Microsoft word - immunology proofing exercises.doc

*Instructions: The proofreading document below is designed to challenge your proofreading and
editing skills. The document may contain missing demographic information, incorrect headings,
misspelled words, misplaced punctuation, and other errors within the document.
First, print the document, locate the errors, and mark the changes that are necessary in pen.
Then refer to the answer key to check the accuracy of your edits. Make the changes on the typed
document and resave it using a new file name.

THYROID ULTRASOUND
PROCEDURE: Using real time ultrasonograph of the thyroid gland, longitudinal and transverse
images were obtained of both lobes in the isthmus. The right lobe measures greater than 4.5 x
2.38 x 2.02 cm, the left lobe measures 4.56 x 2.57 x 1.95 cm. Overall, the gland is enlarged and
markedly heterogeneous.
Within the right lobe, a subtle.64 x.68 x.51 cm nodule was noted. Overall, this is consistent
with a Hashimoto's thyroiditis.

*Instructions: The proofreading document below is designed to challenge your proofreading and
editing skills. The document may contain missing demographic information, incorrect headings,
misspelled words, misplaced punctuation, and other errors within the document.
First, print the document, locate the errors, and mark the changes that are necessary in pen.
Then refer to the answer key to check the accuracy of your edits. Make the changes on the typed
document and resave it using a new file name.

Inpatient History and Physical Exam

Reason for Admission: The patient is a 74-year-old gentleman who was transferred here from the
micu with a diagnosis of a large b cell lymphoma for chemotherapy.
History of Present Illness: His medical problems began last fall when he noticed that he had a
distended bladder and difficulty urinating. He was seen by a urologist who, at the time, diagnosed
him with acute urinary tract infection and benign prostatic hypertrofy. The patient had a CT scan
performed at the time, which showed abdominal lymphadenography.
The patient was also noted to have increasing weight loss. He was seen by his internist who then
referred him to numerous specialists, including infectious diseases, hematology/oncology, as well as
a parasitologist as the patient had traveled extensively. Eventually the patient was admitted to a
hospital in Virginia for placement of a J tube. During this placement of the J tube, which was done
with a laparotomy, some lymph node biopsies were taken which were nondiagnostic.
On admission here, the patient had multiple complications that delayed the eventual work up of his
lymphadenopathy. On CT, this appeared to be developing a fluid collection around the J tube.
Cereal abdominal CT scans did reveal an enlargement of this abdominal lymphadenopathy. A CT-
guided biopsy was performed and read by pathology and finalized today as consistently with a
diffuse large B-cell lymphoma, which was suggested to be quite aggressive with a high index of Ki-
67 staining. Stimulating cells were also noted to be CD20 positive.
Physical Examination: The patient is extremely debilitated. He is barely able to lift his arms up
from the bed and can simply just move his legs against gravity; however, he is alert and oriented,
although at times in the conversation, he falls asleep due to fatigue. He expressed understanding,
that he has been diagnosed with cancer and that he is now here for possible chemotherapy.
The rest of his exam was notable for a chest tube in the right chest, which was placed after
pneumothorax which patient developed after thoracentesis. He had a right internal jugular triple-
lumen catheter in place. He also has a Foley catheter as well as an ostomy bag over his J tube site
which is now a duodenal fistulas coming through the skin. His lungs showed rhonchorous breath
sounds with dullness, particularly on the left. Abdomen was soft with bowel sounds. His
extremities and flanks showed pitting edema.
Laboratory Data: He has an elevated bilirubin, which has been trending upward, hypoalbuminemia at 1.5, and increased alkaline phosphatase. His hemogram is notable for a total white count of 27,500, hematocrit 32.5, and platelet count of 64,000. His pseudomonal UTI grew two species of Pseudomonas, one that was sensitive only to meropenem and another that was sensitive only to amikacin. His wound culture from the J tube site showed MRSA as well as VRE as well as yeast forms and some gram-negative rods. Impression: The patient has diffuse large B-cell lymphoma. It is likely that this progressive weight loss, anorexia, and debilitation at this point are all progression of his lymphoma. Given his history of stable lymphadenopathy and now progression, it is possible that he had a more indolent lymphoma, which has now transformed into a more progressive lymphoma. After a very extensive discussion with the wife, we explained to him that without treatment, he will die of lymphoma. However, given his severe debilitated condition, he is likely to die from chemotherapy as well. She has elected to go ahead with therapy and we have, therefore, transferred him over to the Oncology Center. After discussion with Dr. Jones, we will likely suggest that the patient receive only Cytoxan or prednisone, given his hyperbilirubinemia and otherwise debilitated condition. We will hold the doxorubicin and vincristine at this point. If he has a good response, we will give him full doses of chop in his next cycles. We will also use Cytoxan, as his malignant is CD20 positive. At this point, the plan is to have a meeting with the family tomorrow to discuss the plan for chemotherapy. We would like to make sure that they understand the risks of him worsening with therapy; however, he does not have any other real options at this point. At this point, his code status is full code. We will address this further as we see how he responds and able to establish a therapeutic relationship between the patient and her family.

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