| { | |
| "Bacterial Pneumonia$Intermedia_4": { | |
| "The presence of MRSA and Klebsiella, both of which are known causative agents of pneumonia, suggests a possible bacterial infection.$Cause_1": { | |
| "Sputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).$Input6": {} | |
| }, | |
| "Pneumonia$Intermedia_3": { | |
| "There were patchy opacities in the left lower lobe and a small pleural effusion, findings consistent with pneumonia.$Cause_1": { | |
| "Lung volumes are diminished. There is patchy opacity in the posterior segment of the left lower lobe.$Input6": {} | |
| }, | |
| "Suspected Pneumonia$Intermedia_2": { | |
| "lethargy is a common sympotom of Pneumonia$Cause_1": { | |
| "lethargy$Input1": {} | |
| }, | |
| "Altered mental status, such as confusion, can be a sign of pneumonia due to hypoxemia or a systemic response to infection.$Cause_1": { | |
| "noticably confused at lunch$Input2": {} | |
| }, | |
| "Cough and bloody sputum are classic symptoms of pneumonia and indicate a possible lower respiratory tract infection.$Cause_1": { | |
| "developed a cough, which produced bloody mucous$Input2": {} | |
| }, | |
| "Fever is the body's natural response to infection and is a common symptom of pneumonia.$Cause_1": { | |
| "a tactile fever$Input2": {} | |
| }, | |
| "Chest pain may be related to a lung infection, especially if the pain is located near the lower respiratory tract.$Cause_1": { | |
| "dull chest pain localizing to the left side of the chest$Input2": {} | |
| }, | |
| "The patient had a recent history of pneumonia for which he had been treated, which may have affected his current health status and response to treatment.$Cause_1": { | |
| "recently admitted for pneumonia$Input2": {} | |
| }, | |
| "Rales at the lung bases are often associated with a lung infection or fluid buildup, a common sign of pneumonia.$Cause_1": { | |
| "Bibasilar crackles$Input5": {} | |
| }, | |
| "Nonpitting edema of the lower extremities may be related to fluid disturbances, which are more common in patients with pneumonia who have severe infection or systemic inflammatory response.$Cause_1": { | |
| "Non-pitting edema in lower extremities$Input5": {} | |
| }, | |
| "An elevated white blood cell count usually indicates an infection and is a common symptom of pneumonia.$Cause_1": { | |
| "WBC-19.7$Input6": {} | |
| } | |
| } | |
| } | |
| }, | |
| "input1": "lethargy\n", | |
| "input2": "The day prior he was noticably confused at lunch with his family. Per the patient, one day prior to admission, he had a runny nose. He denied a sore throat or cough at that time. One day prior to admission, on the same day his family noticed that he was confused, he had a headache. He denied visual changes or recent falls. He continued to have a runny nose and developed a cough, which produced bloody mucous per his daughter, and a tactile fever per his daughter. He vomited 2 times during the day. He denied shortness of breath, abdominal pain, abdominal cramps, or diarrhea. He also complained of dull chest pain localizing to the left side of the chest between the midline and midclavicular line. He denied chest pressure or heaviness and denied exacerbation during inhalation. He denied orthopnea, sleeping well on 1 pillow at night. He does note rare paroxysmal nocturnal dyspnea. He was recently treated for chest pain from ___ to ___ and myocardial infarction was ruled out during that hospitalization. He was also recently admitted for pneumonia from ___ to ___ and was treated with levoflaxacin 250mg qD and metronidazole 500qD.\n\nThe morning of admission he was noted to be lethargic and incontinent of stool. His vital signs in the ED were T 98.3 BP 95/38 HR 78 RR 22 Oxygen 100% NRB. WBC 33.4 with 19% bands, BUN 51, Cr 2.1, lactate 4.2, and Troponin T 0.17. He received 2L IVF, vancomycin 1g IV, metronidazole 500mg IV, ceftriaxone 1g IV, and aspirin 325mg PO. He had a central line placed, with an abdomen/pelvic CT notable for left lower lobe pneumonia. He was transferred to ___, but declared DNR/DNI and transferred to ___ to treatment of pneumonia and evaluation for sepsis.\n", | |
| "input3": "- recent anginal symptoms MI r/o (___)\n- s/p bioprosthetic AVR for aortic stenosis in ___ valve area 0.8-1.19cm2, peak gradient 80 mm Hg \n- hypertension \n- chronic diastolic CHF \n- TIAs\n- AV block \n- hyperlipidemia \n- prostate cancer, status post XRT \n- BPH \n- bladder cancer: ___ \npapillary urothelial carcinoma, low-grade, no lamina propria invasion seen \n- amaurosis fugax\n", | |
| "input4": "Non-contributory.\n", | |
| "input5": "VITAL SIGNS: T 98.4 BP 110/50 HR 68 RR 16 O2 95% RA\nGENERAL APPEARANCE: Well-appearing elderly man laying in bed.\nHEENT: NC/AT, sclera anicteric, mucous membranes moist, white plaques on tongue soft palate and uvula, no exudates or erythema in oropharynx.\nNECK: Supple, No LAD, JVD < 5cm.\nLUNGS: Symmetric expansion. Bibasilar crackles. No wheezes.\nHEART: Normal S1 and S2, III/VI systolic mumur heard best at the RUSB and apex, PMI at midclavicular line inferior to nipple, no rubs or gallops.\nABDOMEN: NT, ND, + bowel sounds in four quadrants, soft, no hepatosplenomegaly.\nEXTREMITIES: Radial pulses bilaterally, dorsal pedal pulses not palpated. Non-pitting edema in lower extremities.\nSKIN: Dry, hyperpigmented skin at the bases of the lower \nextremities and superior aspect of the feet bilaterally.\nNERUO: Awake, alert, and attentive. CNII-XII intact. Strength ___ on dorsiflexion and plantar flexion bilaterally, ___ at iliospoas bilaterally, DTRs symmetrical at patellar tendons, sensitive to temperature, vibration, light touch, and \nproprioception at the great toes bilaterally.\nPSYCH: Normal affect.\n", | |
| "input6": "___ 12:04PM WBC-33.4*# RBC-3.77* HGB-12.0* HCT-34.7* \nMCV-92 MCH-31.9 MCHC-34.7 RDW-13.8\n___ 12:04PM NEUTS-76* BANDS-19* LYMPHS-1* MONOS-4 EOS-0 \nBASOS-0 ___ MYELOS-0\n___ 01:36PM LACTATE-4.2*\n___ 12:04PM CK-MB-6\n___ 12:04PM cTropnT-0.17*\n___ 12:04PM GLUCOSE-128* UREA N-51* CREAT-2.4* SODIUM-145 \nPOTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-29 ANION GAP-19\n___ 12:04PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 12:04PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 06:55AM BLOOD WBC-19.7* RBC-3.17* Hgb-9.9* Hct-29.2* \nMCV-92 MCH-31.2 MCHC-33.8 RDW-13.5 Plt Ct-76*\n___ 06:55AM BLOOD Glucose-89 UreaN-48* Creat-1.6* Na-141 \nK-4.1 Cl-106 HCO3-28 AnGap-11\n___ 02:17AM BLOOD CK-MB-6 cTropnT-0.20*\n___ 06:10PM BLOOD CK-MB-4 cTropnT-0.20*\n___ 03:00AM BLOOD Lactate-1.3\nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW \nPlt Ct \n___ 9.9 3.31* 10.4* 30.3* 91 31.3 34.2 13.7 \n115* \n\nSTUDIES:\nECG ___\nSinus rhythm. Left atrial abnormality. Delayed A-V conduction. Right bundle-branch block. Compared to the previous tracing of ___ the heart rate is faster. \n\nIMAGES:\nCHEST XRAY ___\nLung volumes are diminished. There is patchy opacity in the posterior segment of the left lower lobe. There is a small left pleural effusion which was present on the prior examination. Evidence of median sternotomy and valve replacement is again noted. The cardiac silhouette is within normal limits for size. There is no pneumothorax. Multiple healed right-sided rib fractures again incidentally noted. \n\nCT HEAD W/O CONTRAST ___\nThere is no evidence of acute intracranial hemorrhage, large areas of edema, or mass effect. There is prominence of the ventricles and sulci, most likely due to age-related parenchymal atrophy. Hypodense areas are seen within the cerebellar hemispheres, most likely due to small vessel ischemic changes. Visualized portions of the paranasal sinuses show some mild mucosal thickening of the frontal and ethmoid sinuses. Mastoid air cells are clear. \n\nCT ABDOMEN AND PELVIS W/O CONTRAST ___\nPatchy consolidation is seen within the left lower lobe of the lung consistent with pneumonia. A small pleural effusion is also seen on the left. In addition, there is dependent atelectasis in the right lung. The heart size is normal. No pericardial effusion is noted. \n \nThe liver, gallbladder, spleen, adrenal glands, pancreas, stomach, and intra- abdominal loops of bowel are within normal limits. There are tiny non- obstructing renal stones seen within the kidneys bilaterally. In addition, multiple well-circumscribed hypodense areas are seen within the kidneys bilaterally, most consistent with cysts, unchanged. There is diffuse calcification of the abdominal aorta and the splenic, celiac, common hepatic, and iliac arteries. There is no retroperitoneal or mesenteric lymphadenopathy. No free air or free fluid is seen. High-density material is seen within the dependent portion of the second segment of the duodenum, which may be due to recent ingestion of high density material (ie medication or contrast).\n\nSputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).\n\n" | |
| } |