Inpatient Consultation
Patient Case Number: IPC22-Sapp, Eric
Patient Name: Eric Sapp | DOB: 05-31-59 | Sex: M
Date of Service: 06-01-XX | Physician: Liam Anton, MD

# Reason for Consult: Gram + bacteremia and staph in urine culture

# History of Present Illness:

Patient is a 59 y/o male admitted to the hospital on 06-01-XX with fever, back pain, urinary retention, and hydronephrosis. His recent history is relevant for an admission for urinary retention, new hydronephrosis, and found to have a very elevated PSA. Patient underwent TURP and bilateral ureteral stenting last month.

Pathology c/w prostate ca (GS 4+5 involving approx 50% of specimen), started on bicalutamide. Known bone mets diffusely per bone scan. He had a foley that was removed, and had been performing CIC since, he says he was compliant. On admission he was found to have fever to 103, blcx drawn, now known to be growing GPC in clusters. Renal US with hydronephrosis, URO recommended a Foley catheter. He improved symptomatically, feels close to his baseline, low grade temps persist but overall his fever curve is much better. Currently on Vancomycin, his MRSA screen was negative. We are asked to comment on his management.

# Surgical History: Laparoscopy, Cystoscopy-insertion of stent, TURP

# Social History: Current every day smoker-.5ppd

# Family History: Non-contributory

# Review of Systems:

# CONSTITUTIONAL: + change in weight, + mild weakness, + fatigue and + fevers, no sweats, or chills

# EYE: No recent significant change in vision, No eye pain, redness, discharge, No diplopia, No h/o cataracts and No h/o glaucoma

# NOSE: No history of frequent colds or sinusitis, No nasal stuffiness, No history of Hay Fever and No significant epistaxis

# MOUTH: No bleeding gums, thrush, or sore throat

# NECK: No lumps or masses, No swollen glands, No recent swelling in thyroid area, No significant pain in neck and No h/o goiter or thyroid disease

# PULMONARY: No cough, sputum, or hemoptysis, No wheezing, No shortness of breath and No recent change in breathing

# CARDIOVASCULAR: No chest pain, No shortness of breath, No dyspnea on exertion, No orthopnea, No paroxysmal nocturnal dyspnea, No edema, No palpitations and No syncope

# GASTROINTESTINAL: No abdominal pain, No change in bowel habits, No significant heartburn, No significant change in appetite, No nausea, vomiting, diarrhea, or constipation, No hematemesis, No blood in stools or black tarry stools, No abdominal bloating or early satiety and No dysphagia

# GU: + urinary retention, resolved back pain, recent dx prostate ca, mets+ to bones EXTREMITIES: Negative for pain, edema or redness SKIN/INTEGUMENTARY: No edema, No rash and No itching NEUROLOGIC: Normal balance, No headaches, No seizures and No weakness ENDOCRINE: No heat intolerance, No cold intolerance, No thyroid trouble and No excessive thirst or urination

# SLEEP: No sleep disorders

# Vitals:

Temperature | 99.9°F
Pulse | 72
Respirations | 19
Blood Pressure | 130/70
SpO2 | 98% on room air

# Physical Examination:

# General: alert, chronically ill but in no acute distress. Lying in bed, talkative, interactive

# Head: Bald, normocephalic, No masses, lesions, tenderness or abnormalities

# Eye Exam: PERRLA, EOMI, Conjunctiva are pink and non-injected, sclera clear, anicteric

# Nose: no mucosal erythema, no mucosal edema, no purulent discharge. Small growth on the tip of his nose. Oropharynx: no exudate, no erythema and lips, buccal mucosa, and tongue normal. No thrush

# Neck: supple, no adenopathy

# Heart: regular rate & rhythm, no murmurs and no gallops

# Lungs: clear to auscultation

# Abdomen: abdomen slightly prominent but soft, normal bowel sounds and no masses or organomegaly. No pain.

# Back: No CVA tenderness

# Extremities: no edema, arthritis, synovitis or effusion

# Neuro Exam: alert & oriented x 3 with fluent speech, no focal motor/sensory deficits

# Skin: skin color, texture, no rashes or significant lesions. No stigmata of cutaneous metastatic infection.

# Microbiology Data: GPC clusters from blood.

# Imaging: I have personally reviewed all pertinent images and available reports

# Impression:

1. Staph infection w/ gram positive bacteremia

2. Prostate ca with known bone mets diffusely per bone scan with elevated PSA.

3. Hydronephrosis

4. Prostate ca with bone metastasis.

5. Urinary Retention

6. Cigarette smoker.

# RECOMMENDATIONS:

Vancomycin for now, switch to cef or naf if MSSA 2 weeks of therapy

TTE

PICC when blcx clear

CBC, BMP weekly during outpt antibx therapy

# Electronically Signed By: Liam Anton, MD

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