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1、CaseConferencePresentedby:PGY楊道欣Supervisor:VS吳冠達PatientprofileChartNumber:14640173Name:蔡x瑞Gender:maleAge:41y/oOccupation:Nil(貨運送菜before)Maritalstatus:MarriedEthnicorigin:本省籍PlaceofResidence:台南縣Sourceofinformation:patientDateofadmission:98/06/08ChiefcomplaintFeverandrightfootpainfor2weeksP
2、resentIllnessIntermittentfeverforabout2wks,R’tfootpainfulswellingwithmilderythematouschangeandlocalheatforabout2wk,HewasadmittedtoLMDandourinfectionOPD,oralantibiotics,painkillerwasgiven,butthefootpainpersisted,therangeoferythemaexpaned.PresentIllnessMildcoughwithwhitishsputumwasnoted,Nos
3、ymptomsof,nausea,diarrheaorvomiting,nodysuria,nos/sofUGIB,noheadache,nononeckrigidity.ERLabshowedincreasedsegmentWBC,hyperglycemiaCXRshowednospecificfindingurineroutineshowedpyuriaheadmittedforfurthersurveyPasthistory1.Medicalhistory：Hypertension：nil Diabetesmellitus：Insulinecontrol S
4、teroidusehistory：nil ChronichepatitisB：positive ChronichepatitisC：negative Others：1)Goutyarthritis 2)Alcoholism 3)DU(960807PES) 4)Headinjury 5)SuspectedTuberculosisperitonitison2008/26)acutepancreatitissince2006/6 2.Surgicalhistory：s/pappendec
5、tomy T-colons/prepairingofmesocolonofT-colonandliverlacerationon960418 Exp.Lapa,adhesiolysis,mesentaryLNsexcisionon97/03/12.PasthistoryFeverunknoworigin:PasthistoryPasthistoryPasthistoryPasthistoryPersonalhistory1.Smoking：2PPD/dayfor20+years 2.Alcohol：(+)1bottle/perday高粱ifinsomnia,quitedi
6、nrecent5-6month 3.Betelnut：(+),quitforyears 4.Herbalmedication：nil 5.Allergy：noknownallergyhistoryPhysicalexaminationVitalsign:1.Generalappearance:chronicilllooking2.Consciousness:clear3.Peripheralperfusion:distalextremity---warm,pink,nocyanosis4.Skin:turgor---normal,nopaperskincolor---no
7、rmalcolor,icteria(+),nopale,noreddish,skinrashoverhisfaceandneckwithitchingnospiderangiomaatchestwall,noecchymosis5.HEENT: Head:normalappearance,notrauma Eyes:pupil---------(3,3),isocoric;lightreflex(L/R):(+/+) sclera--------icteriaconjunctiva---pi
