Pulmonology, Week 1, Day 2

Day 2 in Pulmonology. Today I accompanied Dr. Yu on his morning rounds. The first patient was a 75 year old male who was admitted for hyperglycemia. He had a PMH of pneumoconiosis, diabetes mellitus, and dementia. The chest x-ray revealed progressive massive fibrosis, a contracted lung, and a deviated trachea. The spirometry results revealed a FEV1/FVC 63.4 and FEV1 44. The patient developed a fever 5 days after admission and Dr. Yu was trying to determine the cause of the fever. He ruled out bacterial infection and UTI based on laboratory results. Today, he considered a liver abscess, so he told me the planned on getting an ultrasound. This case really demonstrated to me that the practice of medicine requires some detective work and mystery solving.

Another patient, a 83 year old female, was admitted for fever and pyuria and was diagnosed with pneumonia, UTI, and multiple pressure wounds. Her urine culture showed polymicrobial growth and her sputum culture showed extensively drug resistant Acinetobacter baumannii. (XDRAB). Dr . Yu explained that XDRAB is usually not treated with antibiotics. Thus, the treatment strategy is not to kill the bacteria, but to downgrade antibiotic use so that other bacteria, which are not drug-resistant will grow and outcompete the XDRAB. However, there is a way to kill XDRAB. Colistin is an old drug that belongs to the polymixin group of antibiotics. It was previously used for treating gram negative infections, however, its used was decreased when aminoglycosides were introduced because of its significant side effects. Now, intravenous colistin has been used to treat panresistant nosocomial infections, like Acintobacter spp. The treatment of antibiotic-resistant bacteria is very difficult and it is interesting to see how treatment of these infections is approached. Seeing multiple cases with drug-resistant bacterial infections reminds me how important it will be in my future practice to distinguish bacterial from viral infections and to educate patients the importance of completing their treatment regimens. 

This afternoon, Dr. Yu showed me some chest x-rays and CT scans of memorable patients. These cases included a large aortic aneurysm, Pneumocystis jiroveci pneumonia in an HIV + patient, intrathoracic goiter, and bronchiectasis. As we discussed these cases, I realized that in order to come up with a diagnosis, there are so many sources of information, like diagnostic imaging, patient history and laboratory analysis. A physician needs to use the clues from these diagnostic modalities to come up with a patient diagnosis, like putting together .. the pieces of a puzzle And being a physician requires some quick thinking and analysis in order to save lives, such as in the case of the large aortic aneurysm I really enjoyed my time with Dr Yu today; I could see how he cared for his patients by how he interacted with them and their families and I am still trying to wrap my head around everything I learned today. Excited for tomorrow!