PowerPoint Presentation

Objectives. To evaluate a patient who body ma To discuss the management of Empyema Thoracis and Hepatic Abscess To present the Antimicrobial Resistance Surveillance Program for Non- Typhoidal Salmonellosis (2019).

General Data. CR 55 y/o Female Single Roman Catholic Filipino San Rafael, Bulacan.

Chief Complaint. Difficulty of Breathing.

HISTORY OF PRESENT ILLNESS. 2 WEEKS PRIOR TO ADMISSION (+) Undocumented Fever Self medicated with Paracetamol 500mg/tab q4 PRN for feve r No c onsult done (-) Dysuria (-) Nausea/Vomiting (+) Occasional productive cough (-) Loose watery stools (-) Chest pain (-) Orthopnea (-) Difficulty of Breathing (-) Easy fatigability (-) Anorexia.

HISTORY OF PRESENT ILLNESS. Few Hours PRIOR TO ADMISSION Persistence of above symptoms With associated DIFFICULTY OF BREATHING Decided to seek consult Admission.

Past Medical History. (-) Hypertension (-) Diabetes Mellitus (-) Bronchial Asthma (-) Allergies (-) Thyroid disorders (-) History of STDs (-) Pulmonary Tuberculosis (-) Previous Hospitalization (-) Previous Surgery.

Family History. (-) Hypertension (-) Diabetes Mellitus (-) Bronchial Asthma (-) Heart Disease (-) Thyroid Disease (-) Kidney Disease (-) Allergies (-) Cancer.

OB-GYN History. G2P2 (2002) Menarche: 14y/o Interval: 28 days Duration: 5 days Amount: 2-3 pads/day Sx : no dysmenorrhea Menopause at 50 y/o No hx of OCPs use.

Personal and Social History. Non smoker Non alcohol beverage drinker Denies illicit drug use Unemployed High School Graduate.

Sexual History. 1 partner at present Denies multiple sexual partner.

Environmental History. Lives in bungalow type of house Well ventilated and well lit Water source: NAWASA Food preferences: Chicken, Egg, Vegetable No pets No nearby factories.

Review of Systems. General: (-) weight loss Skin: (-) rash, (-) pruritus, (-) jaundice Head: (-) headache Eyes: (-) discharge, (-) pain, (-) diplopia, (-) dryness Ears: (-) tinnitus, (-) pain, (-) discharge Nose: (-) nasal stiffness, (-) itchiness, (-) discharge Throat: ( - ) itchiness , (-) hoarseness.

Review of Systems. Neck: (-) pain or stiffness, (-) mass Respiratory: (-) pleuritic chest pain (-) wheezing Cardiac: (-) palpitations, (-) syncope GIT: (+) abdominal pain for 1 month (no aggravating and relieving factors, crampy , on RUQ, non-radiating, 6/10 pain scale, intermittent (-) regurgitation (-) hematemesis, (-) hematochezia or melena, (-) anorectal pain Genitourinary: (-) hematuria (-) flank pain Musculoskeletal: (-) decrease sensation.

Review of Systems. Hematologic: (-) bleeding tendencies, (-) easy bruising, (-) petechiae , (-) hematoma Endocrine: (-) polyuria, (-) polydipsia, (-) polyphagia, (-) heat intolerance, (-) cold intolerance CNS: (-) seizure, (-) tremors, (-) numbness, (-) slurring of speech.

Physical Examination. General Survey: conscious, coherent, in cardiorespiratory distress Vital Signs: BP: 1 3 0/ 8 0 HR: 107 RR: 31 T: 37.8C O2 Sat: 89-90 % Room Air Weight: 60kg Height: 5 ft and 3 inches BMI: 23.4 (Normal).

Physical Examination. Skin: no cyanosis, no pallor, no jaundice, warm to touch, good skin turgor, no rashes Head: no lesions, no palpable mass, no tenderness Eyes: anicteric sclera, pink palpebral conjuctiva , no discharge Ears: no discharge, no mastoid tenderness, no lesions.

Physical Examination. Nose: +alar flaring , no nasal discharge, no nasal congestion, no visible bleeding Mouth and Throat: moist lips and buccal mucosa, no gum bleeding, n on hyperemic tonsils , no lesion, no dental caries, no post nasal secretion Neck: no cervical lymphadenopathy, non distended neck veins, non-enlarged thyroid, no carotid bruit.

Physical Examination. Chest and Lungs: no visible scar, no lesion, symmetrical chest wall expansion, +subcostal retractions , decreased tactile and vocal fremitus mid to base right , dull to percussion mid to base right , + rales and decreased breath sounds mid to base right Heart: adynamic precordium, no heaves, no thrills, tachycardic and regular rhythm, S1 heard best at the apex, S2 heard best at the base, no murmurs, PMI: 5 th ICS left midclavicular line.

Physical Examination. Abdomen: flabby, non-distended, normoactive bowel sounds, tympanitic , liver span approximately 15cm right MCL , no obliteration of traube space, soft, palpable nodular mass on RUQ , tenderness on RUQ upon deep palpation Genitourinary: (-) mass, (-) lesion (-) CVA tenderness Extremities: no cyanosis, no deformities , no erythema , no swelling, no clubbing, full and equal pulses, no crepitations, no limitation of range of motion.

Physical Examination. Neurologic: Awake, alert, oriented to 3 spheres Cranial nerves: CN I – no anosmia CN II – pupils 2-3 mm, equally reactive to light and accomodation CN III, IV, VI – intact EOMs CN V – no facial numbness, intact mastication CN VII – no facial asymmetry, intact taste anterior 2/3 of tongue.

Physical Examination. CN VIII – intact hearing CN IX, X – intact gag reflex CN XI – can shrug shoulder, no asymmetry CN XII – no tongue deviation Motor: Poor muscle bulk and good tone, 5/5 all extremities Cerebellar: no abnormal gait, no dysdiadochokinesia , negative heel to shin test DTRs: Normoactive reflex 2+ No pathologic reflex, No meningeal signs Sensory: 100% all extremities.

Salient Features. Pertinent Subjective Pertinent Objective 55 y/o Female Difficulty of breathing Undocumented fever Productive cough Abdominal pain for 1 month Tachycardic Tachypneic Febrile (3 7 . 8 C) +Alar flaring +Subcostal retractions +Decreased tactile and vocal fremitus right lung + Rales right lung Liver span 15cm Palpable nodular mass on RUQ Tenderness on RUQ upon deep palpation.

55/F Fever Cough DOB Abdominal pain. Differential Diagnosis.

Community Acquired Pneumonia. Rule in Rule out Fever May present with pleuritic chest pain but not abdominal pain Cough Hepatomegaly and palpable mass DOB + Rales May present with decreased BS if associated with pleural effusion, with decreased tactile and vocal fremitus.