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정 0 연 F/73 2007313075 손의영. Chief Complain Headache Onset : 1 week ago Quality :...
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Slide 1
0 F/73 2007313075
Slide 2
Chief Complain Headache Onset : 1 week ago Quality :
Slide 3
Present Illness 1980. Diagnosis of TB Medication 2001.
Diagnosis of Spinal stenosis Operation 2010. Skull base fracture
dura . 2 2011.04.16 .
Slide 4
Present Illness 2011.04.21Headache with fever local clinic
manage 2011.04.27 ER refer Initial V/S, Lab, CSF tapping PND cough
PNS CT Acute rhinosinusitis f/u PO Augmentin 2011.04.2904.27 Blood
culture Gram (+) Cocci ER 2011.04.30R/O infective endocarditis TTE
followed management
Slide 5
Other Histories Past Medical History HTN(+) DM() Hepatitis ()
TB(+) Allergy() Family History Social History Occupation : ( )
Alcohol : never Smoking : never
Slide 6
Review of System General weakness / Easy Fatigue ( / ) Weight
change () fever/chill ( + / ) Headache/dizziness ( + / )
Rhinorrhea/ cough / sputum ( / / ) Dyspnea () Chest pain ()
Palpitation ()
Slide 7
Review of System anorexia/nausea/vomiting ( / / ) abdominal
pain/discomfort ( / ) constipation/diarrhea ( / )
hematemesis/melena/hematochezia ( / / ) Urinary Sx () Arthralgia ()
Myalgia ()
Slide 8
Physical Exam V/S : 2011.04.30 20:21 BP 154/72 mmHg PR 88 /min
RR 21 /min BT 37.7 G/AAcute ill-looking appearance Mentalityalert
& well orientation HEENTpinkish conjunctivae, anicteric sclerae
dehydrated tongue() JVP() Cervical LNE ( / ) Maxillary sinus
tenderness ()
Slide 9
Physical Exam Chestsymmetric expansion, regular heart beat no
murmur, clear breathing sound AbdomenSoft & Flat normal bowel
sound tenderness / palpable mass ( / ) no shifting dullness Backno
CVAT no tenderness Extremity Peripheral embolic phenomenon ()
Slide 10
Lab test 2011.04.29 WBC10.3 x10/L Neut. 60.6% (seg.) Mono.10.4%
Hb 12.7 g/dL Hct 37.9% PLT320,000/L Protein 6.9 g/ Albumin 3.7 g/
Globulin 3.0 g/ CRP 5.66 mg/dL AST31 U/l ALT27 U/l ALP 259 U/l
(05.02) BUN8.5 mg/dL Cr 0.74 mg/dL BUN/Cr11.5 Na141 mmol/ K4.2
mmol/ Cl 104 mmol/
Slide 11
CSF Findings 2011.04.27 RBC50 /mm 3 WBC1 /mm 3 Protein17.9
mg/dL Glucose70 mg/dL (Serum: 128 mg/dL)
Slide 12
Chest X-ray (04.27) Follow up (05.02)
Slide 13
Problem List #1.Headache #2.Fever #3. Blood culture Gram
positive cocci in cluster #4. Hypertension #5. Past TB history #6.
Postnasal drip, cough
Slide 14
Initial Impression #1, #2, #3 r/o Infective endocarditis r/o
partially treated meningitis r/o odontogenic rhinosinusitis #2, #5
r/o TB recur
Slide 15
Diagnostic plan For infective endocarditis Transthoracic
echocardiography Transesophageal echocardiography For Meningitis
Meningeal irritation sign : kernig, brudzinski sign CSF
tapping
Slide 16
Therapeutic plan Infective Endocarditis Streptococci :
Penicillin Penicillin G, Ceftriaxone, Vancomycin, Gentamicin
Enterococci : Penicillin G, Ampicillin, Vancomycin Staphylococci :
Methicillin Nafcillin, Cefazolin, Vancomycin Harrison's Internal
Medicine 17 th Ed. Table 118-4
Slide 17
Therapeutic plan Meningitis (IDSA guidelines, 2004)
Slide 18
Therapeutic plan Meningitis (IDSA guidelines, 2004)
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