This morning, nothing was scheduled
for my rotations so I decided to tag along with Arthur and Christine in their
Pulmonology rotation.
Interesting Cases
Case 1: Acute exacerbation of
COPD. Patient and family have signed DNRs. Patient has been in and
out of the hospital often and shows signs of wasting. History of anxiety
and depression. 2 days ago, patient attempted suicide with nasal cannula.
Doctor said that keeping the patient alive with respirators, etc. is futile
because he will die of this disease.
In the afternoon, we followed Dr.
Wang for outpatient referrals. First, he updated us on the condition of
the ER patient from yesterday. It turns out that she suffered a stroke in
her cerebellum.
Interesting Cases
Case 1: Middle age to old Taiwanese
male presents with chest pain without exertion. He has a PMH of HTN, ESRD,
Diabetes, CHD and has had 6 stents placed in his coronary system. This
past year, he has been noncompliant with his Aspirin regimen because it has
caused his eye to bleed. He has lost contact with his doctor this past
year as well. EKG reveals ST depression in leads V5, V6, and lead 1,
indicating lateral ischemia. Circumflex artery may be occluded. Dr.
Wang decides to admit him into the ICU and he proceeds to see other
outpatients. During seeing other patients, the original patient
experiences chest pain and is given nitroglycerine, which does not relieve the
pain. We are called outside the room to see him because he is having
severe bouts of chest pain. He was then rushed to the ICU. We come
to find out that he has visited the ER 3 times in the past four days due to
unstable angina, but was discharged without being admitted into the ICU.
Case 2: Middle Aged Taiwanese
Male has a systolic murmur grade 4/6. He is sent for CXR. Possible
atrial enlargement is found, which can be caused by ASD, TOF, Tricuspid
Stenosis, Pulmonary Stenosis, and Cor Pulmonale. Echocardiography is
scheduled.
Interesting things I learned:
- Often, CAP can mimick TB so treat empiracally with CAP before treating for TB.
- Residents in Taiwan earn approximatly 4000 USD per month, which is approximatly equal or greater than the US; however, cost of living is much cheaper in Taiwan.
- Vocal Cord Palsy can be due to old age and degeneration of the nerve.
- Cold can cause an increase in BP
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