Principal Procedure Diagnosis Flashcards
The patient has a known diagnosis of prostatic cancer. He started having fevers approximately one week earlier. The fevers did not respond to outpatient antibiotics. Blood and urine cultures showed no growth. He was admitted for workup of the fevers with possible prostatic abscess formation. There were no obvious signs of infection or abscess on a transrectal ultrasound of the prostate. An iodine-123 radioisotope bone scan of the body revealed no skeletal metastases. The antibiotic therapy was changed, and he was given an IV push. He improved and was discharged.
What is the Principal Procedure?
Fever of unknown origin
The two-year old patient had an acute onset of fever and some shaking chills at home. He was thought to have experienced a febrile seizure and was admitted for workup and treatment. There was some infiltrate in the right lung per chest X-ray. All laboratory work was within normal limits. He was observed during his stay. No problems were noticed, and he remained afebrile after the first day. He was discharged for office follow-up.
What is the Principal Procedure?
Rule out febrile seizure
The patient, an elderly woman with type 2 diabetes mellitus, developed hypoglycemia at the nursing home and was symptomatic. In the emergency department, her decreased blood sugar was treated with intravenous D5W. A urinary tract infection was also present and was treated with antibiotics. The urine culture grew Klebsiella, sensitive to Cipro. She then developed mild congestive heart failure, probably secondary to the hypoglycemic reaction, which responded to oxygen and rest. Her Diabetes was restarted at a lower dosage.
What is the Principal Procedure?
type 2 diabetes
The patient with type 1 diabetes mellitus seriously out of control was admitted for regulation of insulin dosage. He had a recently abscessed right molar, which was determined, in part, to be responsible for the elevation of his blood sugar. The patient had been in the hospital three weeks earlier for an acute myocardial infarction of the inferoposterior wall, and an EKG was performed to check its current status
What is the Principal Procedure?
uncontrolled type 1 diabetes mellitus
A 50-year-old man receiving Coumadin therapy was admitted with hematemesis secondary to acute gastritis. A prolonged prothrombin time was reported, secondary to the anticoagulant effect of the Coumadin therapy.
What is the Principal Procedure?
Acute gastritis
The patient, a 51-year-old woman with acute respiratory failure secondary to an acute exacerbation of chronic obstructive bronchitis, was brought to the emergency department (ED) by emergency medical services. In the ED, she was intubated and placed on mechanical ventilation. On admission, it soon became apparent that she had suffered severe, irreversible hypoxic encephalopathy. On day 5, she was weaned from the ventilator and extubated; however, significant neurological function was never regained. In accordance with her advance directive, tube feedings were discontinued. She became febrile and dyspneic. Antibiotics were started to provide comfort and relief of her pneumonia. She expired on day 13.
What is the Principal Procedure
Acute respiratory failure secondary to chronic obstructive bronchitis
The patient, an elderly woman, was known to have congestive heart failure, arteriosclerotic heart disease, and chronic obstructive pulmonary disease. She has no history of CABG. She developed increased shortness of breath, dyspnea on exertion, temperature elevation, and productive cough. These problems were felt to represent congestive failure and pneumonia. She was admitted for cultures, IV antibiotics, pulmonary toilet, and increased diuresis. Her initial non-contrast chest film showed congestive heart failure and bilateral lung infiltrates. In discussing this case with the pulmonary consultant, the physician felt it was wise to transfer the patient to another hospital so that both pulmonary and cardiology staff could work together with this patient
What is the Principal Procedure?
congestive heart failure or pneumonia
The patient is status post heart transplantation six months earlier. Since then, he had been admitted numerous times for fever and diarrhea, presumably due to cytomegalovirus. On this occasion, he was admitted for further evaluation of fever and diarrhea. Stool and blood cultures were negative. A single, shallow erosion in the colon was viewed and biopsied on colonoscopy. Internal, bleeding hemorrhoids were also visualized. The pathology report showed moderate, nonspecific, chronic colitis with no diagnostic evidence of cytomegalovirus. Chronic colitis was determined to be the cause of the patient’s symptomatology. The patient was also followed by endocrinology for his diabetes, and no changes were recommended in his medication. His diarrhea improved, medication and diet were prescribed for bleeding hemorrhoids and chronic colitis, and he was released.
What is the Principal Procedure?
Chronic colitis
The patient came to the emergency department because she was unable to speak well. She was admitted because she appeared to be somewhat aphasic. Following admission, she was found to be in atrial fibrillation. A CT scan of the head showed only some probable old defects, and the aphasia was thought to probably be due to a recent cerebral embolus. By the fifth day, she was stable and able to go home. The aphasia had cleared, and the fibrillation was controlled with medication.
What is the Principal Procedure?
Cerebral embolism
The patient was brought to the hospital emergency department with burning, low sternal, epigastric pain. While in the ED, she developed respiratory distress and subsequent acute myocardial infarction with cardiopulmonary arrest. She was resuscitated, and maneuvers involved in this activity included intubation and defibrillation. Chest X-rays confirmed pulmonary edema and congestive heart failure. EKGs confirmed acute subendocardial myocardial infarction in progress. The patient was then admitted and remained on the ventilator for approximately 24 hours, with gradual improvement. She was transferred to another hospital for further workup and treatment.
What is the principal procedure?
Acute myocardial infarction
The patient, a female resident of a nursing home, was transferred because of nausea and vomiting. She also had type 1 diabetes mellitus and arteriosclerotic cardiovascular disease. An upper GI X-ray showed esophageal obstruction. She was then admitted with provisional diagnoses of esophageal obstruction versus hiatal hernia versus esophagitis. A gastroscopy was performed to evaluate the stomach, and a partial obstruction due to stricture to the level of the distal esophagus was viewed and dilated. The patient improved without further symptoms. Her blood sugar levels rose to 500 on the third day of admission, and the diabetes was diagnosed as out of control. Her insulin was increased twice in an attempt to lower her blood sugar to baseline. The long-term outlook was not good inasmuch as the patient was not a candidate for definitive surgery. The esophageal stricture was thought to have resulted from a previous cerebrovascular accident.
What is the principal procedure?
Esophageal stricture
The patient was admitted for a planned exploratory laparotomy and a possible excision of a cystic mass in the pelvis. Shortly after admission, however, she developed bigeminal pulse. The anesthesiologist believed that she should not have surgery. The surgery was canceled, and she was referred back to her internist.
What is the principal procedure?
pelvic mas
The elderly woman’s admitting diagnosis was carcinoma of the stomach with metastasis to the ovaries. An exploratory laparotomy was performed for the purpose of excising the gastric tumor, but it was so densely attached to other structures that it could not be resected. However, a total abdominal hysterectomy and bilateral salpingooophorectomy were accomplished, and the patient returned to her room in fair condition. Palliative systemic chemotherapy infusions were given. On the third postoperative day, a large right pleural effusion developed, and a chest tube was percutaneously placed in the right pleural cavity for drainage. Cytology for malignant cells in the pleural effusion was negative. The patient remained stable and wanted to return to her home. The chest tube was removed before discharge
What is the principal procedure?
Carcinoma of the stomach
The patient, an elderly woman, had a rather sudden onset of severe pleuritic chest discomfort that brought her to the emergency department. She had been undergoing a series of radiation therapy treatments for history of endometrial carcinoma. She was admitted for further evaluation. A right pulmonary angiogram with high osmolar contrast confirmed the diagnosis of pulmonary embolism in the right lower lobe. She was treated with heparin and later Coumadin. Coumadin was to be continued on discharge. The patient was to return for her regular radiation therapy treatment as scheduled.
What is the principal procedure?
Pulmonary embolism
This HIV-positive patient was admitted with skin lesions on the chest and back. Excisional biopsies were taken, and the pathological diagnosis was Kaposi’s sarcoma. Leukoplakia of the lips and splenomegaly were also noted on physical examination.
What is the principal procedure?
HIV infection
