vimwiki

beau's personal wiki, made using vim
git clone https://git.beauhilton.com/vimwiki.git
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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:
Mindex.md | 1+
Alearn/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 +