commit 17f735771e349ee1daa62e3bd8ac7fcf7375a9fc
parent 39c2ec1d7e1f58be82306377f49f9b053e0c0766
Author: Beau Hilton <beau.hilton@vumc.org>
Date: Sat, 21 Aug 2021 22:58:50 -0500
mr first draft
Diffstat:
3 files changed, 94 insertions(+), 4 deletions(-)
diff --git a/index.md b/index.md
@@ -22,5 +22,6 @@ Feed for this page.
## Posts
-* Forthcoming. Check out the [memex](https://memex.beauhilton.com) in the meantime.
-- See old posts [here](https://cbeauhilton.github.io).
+[Morning Report 08/2021](/mr-2021.html)
+
+See old posts [here](https://cbeauhilton.github.io)
diff --git a/mr-2021.md b/mr-2021.md
@@ -0,0 +1,90 @@
+## HPI
+
+70F with chest pain, abdominal pain, and constipation.
+
+2-3mo weight loss, night sweats.
+
+2-3wk +perineal ?cyst, initially ttp and hurt to walk, but now nontender.
+
+~1wk constipation, BRB on TP.
+
++crampy LLQ pain 8/10, x3-4 days, improves with positioning (supine with head raised somewhat, 3-4 pillows).
+
++LUQ and left-sided chest pain x1-2 days, radiates to L arm, not related to exertion, lasts a few minutes.
+
+
+## PMSHx
+- TVH-BSO for fibroids and endometriosis (~20y ago)
+- hemorrhoids (no surgeries)
+- s/p Moderna COVID vaccine (~4wk ago)
+- utd on mammograms, colonoscopies, no deviations from regular schedule
+
+## SHx
+- monogamous x45y, G2P2 sons, 6yo grandson, all healthy
+- never smoker
+- social EtOH, none this year
+- previously secretary
+- likes to DIY: painting, home crafts, gardening
+
+## FHx
+- M GM: uterine cancer (~40yo)
+- P GF: lung ca, unknown type (~70yo)
+
+## OP Meds
+- duloxetine 60mg
+- ASA 81mg
+- melatonin 6mg
+- no notable allergies
+
+## PE
+- VS: wnl
+- GEN: NAD
+- HEENT: no LAD
+- PULM: fine
+- CV: fine
+- ABD: NTND, +splenomegaly
+- GYN: 0.5cm lesion R side of anterior perineum, NT, freely mobile
+- NEURO: fine
+
+## Labs
+- Hgb 12.7
+- WBC 58.3
+ - 0 blasts
+ - 0 atypical lymphs
+ - + slight L shift
+- Plt 490
+- BMP grossly wnl (gluc 202)
+- LFTs fine
+- Trop <0.01
+- urate 10.4
+- phos 5.0
+- LDH 330
+- fibrinogen 355
+
+## Other studies
+- EKG wnl
+- CT-PE -ve
+- CT a/p wwo
+ - +10x7cm pelvic mass (central/R adnexum, exerting mass effect on sigmoid colon)
+ - spleen ~20cm largest dimension w ?infarcts x2,
+ - L internal iliac vein filling defects c/w nonocclusive DVT
+- PET/CT
+ - splenomegaly with diffusely increased uptake, diffuse FDG uptake of axial and appendicular skeleton, mild uptake of abdominal pelvic lymph nodes, and minimal to mild uptake in the pelvic mass.
+
+## Further notes on hospital course
+- CEA 1.7 (wnl), CA-125 52 (-)
+- urate 9.5 5d later w IVF, given rasburicase 3mg x1 -> urate 3.8
+- phos similarly without movement, sevelamer eventually helpful
+- pelvic mass bx: smooth muscle
+- BMBx: hypercellular >90%, no blasts, +trilineage atypica > myeloid, MF-1 fibrosis.
+- JAK2 -ve, BCR/ABL -ve
+
+## TLS
+- laboratory vs clinical
+- risk assessment
+- rasburicase
+- allopurinol
+- when to expect
+
+## MDS/MPN overlap syndromes
+- something profound
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