vimwiki

commit cca31f6935223ec269ad1539350444ec7b39770a
parent 786312f95e54bcf528f6dddb292f6512698c3aef
Author: Beau <cbeauhilton@gmail.com>
Date:   Mon,  8 Nov 2021 11:27:11 -0600

add muhs mr on atypical pna

Diffstat:
M
index.md
 | 
1
+
A
learn/2021-11-08-mr-muhs.md
 | 
53
+++++++++++++++++++++++++++++++++++++++++++++++++++++

2 files changed, 54 insertions(+), 0 deletions(-)
diff --git a/index.md b/index.md
@@ -13,6 +13,7 @@ I use it.
 ## lectures attended
 
 ### 2021
+- [2021-11-08-mr-muhs-atypical-pna](learn/2021-11-08-mr-muhs.md)
 - [2021-10-28-ahd-transgender](learn/2021-10-28-transgender-medicine.md)
 - [2021-10-28-ahd-endo](learn/2021-10-28-adrenal-disorders.md)
 - [2021-10-01-vents](medicine/2021-10-01-micu-morning.md)
diff --git a/learn/2021-11-08-mr-muhs.md b/learn/2021-11-08-mr-muhs.md
@@ -0,0 +1,53 @@
+# Morning Report
+
+
+# Case 1
+
+Dr Amelia Muhs
+
+CC: 1wk flank pain, dark urine, dyspnea
+
+HPI: 24F 1wk b/l flank pain, dark urine, subjective fever x1wk, 
++intermittent dyspnea, no productive cough.
+
+ROS: 30lb unintentional wt loss over 6mo, 
+night sweats 5-6 nights/wk,
+no measured fevers,
+intermittent hip and knee pain after work,
+no [rashes, throat pain, HA, n/v]
+
+PMH: COVID 8mo ago, tx for bartonella w azithro 1mo ago
+
+Meds: none
+
+FH: maternal grandmother (Graves)
+
+Social: no tobacco, 2-3 EtOH/wk, vapes mj 1-2x/wk, work: vet tech
+
+Exam:
+
+wnl other than 101.8F, 102 HR, wt 105lb, 65"
+
+Labs:
+WBC 14.3 (90% PMN), ALK 205, Cr 0.8, UA wnl, Ferritin 803, D bili 1.8, CRP 303, ESR 79
+
+Huge infx w/u -ve (tularemia didn't get sent, on accident), rheum w/u -ve other than ANA 1:160.
+
+Got better rapidly w LVQ (did not get better w 1d CAP covg, 1-2d vanc-cefe).
+
+Presumed dx: Legionella
+
+## Legionella and other atypical pna
+
+Legionella
+
+w/u: 
+- BAL/tissue/pleural fluid cx, needs buffered charcoal yeast extract agar, 4-5d process, sens 20-80, spec 100%
+- U Ag test: only detects serogroup 1, sens 70-80%, 
+
+Atypical pna: 22% CAP in US. legionella pneumophila (U Ag), chlamydia pneumoniae (PCR - remains + for months to a year), mycoplasma pneumoniae (PCR)
+
+
+Other learning points:
+- renal failure in young female needs formal pelvic eval, cervical cancer can met to LN and cause obstruction
+