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Internal Medicine Clinical Pathological Conference

Internal Medicine Clinical Pathological Conference. July 18, 2008. CPC FORMAT. Presentation of case Medical student discussants (5 minutes each) Radiology speaker (5-10 minutes) Faculty discussant (10 minutes) Pathology speaker (5 minutes) Case wrap-up. Chief Complaint:.

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Internal Medicine Clinical Pathological Conference

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  1. Internal MedicineClinical Pathological Conference July 18, 2008

  2. CPC FORMAT • Presentation of case • Medical student discussants (5 minutes each) • Radiology speaker (5-10 minutes) • Faculty discussant (10 minutes) • Pathology speaker (5 minutes) • Case wrap-up

  3. Chief Complaint: 55 year-old male presents to Bellevue Hospital complaining of worsening diffuse body weakness, dysphagia, and cough for 3 months.

  4. History of Present Illness: • The patient is a 55 year-old Senegalese male cab driver without any medical problems who first complained of body weakness after a long day of driving, 3 months prior to his presentation. • Over the next 3-months, he noticed that his symptoms were progressively worsening and that he was unable to tolerate driving for long periods of time. He complained specifically of: • Bilateral shoulders and thigh weakness • Symmetric, diffuse arthralgia that was worse in the morning • Arthralgia and joint swelling of his wrists and hands • Difficulty getting up from a seated position

  5. History of Present Illness: • Approximately 3-weeks prior to admission, his symptoms had become so severe that he quit his job as a cab-driver. • During this time, the patient also complained of dysphagia to both solids and liquids. The patient denied any odynophagia. • The patient also complained of cough that was worse at night. The cough was productive of white-yellow sputum without blood. He denied fever, chills, or weight loss.

  6. History of Present Illness Past Medical History: Latent TB treated in the past Chronic constipation for 40 years Past Surgical History: none Medication: none Allergy: no known drug allergy Family History: Father and sister in Senegal described body weakness that was treated by medication with improvement. No definite diagnoses were given. Social History: Moved from Senegal 20 years ago. Works as a cab driver. No tobacco, no alcohol, and no drug use. No recent travel. HIV status unknown

  7. Physical Exam: • Gen: lying on a stretcher, appeared comfortable. • Vital signs: T 98.9, P 104, BP 122/67, RR16 SaO2 98% on RA • Neck: no lymphadenopathy • Lungs: decreased breath sounds at the left base with bilateral crackles • Heart: Regular, rate, and rhythm, no murmurs, no rubs • Abdomen: Soft, non-tender, non-distended, normal bowel sounds • Neurologic: unable to abduct his upper extremities past 90 degrees, unable to lift his knees off the chair. Distal strength was normal, normal reflexes • Extremities: normal joints, no effusion, no swelling • Skin: no rashes

  8. Laboratory Assessment:

  9. Laboratory Assessment:

  10. Laboratory Assessment:

  11. Laboratory Assessment:

  12. EKG • Sinus Tachycardia

  13. RADIOGRAPHIC FINDINGS

  14. Chest X-Ray

  15. Chest X-Ray: Lateral Decubitus

  16. CT CHEST

  17. CT CHEST

  18. CT CHEST

  19. Hospital Course • The patient was triaged to a regular floor bed for further diagnostic testing. • A diagnostic procedure was performed.

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