General Medicine

Question 1 
Long case 1 
link:https://201821batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

The present illness of the patient is presented conventionally with each and every particulars 
The case history is quintessential which gives us a broad idea of the case .
Adding a note on localization of acute and  chronic problem was compelling.
The examination details were delineated very nicely.
The investigation reports and pictures were illustrated  which make easy to understand.
The diagnosis approach was presented perfectly with each and every particular and the final diagnosis was mentioned clearly .
Treatment mentioned was pertinent.
Plans used further were presented which was riveting.

short cases  

Link:https://201821batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

  A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
 
The case history was presented in detail.
The examination details were precise and presented properly.
Investigation reports are depicted clearly 
problem presentation and treatment was mentioned appropriately.

Short case 2 
 link:https://201821batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :

-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .

-Abdominal distension and facial puffiness since 6 months.

- Pedal edema since 3 months.

- Low back ache since 3 months .

- Feeling low , not feeling to talk to anyone.

- Weight gain and decreased libido since 3months.

- Loss of libido and erectile dysfunction since 2 months .

The case was briefed very well which gives us an rough idea about the case.
The chief complaints mentioned were comphrensible
The investigations were depicted with the pictures very clearly.
Treatment presented was good but could be more better to understand 


𝐐uestion 2
𝐋𝐨𝐧𝐠 𝐜𝐚𝐬𝐞𝐬-
π‚πšπ¬πž 1 π₯𝐒𝐧𝐀-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

π‚π‘πžπ’πŸ 𝐜𝐨𝐦𝐩π₯𝐚𝐒𝐧𝐭𝐬-
• bilaterally symmetrical rapidly progressive generalized
• Severe joint pains
• Limitation of movements in his hands,wrists and feet.
• Burning eyes since 3days
• Subcutaneous swelling
• Involuntary weight loss and loss of appetite since 1yr.

π‘«π’Šπ’‚π’ˆπ’π’π’”π’Šπ’”
• Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
• Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis.
• Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
• Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

π‘»π’“π’†π’‚π’•π’Žπ’†π’π’• 𝒑𝒍𝒂𝒏
• Free water restriction for Hyponatremia

• Tab. PREDNISOLONE P/O 20 mg OD

• Tab FEBUXOSTAT P/O 80 mg OD

• Haemodialysis for worsening renal dysfunction


𝑺𝒉𝒐𝒓𝒕 𝒄𝒂𝒔𝒆𝒔
π‘ͺ𝒂𝒔𝒆  π’π’Šπ’π’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

π‘ͺπ’‰π’†π’Šπ’‡ π’„π’π’Žπ’‘π’π’‚π’Šπ’π’•π’”-
• Vomitings
• Abdominal pain since 4days
• Swelling of right foot non pitting type
• Anorexia,myalgia,fatigue and anasarca since 5days

π‘«π’Šπ’‚π’ˆπ’π’π’”π’Šπ’”
Acute kidney injury , secondary to acute tubular necrosis , due to snake bite . 



π‘»π’“π’†π’‚π’•π’Žπ’†π’π’• 𝒑𝒍𝒂𝒏

1. 4 sessions of haemodialysis
2. Inj zofer 4 mg TID
3. Inj pan 40 mg Od
4. Strict input / output    charting.


π‘ͺ𝒂𝒔𝒆  π’π’Šπ’π’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

π‘ͺπ’‰π’Šπ’†π’‡ π’„π’π’Žπ’‘π’π’‚π’Šπ’π’•π’”-
• Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year
•  Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year
•  Abdominal distension
•  Facial puffiness since 6 months
•  Pedal edema since 3 months
• Low back ache since 3 months .

π‘«π’Šπ’‚π’ˆπ’π’π’”π’Šπ’”
Iatrogenic cushings syndrome
Tinea Corporis
Denovo HTN

𝑻𝑹𝑬𝑨𝑻𝑴𝑬𝑡𝑻 𝑷𝑳𝑨𝑡
• Ointment AMLORFINE 
• FUSIDIC ACID CREAM.
• SALINE COMPRESS OVER LEISONS.

This was the treatment given for tinea corporis.
• Tab. Telma 20 mg OD-for left ventricular hypertrophy
• Tab.Hizone 15mg TID-as there was suppresion of HPA Axis.

25/6/21
• Dose of tab. Hizone was reduced to 10mg.
• Tab. Shelcal 500mg OD
• Tab.Vitamin D3 OD
• Tab. Ultracet SOS

6/8/21
• Telma dose increased to 40mg OD
• Tab Itraconazole 100 mg BD
• lulifin cream
• Tab levocitrixine 5mg od.
• Ultracet tab.is continued

𝐐uestion 3 

𝐋𝐨𝐧𝐠 𝐜𝐚𝐬𝐞

π‚πšπ¬πž π₯𝐒𝐧𝐀-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

A 44 year old man presented to OPD  with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

The symptomatology of the case was accurately presented . All the positive findings of acute glomerulopathy and chronic problem were clearly discussed along with the favouring features of inflammatory pathology  were elaboratively diacussed before coming into the final diagnosis which is acute glomerulonephritis secondary to Amyloidosis, anaemia of chronic disease secondary to poorly treated rheumatoid arthritis.


Short cases-

Case link-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

A 19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year 
Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year 
Abdominal distension and facial puffiness since 6 months
Pedal edema since 3 months 
Low back ache since 3 months .

The case was presented in chronological order , he was diagnosed with Iatrogenic cushings syndrome which means raised cortisol levels due to over use of Clobetasol which is a corticosteroid.
The patient was also referred to dermatologist for the treatment of tinea corporis and also to the opthalmologist .
The patient has also lost his self esteem and was also referred to psychiatry department.

Case link-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html

35 year old man working as a food caterer  presented to our OPD with the chief complains of  
Dyspnea at rest since 5 days 
Cough with expectoration since 5 days 
Bilateral pedal edema since 4 days 
Abdominal distension since 3 days

The symptomatology was clearly and comprehensively explained.Upon examining the abdomen through ultrasound grade 1 fatty liver as he was an alcoholic,mild ascites so was advised salt restricted diet  and right pleural effusion. On analyzing all the investigation reports and examinations he is diagnosed with Heart failure  with reduced ejection fraction  and denovo detected type 2 diabetes mellitus.

Question 4- 
 link to my case assigned this month 
http://rohit1425.blogspot.com/2021/08/general-medicine.html

Question 5 
Preparing the logs is new experience and benifit for all of us. Gaining the knowledge about different cases presented in the logs are very helpful.By the logs one can know the convention of the case to be dealt with .In the beginning it was new and difficult but now we are getting familiar to it. I have learned many things from the logs made.

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