Gen Medicine Case Discussion

A  25yr old female came to OPD with c/c/o   fever since 4 days, Abdomipainal pain, Vomitings, generalized weakness since 4 days  Decreased appetite day since 1 day Fever -Low grade, Intermittent associated with  chills & rigor, generalized weakness, decreased appetite, Abdominal pain, nausea, vomitings. Vomitings-3 to 4 episodes/day, non bilious, non projectile food, water as content, no blood/mucous in stools Pain - Dragging type, localised to epigastric & hypochondrial region  Not a k/c/o DM, HTN, Asthma,TB, CAD Past surgeries- Family planning 8 years back Personal History- Single, Non vegetarian Appetite-Decreased B and B movements- Regular No known allergies On examination :  Pt is c/c/c Moderately built and nourished No signs of pallor, icterus, cyanosis, clubbing, lymphadenoapathy, edema Vitals : Afebrile PR: 102 bpm, regular RR: 20 cpm BP: 100/70mmHg-supine Standing-80/70 mmhg SPO2: AT ROOM AIR-99% Systemic examination :  CVS:S1,S2 heard  Apex beat:5th ICS Resp: BAE+

  This is an online E log book to discuss our patient\"s de-identified health data shared after taking his/her/guardian\"s signed informed consent. Here we discuss our individual patient\"s problems through series of inputs from available global online community of experts with an aim to solve those patient\"s clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comments A 45 year old male resident of Nalgonda labourer by occupation presented with chief complaint of :   • shortness of breath since 10 days    • Cough since 10 days   • Pedal edema since 10 days  History of presenting illness   Patient was apparently asymptomatic 10 days ago,then developed —  • Grade III shortness of breath which was insidious in onset , nonprogressive,aggravated by walking and strenous work and dressing , relieved by sitting                             There

90 yrs old male came to casuality with chief complaints of haemoptysis since 2 days(2 episodes) Pt was apparently asymptotic 2 days ago, later he had cough ass with blood tinged sputum-small quantity H/O similar complaints for the first time 40-50 yrs back  From then on and off for every 6-8 months -Not on medication PAST ILLNESS-  60 yrs back he had a h/o trauma(Accident) to liver, got admitted in hospital and got operated 40 yrs back-He had a h/o trauma(accident) to  right side of his shoulder and got treated conservatively 20yrs back -He had a h/o  trauma to his front side of right leg-femur fracture and got operated 14yrs back he had h/o of trauma to his left eye for which he went through eye surgery(enucleation) in Hyderabad hospital and his eye got removed. No H/o asthma,TB, epilepsy, CAD, DM, HTN On examination :  Pt is c/c/c No signs of pallor, icterus, cyanosis, clubbing, lymphadenoapathy, edema Vitals: Afebrile PR: 80 bpm, regular RR: 20 cpm BP: 130/80 mmHg SPO2:

*ICU Admission under unit-6*  Under the guidance of DR.VAISHNAVI MAM AND DR.MANASA MAM  45 yr old Male came to casuality with chief complaints of Fever since 2 days in Drowsy state.. Fever - High grade, intermittent, associated with chills HOPI+ pt was apparently asymptomatic 6 days ago, later he developed vomitings-1 to 5 episodes/day, non bilious, non projectile, non blood tinged for which he went to a govt hospital & got treated...  Prior to vomitings pt had intake of alcohol (360ml) 2 days after he had involuntary movements of both upper & tower Limbs (? Generalized tonic clonic seizures) - 1episode, which is associated with froathing, tongue bite.. pt was unconscious during this episode. He was taken to a private hospital & managed conservatively 2 days back patient was conscious & coherent, talking  but he is in drowsy state. Patient stopped working since 1 year (due to generalized weakness ) 2 months back - pt had back pain ( occasionally taken pain killers)

ADMISSION UNDER UNIT 6 A 38 Yr Male, Toddy climber by occupation came to casuality on 11/9/21 at 4:30 pm in unresponsive state since 30 minutes Pt was apparently asymptomatic till 2pm on 11/9/21. Pt had alcohol intake on 10/9/21 night→ followed by, he woke up 11/9/21 morning, done his routine works and had food and went to bed at 1pm f/b he had 2 episodes of vomitings- non bilious, non projectile, food as contents, non- blood tinged. After vomiting, patient became unresponsive.    Not responding to oral commands with GCS as E1V1M2        On presentation to casuality, pt- stuporous, vital - stable  pupils : B/L dilated, sluggish to light reaction ) H/0-?Gouty Arthritis since 4 years and on tab. Febuxistat - H/O Recurrent joint swellings from Local RMP he received Injections for swelling ? Diclofena- Steroid injection(Decadion) Around 9 pm pt became conscious but so irritable and not oriented to time, place and person Psychiatric opinion is taken  ?steroid induced psychosis Inj.Haloperid