GENERAL MEDICINE

CASE SCENARIO 

Pt aged 75 yrs M farmer by occupation came to opd with c/o 5 days back(Tuesday) has loose stools(4 episodes) and fever for 2 days (tue and wed) then on Friday he went to a pvt hsptl with c/o of generalised weakness .

HISTORY OF PRESENT ILLNESS

Pt was apparently normal 6 yrs back and got diagnosed with pulmonary TB and took treatment for 1 yr and got controlled on TB.

Then he again started smoking and 3 yrs back he again again developed wheeze and on medication for TB               

3 months Back the wheeze is aggregated and and 5 days back he has 4 episodes of loose stools which were non mucous non blood stained  watery and small quantity and fever for 2 days and generalised weakness since 5 days and grade III dyspnea since a week

HISTORY OF PAST ILLNESS 

Pulmonary TB and on medication 

N/k/c/o DM,HTN

TREATMENT HISTORY

Pt is on TB medication .

PERSONAL HISTORY 

Mixed diet

Farmer by occupation

Decreased appetite 

General Examination

No pallor 

Icterus present 

No cyanosis

No clubbing 

No lymphandenopathy 

No oedema 

Vitals 

Temp - 99F°

BP - 100/70mmHg

Pulse - 82Bp

Resp rate - 26/min 

Spo2 - 92%

Systemic examination 

Cardiovascular system

No thrills 

Cardiac sounds S1 S2 heard 

 No Cardiac murmurs 

Respiratory system

Dyspnoea present

Wheeze present

Abdomen 

obese abdomen 

No tenderness 

No palpable mass 

No bowel sounds 

Central Nervous System

Conscious 

 Normal Speech

No neck stiffness 

No kerning's sign 

Investigations 

ECG 

HEMOGRAM 

SERUM ELECTROLYTES 


ABG

Provisional diagnosis

Acute gastroenteritis with old pulmonary koch's 






Comments

Post a Comment

Popular posts from this blog

Prefinal -83 year old male with shortness of breath with pnemonia

Image
This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. The patient/ attender was informed the purpose of the information being acquired. An informed consent was taken from patient/ attender and there is omission of information that was requested to be omitted. A 83yr old male came with complaints of   cough since 20 days Fever since 19 days Shortness of breath 17 days  History of Presenting illness: Patient was admitted to ICU on 20/11/23 in the morning at 10 am with  breathlessness. It was insidious in onset and gradually progressive, continuous a
Read more

osce learning points

Dec 7 2023 OSCE questions 1. What are bronchial breathsounds how to differentiate it from vesicular breath sounds  I have learnt how to identify bronchial breath sounds clinically  Brochial breath sounds It is loud, hollow, and high pitch Expiratory phase is longer than inspiratory phase There is distinct pause between inspiration and expiration due to absent alveolar phase Vesicular breathsounds Soft, low pitched, and rustling in quality   a) Inspiratory phase remains  longer than the            expiratory phase    b)   Inspiration is higher pitch than expiration    c) No pause between inspiration and expiration What are crepitations? How they occur ? Crepitations are adventitious breath sounds.  Crepitations are made either by air passages and alveoli (air sacs) opening up during inspiration or by air bubbling through fluid. They are not normally heard in healthy lungs. During expiration alveoli stick together while during inspiration the alveolar walls are seperated with difficulty
Read more

LIVER ABSCESS

Image
Hello all this is K.Rohit ,a eighth semester student.This E Log depicts the patient centered approach to learning. This is an online E Logbook recorded to discuss and comprehend our patient's de-identified health data shared, AFTER taking his/her/guardian's signed informed consent. A 32 yr old male came with the complaints of fever since 1 week  HOPI  Patient was apparently asymptomatic 1 week back and then developed fever which was sudden in onset gradually progressive high grade associated with chills and generalised weakness for which he went to local RMP and took medication for 2 days still the symptoms didnot subside and further investigation like blood test done and his blood sugars were 300mg/dl  As the symptoms didnot subside they went to Miryalguda hospital there USG was done and impression showed HEPATIC ABSCESS  and refered to our hospital  Patient came to hospital yesterday and USG was done impression showing:  NO H/o vomitings  No h/o cough cold diarrhoea  Past his
Read more