Ca lam sing 1 LOET DA DAY Béoh nhén nf 66 tudi, cao 156 cm, ning 61 ke, di khém bénh vi ae a at ig 61 kg, di bénh vi phan khé, cimg, dau ving sir b@nh: Tika si Lbish aa ear 10 mim. Céch day 4 thang bj xuét huyét da day HP (+), da duge ké don phée Thodi héa khép of tay 6 nim, khong 46 dau khi ding paracetamol. ‘Tang huyét ép 15 nam DAi th4o dong type 2 12 nim ‘Nhdi mau co tim 6 nam truée Loing xuong ing: udng 1 ly ruqu nhé mdi ngay, thuimg thite khuya do Kh6 ngi. Tap thé due ngoai cdng vign gin nha méi budi sing 30 phit. Thude dang sit dung: ie Aspirin 81 mg 1 vign/ngay 2. Lisinopril20mg 1 vién/ngay 3, Alendronat 70mg 1 vién/tuin 4. Genfibrozil 600 mg 1 vién x 2 lan/ngay 5. Glyburide 5 mg Ysvien x 2 an/ngay 6. Diclofenac 75mg —_ 1 vién #2 lAn/ngay 7. Lanzoprazol 30mg 1 vién/ngay 8. Phosphalugel 1 g6i/ldn khi dau Kh4m lm sang: Bénh nhén tinh, tiép xc t6t. - Huyét 4p 150/90 mmHg - Nhip thé 15 lAn/pht = Nhip tim 80 ln/phut - Than nhiét 36,3°C Cfn lim sang: - Na 141 mEq/L (135 - 150) - WBC 7,0K/uL (4-10) =, Ki 4,6 mEq/L (3,5 -5) - Retic 1,8 % (0,5-1,5) - BUN 21 mg/dL (7-20) - HbAic 69% - Creatinin 1,1 mg/dL (0,7-1,5) - Chol TP 195 mg/dL (150-200) - Glucose 119 mg/dL (80 - 110) - LDL-C 125 mg/dL (< 130) - Hb 7,2 g/dL (12-15) + HDL-C 39 mg/dl > 35) - Het 21% (35 - 45) - 16 195 mg/dL (< 165) - PLT 390 K/L {200 - 400) - TSH 2,93 pUImL (0,27 - 4,94) Xét nghiém tim HP: = Test huyét thanh (+) = CLO-test (-) Noi soi dg day: 2 vét loét durdmg kinh khoang 6 mm, cé vét mau dong 6 ba cong nhé. Chan doan: Loét da day.Ca lam sing 2 TANG HUYET AP ‘Thong tin chung ~ Béoh nbéin nd, sinh nim 1958, cfn ning 49 kg, chiéu cao 1,57 m LY do nb§p vign: Chong mat Dita tién bgah Khoing 4 ngay nay, bénh nhén cém giée met, t€ moi 2 chan, huy&t ép do duge 260/100 mmlig khi Khdm bac sf tu, Sén 14/05, bénh nbn vi vit i i bee aly be Ao bénh vign chi kkhém thi cém giéc mét méi, chéng Tidn sir bénh ~ Tang huyét ép trén 5 nim, khong khém va didu tr. ~ Parkinson 1 nim, Tika sit gia inh: Cha mét vi nhdi méu co tim nim 60 tudi. Tidn sir dimg thude ‘Madopar 100/25 (Levodopa/ Benserazid) x 3 lin/ngay Vitamin 3B x 31in/ngay Kham bénh Sinh higu: Mach 98 lan/ph; than nhiét: 37°C; HA: 210/130 mmHg; Nhip thé: 20 lén/ph; SpO, 98% ‘Bénh nhfan tinh, tiép xic t6t, da niém hdng, tim du, phi trong, bung mém, gan léch khong sb cham, khéng phi; khong ligt kiu tra. Siéu am tim: Hé van 2 14 %, EF thét tri 61% Can 1am sang Dudng huyét d6i: 271 mg/dL. HbA\c 10,8% (4,4 - 6) Creatinin: 0,8 mg/dL. (0,8 - 1,4) ‘Ure 38 mg/dL (20 - 40) Cholesterol TP: 232 mg/dL (150-200) Triglycerid: 292 mg/dL (< 165) HDL-C: 38 mg/dL (> 35) LDL-C: 124 mg/dL (< 130) AST: 12 U/L (9-48) ALT: 10 U/L 6 -49) RBC: 4,65x10"? /L (4,3 — 5,3x10"2) HGB: 12,6 g/dL (13 - 16) HCT: 35% (37-49) MCV: 75,3 £1 (78-98) MCH: 26,2 pg (25 - 35) MCHC: 36,1 g/dL (32-35) Thuéc sir dyng tai bénh vign Captopril 25mg ngim + Furosemid 20mg IV % 6ng x 3 lan/ ngay Mixtard 30 HM: SC 15 UI x 2 ldn/ ngay Bénh nbn duge theo d6i mach, huyét ép va duimg huyét thong xuyén. Huyét 4p vao bubi sing: Ngay 1: 210/130 mmHg; Neay 2: 180/100 mmHg; Ngay 3: 140/80 mmHg ‘Thuédc sir dyng khi xudt vign Lisinopril 10 mg x 2 lan Nifedipin LA 20 mg x2 lén Bisoprolol 2,5mgx 1 lan ‘Metformin 500mg x 2 lan Atorvastatin 10mg x 1 lin ‘Levodopa/ Benserazid 100/25mg x 3 lAn/ ngay Chan Goan Tang huyét 4p, dai thio dung type 2, r6i loan lipid méu, ParkinsonWK Ca lam sing 3 GOUT Bénh nhfin nit 84 tubi, nang 55 kg. ia oe fog no ring ante 0 ot Hi non cn 8 Tiinsirbénh = Suy tim sung huyét - Tang huyét 4p - Suy thin mgn - Gout (trong nim vira qua, cé 3 lan xAy ra con gout cdp; dugc chi djnh allopurinol nhung bénh nhan bj ndi min 46 va phai ngung sir dyng, Bac si & phong kham ké don colchicin ‘Img khéi du, sau 46 gidm xudng lidu 500 pg) Thudc dang sir dung = Bumetamide I mg / ngay - Ramipril 5 mg / ngay Thim khém lim sang ~ Thén nhigt 38°C ~Chge dich khép, phét higm tinh thé urat Cn Jim sang =Creatinin huyét 160 pmol/L -ESR 115 mm/gid ~ Ac. uric buyét 745 umoV/L. Chin dodn Con gout cap tai phatCa lam sing 4 PARKINSON Théng tin chung: Bénh nhan nft, 82 tdi, cao 153 cm, nang 55 kg, Ly do nh§p vign: Bénh nhén bj cdng cimg co khi van dong va run khi nghi ngoi Difn tién bgnh: Khoang niza thang nay bénh nhén thdy run toan than khi nghi ngoi, cing cimg co khi di chuyén va mét thing bing. Ngudi nha cho biét bénh nhan cé nhiéu lic in Jn va hay khé nga vao ban dém. Tin sir bgnh: Parkinson - DTD type 2 - Trdm cam - Huyét khéi tinh mgch su Tien sir gia dinh: Khéng ghi nhén Tién sir ding thuée: ~ Fluoxetin 20 mg x 1 vién/ngay ~ Selegilin 5 mg x 1 vién/ngay - Metformin 850 mg x 2 lan/ngay ~ Sitagliptin 100 mg x 1 La/ngay Kham bgnh: - Sinh higu: mach 80 l4n/phit, nhip thé 20 lan/phut, huyét 4p 150/100 mmHg, than nhigt 37°C - Bénh nhén tinh, vé mat it cam xtc, da niém nhat = Tim déu 16, phi khéng ran, bung mém Myerson (+), banh xe rang cua (+) - Babinski (-) Cfin Kim sing: - Scr 1,8 mg/dL (0,7-1,5) - Hb 10,3 g/dL (12-15) - BUN 30 mg/dL (7-20) - MCV 701 (80-100) = Glucose d6i 170 mg/dL (80-110) - MCHC 280 g/L (310-370) HbAIc 8,2% Chin don: Bénh chinh: Parkinson nang Xir tris Bénh nhfn duge cho nhap vign khoa n9i than kinh. Thuéc sir dung tai bénh vign: BS sung = Sinemet 25/100 mg 1 vién x 3 lan/ngay = Sit sulfat 325 mg 1 vién x 3 lan/ngay - Cc thude khée gitr nguyénCa lim sang 5 THIEU MAU THIRU SAT Thong tin chung Bénh nhfn: Bai ML., ntt ‘Tubi: 28 Dang mang thai dita con du tién thing thir 4. Thai ky phat trién binh thutng. Ly do kham ‘Bénh nhén cAm thdy mét va khé thé ngay ca khi lam nhiing viée nhe nhang nhdt. Trong qué trinh tora khém, b@nh nban cho biét them gin day hay bj chéng mit, chudt rit, thém &n nu6c 44 va dau Ludi. Tikn sir bénh Khong Tidn sir gia dinh Cha me khée manh Léiséng Khéng hit thudc, khong uéng rugu Titn sir dj img Chua ghi nhdn Kham bénh % ‘Sinh higu: Mach: 110 lan/ phit. Huyét 4p: 120/80 mmHg. ‘Than nhiét: 37°C. Khdm tong qudt: Da, niém va méng tay nhat ” ‘Viem lui. Cn lim sing Hb 8 g/L (11,5-16,5) __| MCV 701 (80-96) Sh huyét thanh 40 mog/dL (40-150) Het 28% (33-43%) MCH 22 pg (27-34) Ferritin huyét thanh 10 ngimL (12-150) Tigu clu 480 000/uL | MCHC 300 LL | TIBC 450 meg/dL (250-400) 150,000-450.000) (310-370) mg chu ludi 0,3% (0,5- | RDW 18.4% (11-14)% 2%) Chin doin Thiév méu thiéu sitCa lam sang 6 \ NHIEM Thong tn chung TRUNG BAN CHAN DO DAI THAO BUONG ‘Bénh nbn nam, 67 tubi, can nfing 80 kg, chidu cao 1,65 m. THe at eg ei" Kde nh ey ied phn nn 8 tinh rang mkt gd gn ty a + Dai théo dudng type 2 (15 nim), kiém soat kém ‘+ DA ting loét ban chén tai dién (3 nim) aug cm iu dag 1 thy ‘Th6i quen: Kh6ng hit thuéc, uéng qu. BN thudng quén uéng thudc va khéng do dung huyét thuéng xuyén theo chi dinh ca béc si. a s : Tidn si ga dah + Cha mit vi bénh nhbi méu co tim, di théo dug type 2, ting huyét ép + Me mét vi ung thu vi Tidn sit dj tng: sulfamid va ampicillin Tidn sir ding thuée Novolin 70/30 60 don ¥i sing va.chiéu Metformin 1000mg ubng x2 n/ngay irs 1 tho/ngay 81mg udng y, Lisinopril 20 mg udng 1 ldn/ngay Atorvastatin 20 mg vubng 1 n/ngay Fhuoxetin 20 mg uéng | lin/ ngay Kham béah Sinh higu: Mach 78 lin/ph; than nhiét: 37,4°C; HA: 140/90 mmHg; Nhip thé: 22 ldn/ph; Sp02 96% x BN tinh, tip xtc tt. Tham khan thy c6 vétloétsumg, hd, su khodng 2 em & an ban chén tréi ten vét loét da lanh truée 6, 06 ri dich. BN khéng than dau va khong bi ‘vét loét tre nén ning hon. ‘C§n lam sang Glucose: 181 mg/dL * HbAje: 11,8% (4,4 - 6) Creatinin: 1,3 mg/dL (0,8 - 1,4) Ure: 30 mg/dL (20-40) Cholesterol TP: 240 mg/dL (150 — 200) Triglycerid: 183 mg/dL (< 165) HDL-C: 41 mg/dL (> 35) LDL-C: 163 mg/dL (< 130) AST: 20 U/L (9 - 48) ALT: 17 U/L (5-49) Hgb: 14,1 g/dL (13 - 16) Het: 42,3% (37-49) WBC: 16,3 x 10°/ mm’ (3,8 - 9,8) PMNs: 78% (50 - 60) Lymphs: 17% (20 - 25) Monos: 5% (5-7) Plt: 390.x 10°/ mm’ (150-4g0) ESR: 73 mmv/h MCH: 26,2 pg (25 - 35) MCHC: 36,1 g/dL (32 - 35) Chin doin Loét ban chan tréi/ di théo durémg type 2a ‘SUY TIM, BENECTIM THU MAU CYC BO ‘ ey ‘Th6ng tin chung (General information) ‘Tén: Lé Van T. Giéi: Nam Tubi: 68 gacus vee ees va Chiéu cao: 1,62 m DSIBS ~ L¥ do vao vign (Chief complain Dau nguc, mét moi nhieu, khé the lated Din bién bgnh (HPI- History of Present Iliness) ‘Tir vai nim nay, bénh nhén thinh thodng 06 nhing con dau ngyc lién quan ging sttc, con khoing 5-10 phit, giém khi nghi ngoi. Vai ngay nay, bénh nhén dau nhidu hon, con kéo dai hon 15 phtt, 2-3 con/ngay. Ngay nhép vign, bénh nhan than dau ngye nhiéu kém khé thé, chong m&t, khOng gitm v6i trinitroglycerin (TNG) dang xit. ‘Tin sit bnh (PMH - Past Medical History) ~ au thit ngyc - Tang huyét ap - Suy tim NYHA TI - D&i théo during type 2 (1 nim nay) ~ RGi loan lipid mau Tin sit gia dinh (FH — Family History) Cha mét nam 70 tudi vi bj nhdi mau co tim Léiséng {SH - Social Histor) ‘Hit 30 di€w/ngay, uéng 1 chai bia/ngay. ‘Bénh nhfn hay quén uéng thuéc va it do duémg huyét Tin sit ding thude (MEDS — Medications) Aspirin 81 mg bao tan tai rugt, udng | lan/ngay © Omeprazol 20 mg, méi sing Nicorandil 10 mg, uéng 2 lan/ngay Isosorbid mononitrat SR 60 mg, uéng m6i sing Atenolol 100 mg, uéng méi ngay Simvastatin 20 mg, uéng m6i t6i ING xjt dui lu6i khi cin Clopidogrel 75 mg, uéng méi ngay Tidn sit dj tmg (ALL - Allergic): khong Kham bénh (PE - Physical Examinition) Khim tong quat BN tinh, tiép xtc t6t, Phdi cé tiéng ran, bung mém Kh6ng vang da, phi chi duéi (+), tinh mach cénh ndi Sinh higu: . Mach 100 ldn/phit ‘Thin nbige 37°C Huyét 4p 155/90mmHg hip tho27 lAn/phiit C§n lim sang (LABS) Sink héa méu: Glucose 9 (4,1-6,1 mmol/L) CK-MB <3% (<3%) AST 31 (<40 U/L) ALT 35 (<40 U/L) Nat 137 (135-150 mEq/L) K+ 42 (3,5-5,0 mEq/L) Urea 27 (20-40 mg/dL) Creatinin 67 (70-123 pmol/L) Cholesterol TP 277 (150-200 mg/dL) LDL-C 165 (<130 mg/dL) Triglycerid © 90 (<165 mg/dL) HDL-C 32 © 35mg/dL) XN mién dich HbA. 72% (4,4-6%) Troponin-T hs 0,025(<0,014 ng/mL) XN huyét hoc: RBC 4,65 (3,8-5;5 M/uL) HGB 13,2. (12-15 g/dL) HCT 45,3 (35-45%) MCV 99,2 (78-100 fL) MCH 28,2 (26,7-30,7 pG) MCHC 33,2, (32-35 g/dL) RDW 143 (12-20%) WBC 9,6. = (4-10 K/uL) PLT 278 (200-400 K/uL) ECG: ST chénh xuéng khodng 1 mm Khi dau agye va hbi phyc khi khéng c6 trigu ching. Sidu 4m tim: EF 35%, r6i loan chire ning tm thu thét trai, day thét tri Chin dodn Nhdi méu co tim khong ST chénh len, suy tim NYHA TIiP Calm sing 8 Wy vitM PHOL Bénh nhén nam, 68 tudi, ning 45 kg, dang duoc chim séc & vign diéu dutmg sau khi bj tai bién mech Tat dog a eg nemE wil Do ah wang dk dung ke al tng pln Hy bah sn ge during qua m ‘hong ml . Hai ngay nay, bénh nhén s6t, kh thé, ho khac dam d9t ngQt ning i, ttm thin bién i nén duge nhép vién. n sir bénh ‘Dai th4o dung phy thugc insulin tir nim 30 tudi. Tai bién mach mau nfo cdch day 5 nim. Nhiém tring duing tidy céch day 1 thing do E. coli va duge ditu tri bing sulfamethoxazol/ trimethoprim 160/800 mg duémg udng trong 10 ngay. Tidn sik ding thuée - Insulin - Famotidin 20 mg m6i ngay Khém lim sang Sinh higu: Mach: 110 nhip/ phi. Huyét ép 147/87 mmHg. Than nhigt: 39°C. ‘Nhip thé: 28 nhip/phit. SpO; 82% (trong khéng khi phong). Khém téng quét: © Téng trang gia yéu, hay bdn chdn lo ling © Du khéng chén thuong, ob mém. ¢ Khém thinh ngyc thy ran né & phdi gitta va phi phai trén. C4n Him sing Sinh héa méu: Glucose 168 (80-110 mg/dL) . Albumin 3,0 g/dL (3,6-5 K* 3,6 G,5-5 mEq/L) Ure 19 (20-40 mg/dL) ‘g/dL Cr 99 (98-110 mEq/L) Creatinin 1,0 (0,7-1,5 GOT/ASAT 37 (<40 U/L) Calei 4,5 (4,5-5,5 mEq/L) mg/dL) GPTVALAT 32 (<40 U/L) CRP 680 (0-50 nmol/L) Na” 135 (135-150 mEq/L) HbAle 8,2 % (4-6%) Xét nghiém huyét hoc: WBC 14,5 (4-10 K/uL) EOS% 6,23 (1-8%) MCV 76 (78-100) YNEU 81,7 (45-75%) EOS 0,59 (0,1-0,8) MCH 24.4 (26,7-30,7) NEU 8,17 (4,5-7,5) BASO% 1,73 (0-2%) MCHC 31,2 (32-35) LYM% 6,3 (20-35%) BASO 0,17 (0-0,2) RDW 14,0 (12-20%) LYM 0,63 (2-3,5) RBC 3,8 (3,8-5,5 M/uL) PLT 240 (200-400 K/uL) MONO% 5,03 (4-10%) Hgb 12,3 (12-15 g/dl) MPV 8,38 (7-12 fL) MONO 0,48 (0,4-1,00) Het 37,6% (35-45%) Xét nghitm hinh énh: X-quang ngyc: thim nhiém phéi thiy trén va gitta phdi phai, déng dc thity phoi. Xét nghiém vi sinh: Dich hat khf quan duge My va dua di nhujm Gram va edy phan lép (bénh nhén tuong d6i khéng hop téc va khdng thé khac dam), Két qua nhugm Gram cho théy tryc khudn Gram 4m véi khoang 4% neutrophil. Dang chi két qua cay phan lép. Chan doan Suy hé hip. ‘Viém ph6i nghi do vi khudn Gram am. Di théo duing type 1/ Di chimg tai bién mach mau nfo, Didu tr) Bénh nbn duge dat n6i khf quin va ding méy tho. Bénh nhfn duge truyén dich 4é duy tri lugng nude tiéu 50 mL/gio. Khéng sinh chi djnh truéc khi c6 két qua khéng sinh 48 : Ceftriaxone 1g tiém tinh mgch, ngay 1 lin.Ca lam sing 9 4 er “ DAL THAO DUONG nam 54 tuéi, cao 1,78m, ning 100kg, t6i phdng khém da khoa vi khong kiém mie dudng huyét. Mot thang trudc, ante atone nay on abi séng trung binh 1a 100 mgt vee én khoding 200 mg/4L. trong tun qua. Bénh nhfin cho biét cm thy rt mét moi tir 2 tuan nay. ‘M(t thang trudc, theo sy tu vin cla bic sf dinh duémg, bénh nhan 4a o6 gidm cAn va cAi thign mic uong trong méu bing céch di b} m&i ngay 15 phat. Tuy nhién, bénh nhan khOng thé bude nhanh vi viém dan khép, trigu chimg nay gidm déng ké khi bac st cho ding prednisone. Bio abin cho biét hit thuéc 14 khodng 1 géi/ ngay tir khi 20 tudi. Thinh thoang uéng 1 ly rugu vao Tian sik bénh — Dai théo during type 2 = Ting huyét ép - COPD - _Viém khop — Réi logn lipid buyét Tién sit gia dink Cha va anh bj bénh dai théo dudng type 2. Me chét khi bénh nhan 8 tudi. Dj ting thube: Chua ghi nhfn, Sink higu Huyét ap hip tim Nhip tho ‘Than nhiét 145/90 mmHg 80 riktp/phat 18 An/ phat 37°C Két qué xét nghigm — Sinh hba méu (nhin Gi 12 gid) Na’ 135 mEq/L .! Glucose 230 mg/dL Cholesterol toan phan 212 mg/dL. Kt 4.0 mEqL HbA, 6.9% LDL-C 130 mg/dL, BUN 21 mg/dL HDL-C 58 mg/dL SCr 0,9 mg/dL Triglycerid 100 mg/dL. — Xétnghiém muéc tiéu: Microalbumin nigu (microalbumin 200 mcg/mg creatinin). Thudc dang ding 1. Glyburide 10 mg 2 lan/ngay 2. Atorvastatin 10 mg 1 an/ngly (méi ding 3 thing gin day, khong ghi nhiin dau co hay téc dyng phy ndo cia thuée) 3. Amlodipine 5 mg 1 lhn/ngay 4, Albuterol MDI born 2 nhét mi 6 gid khi clin. 5. Prednisone 10 mg 1 lAn/ngay (2 tudin gan day vi bénh viém khép do thép béc phat). 6. Aspirin 81 mg (by ¥ ding theo Idi khuyén ca gia dinh).Ca lim sang 10 ROILOAN LIPD MAU ‘ThOng tin chung Ten: Cao Thi L. Tuédi: 50 Can ning: 50 kg Chiéu cao: 1m60 Ly do khim Khém sttc khée dinh ky. Gi6i: NO Tién sir bénh Gao hist Tién sit gia dink ‘Ong ngogi bj nhdi méu co tim lie 56 tudi, mat Léi sény Ft thube 20 g6i-ntm, tp thé dye 4 tubs, ch an cht bo ‘Thudc dang ding Enalapril 10mg/ngay Tién sir dj tmg Chua ghi nhén Khém bénh Sinh higu: Mach: 65 Win/ phit. Huyét dp: 135/85 mmHg. ‘Than nhiet: 37°C. Nhip thé: 12 nhip/ phat Khdm tong quét Chite nang gan binh thuémg. Khém tim, phdi, bung khéng c6 gi bét thuémg. Cn lim sing Na*: 138 mEq/L (135-145) K*: 4,0 mEq/L (3,5-5,2) Ca: 1,2 mmol/L (1,13-1,35) Cr: 98 mmol/L (95-105) BUN: 12 mg/dL (8-20) Cr huyét tong 1,0 mg/dL (0,8-1,2) Cholesterol toan phan: 230 mg/dL (<200) Trighycerid: 180 mg/dL (<150) HDL-C: 45 mg/dL (> 50) Glucose: 96 mg/dL (85-110) ALT: 1 univ (<40) AST: 8 unit/L (< 40) Chin doan R6i logn lipid huyét