clear
  - Heart: RHB, no murmur

  Physical Examination (2)
  - Abdomen: epigastric tenderness (+), rebounding pain (-)
  - Murphy's sign (-)
  - soft and flat, L/S impalpable
  - Back: knocking tenderness (+)
  - Extremities: no pitting edema

  Question 3: What could be the differential diagnosis?

  Question 4: What examinations will you arrange?

  CBC/DC

  WBC    RBC   Hb   MCV   MCHC  PLT
  19470  4.61  14.1 88.5  34.6  181k

  Blast  Band  Seg   Eosi  Mono  Lym
  0      0     80.2  3.9   7.2   8.4

  BCS + electrolyte

  BUN  Cre  Na   K   Bil-t  Bil-d  Glu
  11.7 1.0  136  4.2 1.89   1.06   112

  AST  ALT  ALP   GGT
  47   46   524   120

  PT/PTT
  PT            PTT         INR
  14.4/13.3     41.5/38.5   1.2


--
※ 發信站: 批踢踢實業坊(ptt.cc) 
◆ From: 140.112.125.68

--
※ 發信站: 批踢踢實業坊(ptt.cc) 
◆ From: 140.112.125.68