ティアニー先生 in 茅ヶ崎 2010年10月27日
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- いいね！0
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<case 1> 68yo M, cc: back pain, anorexia, nocturnal polyuria, general malaise
2010-10-27 07:37:20
家庭医療WS＠東京５月８、９日
@kateiiryouWS
back pain started on 7 weeks before,anorexia and nocturnal polyurea, general malaise two weeks before. he had lost 2kg in two month
2010-10-27 07:40:04
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<pearls> Patient's chief complain gives you most information in most time IF we take history correctly!!!
2010-10-27 07:44:30
家庭医療WS＠東京５月８、９日
@kateiiryouWS
He was a carpenter. Type2 DM for 20 years. Meds: Voglibose,a-glucosidase inhibitor. Smoking 1ppd, No alcohol drinker. FH is unremarkable
2010-10-27 07:51:05
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<What makes DM worse??> Infection, MI , Hypertriglycemia, Forget medicine, Pancreatic carcinoma
2010-10-27 07:54:23
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Always ASK patients "What makes pain better, What makes pain worse"
2010-10-27 07:57:27
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<From floors > DDx => Kidney stone, UTI, Kidney infarction, Tumor (Primary, metastasis), DM, ,,,,
2010-10-27 07:58:34
家庭医療WS＠東京５月８、９日
@kateiiryouWS
PE: KT 36.2c , BP 124/70, P 66, Patient is lethargic. No rash, No lymphadenopathy. Chest and Abdomen is normal
2010-10-27 08:03:00
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Tenderness on Upper and Lower back. Another Neurological exam is normal
2010-10-27 08:03:35
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Think of Pre-test possibility BEFORE you would order ANY test!!
2010-10-27 08:08:07
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<High Ca symptom> 1. Constipation 2. Polyuria ( Nephrogenic DI, work on distal nephron in kidney, Block ADH)
2010-10-27 08:11:29
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Pack pain + Polyuria ===> You need to think "Multiple myeloma" (Also HyperParathyroidism, too I think )
2010-10-27 08:13:36
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<Cause of High Ca> Sarcoidosis, TB, many Fungus disease (Gulanuroma relating disease)
2010-10-27 08:16:40
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Lab) Hb. 13.4, WBC 6700, Plt 143000. TP 7.6 Creatinine 2.9 Na 137 K 4.4 Ca 16.3. U/A is normal
2010-10-27 08:19:16
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Chest X ray and Abdominal US are normal. Collaps of Th8, Th9, L1, L4, L5. Skull is normal.
2010-10-27 08:21:10
家庭医療WS＠東京５月８、９日
@kateiiryouWS
Serum IgA, igG, igM were 119, 1229, 1020. Immunoelectrophoresis shows igG and IgM biclonal gammapathy. PTH-rP is HIGH.
2010-10-27 08:23:35
家庭医療WS＠東京５月８、９日
@kateiiryouWS
DDX ==> Lymphoma, Solid tumor with metastases, Multiple myeloma, Leukemia
2010-10-27 08:24:45
家庭医療WS＠東京５月８、９日
@kateiiryouWS
<Tissue is the issue!! > Biopsy of L1 ==> CD20+ B cell is positive
2010-10-27 08:25:54
家庭医療WS＠東京５月８、９日
@kateiiryouWS
On day15. Left lynpho node were enlarge (no tenderness)=> Biopsy => CD20+ B cell
2010-10-27 08:26:58