Skip to main content

 

CASES IN GENERAL MEDICINE



A 57 yr male agriculture by occupation came to follow up for dialysis.

CHIEF COMPLAINTS:-

*Abdominal distension 
*Burning micturition since 3 days
*Vomiting since 3 days

HISTORY OF PRESENT ILLNESS:-

*Patient was apparently asymptomatic 5 years back, had complaints of polyuria and polydipsia.
*1 year back had H/O of left Hemiplegia.
*10 days back he had H/O of bilateral pedal edema, SOB  and abdominal distension. 

PAST HISTORY :-


*k/c/o HTN, DM-2 since 5 years
*Had CVA 1 year back
*He had 2 dialysis before coming here

TREATMENT HISTORY :-

*He was on medication for DM and HTN since 5 years
*He was on antiplatelet and physiotherapy for Left Hemiplegia 

PERSONAL HISTORY :-

*He is a vegetarian, stopped Non-veg 1 year back
*Bowel movement is Regular
*No H/O of alcohol and smoking but occasionally he used to drink Toddy

FAMILY HISTORY:-

*No familial History

GENERAL EXAMINATION:-

*Patient was in a conscious state
*Pallor-Mild
*Icterus present
*No cyanosis and clubbing
*No lymphadenopathy
*B/l pedal edema- pitting type

ON EXAMINATION:-

*Temperature- Afebrile
*Pulse Rate- 89bpm
*BP- 180/110 mmHg
*SPO2-100%

SYSTEMIC EXAMINATION:-

CVS:-

*S1,S2-+
*No cardiac murmur

RESPIRATORY SYSTEM:-

*No Dyspnea


ABDOMEN:-

*Obese 
*No Tenderness
*Bowel sounds- +

CnS:-

*Conscious 
*Speech is normal
*Motor system- Power    R           L
                                            5/5      4/5
                                            5/5      4/5

*Tone- Normal


INVESTIGATIONS:-
















Comments

Popular posts from this blog

A 45 YEAR  FEMALE WITH FEVER, VOMITING AND SHORTNESS OF BREATH 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 comment box is welcome.” I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. A 45year female Presented with  C/O Fever since 5 days C/O Vomiting since 4 days C/O Headache since 4 days C/O Shortn
  BIMONTHLY ASSIGNMENT OF MEDICINE FOR AUGUST 2021 BELOW IS THE LINK TO THE QUESTIONS ASKED TO US:- http://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html QUESTION 1:- Below is the link of the student for which I am giving my peer review. https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1 LONG CASE  :- A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema. REVIEW:- *The Case is well presented and  p atient data has be deidentified and privacy is marked. *C ase history is taken beautifully precisely taken including social ,educational and surgical  history which is way too essential to understand the socio economic back ground of the patient and helpful in accurate diagnosis. FINAL DIAGNOSIS : - *Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis. *Dilutional Hypona
  BIMONTHLY ASSIGNMENT OF MEDICINE FOR JULY 2021 BELOW IS THE LINK TO THE QUESTIONS ASKED TO US:- http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1 QUESTION 1:- Below is the link of the student for which I am giving my peer review. https://www.google.com/url?q=https://www.google.com/url?q%3Dhttps://angasanvith09.blogspot.com/2021/07/general-medicine-assignment.html%26amp;sa%3DD%26amp;source%3Deditors%26amp;ust%3D1626285857750000%26amp;usg%3DAOvVaw1I_MGzhIo0PPVtxipHNTa3&sa=D&source=editors&ust=1626285858217000&usg=AOvVaw1DbqqMfufy_38kPpzIaX2r Reviews to all the questions answered:- 1) The reviews for the cases selected are well described. A detailed pinpoint review has been given to each particular case selected, which is helpful in easy analysis.  Even though the peer reviews giving are short they are well described. 2)He  went with good investigations and given a better explanation for every case. Even every  investigation a