CASE I
Patient Name - 52 year old male
Diagnosis
HYPERTENSION
DIABETES MELLITUS TYPE II
HYDRONEPHROSIS SECONDARY TO LEFT RENAL CALCULI
Case History and Clinical Findings
C/O LEFT SIDE LOIN PAIN SINCE 3MONTHS
HOPI: PATIENT WAS APPARENTLY ASYPTOMATIC 3MONTHS BACK THEN HE DEVELOPED
LOIN PAIN LEFT SIDED WHICH WAS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE AND
RELIVED ON VOIDING URINE
NO H/O BURNING MICTURATION,FEVER,COUGH,COLD,SHORTNESS OF BREATHE,LOOSE
STOOLS SEZIURES
PAST HISTORY
K/N/O HYPERTENSION SINCE 10 YEARS AND ON MEDICATION WITH METOPROLOL 25mg
1...0...0
TYPE 2 DM SINCE 10YEARS OM METFORMIN 500MG BD
H/O RENAL CALCULI 5YEARS BACKFOR WHICH SURGERY WAS DONE ONCE IN 2016 AND
OTHER IN 2019
H/O COVID INFECTION IN 2020, RESOLVED
PERSONAL H/O
SLEEP ADEQUATE
BOWEL AND BLADDER MOVEMENTS REGULAR
APPETITE NORMAL
NO ALLERGIES
GENERAL PHYSICAL EXAMINATION
GENERAL EXAMINATION:
PATIENT IS C/C/C
NO SIGNS OF PALLOR,CYANOSIS,CLUBBING,LYMPHADENOPATHY,EDEMA
VITALS:
TEMP:AFEBRILE
PR:82BPM
RR:16 CPM
BP: 130/80 MMHG
GRBS:110MG/DL
SYSTEMIC EXAMINATION
CVS:S1 S2 HEARD
RS:BAE PRESENT
P/A:SOFT,NON TENDER,NO ORGANOMEGALY
CNS:NFND
REFERED TO UROLOGY I/V/O STRICTURE? ON 17/11/2023
LEFT URETERIC CALICULI WITH BPH GRADE I
,NCCT
NCCT SHOWED MULTIPLE LEFT RENAL CALCULI LARGEST MEASURING 5 MM IN LOWER
POLE, WITH LEFT PCS MILDLY DILATED
PARENCHYMAL THINNING 15 MM, 10M
PROSTATE- 32 CC
REVIEW REFERAL ON 20/11/2023
ADVISED IVP ON 24 /11/2023
Investigation
CBP :
HB: 11.7GM/DL
TOTAL COUNT : 6600CELLS/CUMM
N/L/E/M/B- 63/27/05/05/00
PLATELET COUNT: 2.17LAKHS/CUMM
SERUM ELECTROLYTES:
SODIUM: 137MEQ/L
POTASSIUM: 4.2 MEQ/L
CHLORIDE: 102 MEQ/L
CALCIUM 9.8 mg/dl
PHOSPHOROUS 2.8 mg/dl
LFT
TOTAL BILIRUBIN: 0.66 MG/DL
DIRECT BILIRUBIN : 0.18 MG/DL
AST 15 IU/L
ALT: 22 IU/L
ALKALINE PHOSPHATE: 94 IU/L
TOTAL PROTEIN:6.6 GM/DL
ALBUMIN : 4.3 GM/DL
A/G :1.95
RBS: 124 MG/DL
PLBS 164 MG/DL
SEROLOGY:NEGATIVE
RFT
UREA 23 MG/DL
CREAT 0.9 MG/DL
UA 3.7 MG/DL
2D ECHO - MILD AR,TRIVIAL TR, NO MR
NO RWMA . NO AS/MS SCLEROTIC AV
GOOD LV SYSTOLIC FUNCTION
DIASTOLIC DYSFUNCTION , NO PAH/PE
Treatment Given(Enter only Generic Name)
TAB. METOPROLOL 25 MG PO OD
TAB. METFORMIN 500 MG PO BD
TAB.DROTIN-P PO BD
TAB.PAN 40 MG PO OD
TAB.TAMSULOSIN 0.4 MG
Advice at Discharge
TAB. METOPROLOL 25 MG PO OD
TAB. METFORMIN 500 MG PO BD
TAB.DROTIN-P PO BD
TAB.PAN 40 MG PO OD
TAB.TAMSULOSIN 0.4 MG
TAB.NETROFURANTOIN 100 MG PO OO X 5 DAYS
SYP.CITRALKA 15 ML IN 1 GLASS OF WATER HS
CASE II
Patient - 48 year old
Diagnosis
LOWER RESPIRATORY TRACT INFECTION
CONTACT IRRITANT DERMATITIS
?SCIATICA
Case History and Clinical Findings
PATIENT CAME TO OPD WITH C/O
BODY PAINS SINCE 2 MONTHS
SHORTNESS OF BREATH SINCE 1 MONTH
PATIENT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS AGO, THEN HE DEVELOPED BODY
PAINS, INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE
HE LATER DEVELOPED SOB GRADE II, INSIDIOUS AND GRADUALLY PROGRESSIVE
C/O LEFT LOIN PAIN RADIATING TO LEFT LEG
ASSOCIATED WITH TINGLING SENSATION IN LOWER LIMBS
H/O PND +
NO H/O ORTHOPNEA, COUGH
NO H/O PEDAL EDEMA, BURNING MICTURATION, PALPITATIONS
PAST HISTORY
N/K/C/O DM, TB, BA, CVA, CAD, EPILEPSY, LEPROSY, THYROID DISORDERS
PERSONAL HISTORY
NORMAL APPETITE
SLEEP ADEQUATE
BOWEL AND BLADDER MOVEMENTS REGULAR
APPETITE NORMAL
SMOKER- 10 CIGARETTES PER DAY SINCE 20 YEARS
NO ALLERGIES
GENERAL PHYSICAL EXAMINATION
PATIENT IS C/C/C
NO SIGNS OF PALLOR,CYANOSIS,CLUBBING,LYMPHADENOPATHY,EDEMA
VITALS:
TEMP:AFEBRILE
PR:82BPM
RR:16 CPM
BP: 120/80 MMHG
GRBS:110MG/DL
SYSTEMIC EXAMINATION
CVS:S1 S2 HEARD
RS:BAE PRESENT
P/A:SOFT,NON TENDER,NO ORGANOMEGALY
CNS:NFND
REFERRAL TO DERMA I/V/O ITCHY SKIN LESION OVER LEFT LOWER BACK SINCE 15- 20
DAYS
DIAGNOSED WITH IRRITANT CONTACT DERMATITIS.
Investigation
SODIUM140 mEq/L
POTASSIUM4.4 mEq/L
CHLORIDE102 mEq/L
CALCIUM IONIZED1.29 mmol/L
LIVER FUNCTION TEST (LFT)
Total Bilurubin
0.71 mg/dl
Direct Bilurubin
0.16 mg/dl
SGOT(AST)14 IU/L
SGPT(ALT)14 IU/L
ALKALINE PHOSPHATE143 IU/L
TOTAL PROTEINS 6.8 gm/dl
ALBUMIN4.4 gm/dl
A/G RATIO1.88
Treatment Given
TAB.SHELCAL PO OD
TAB.PAN 40 MG PO OD
TAB.NEUROBION FORTE OD
NEB.IPRAVENT 6 HOURLY
NEB.BUDECORT 12 HRLY
TAB.AMOXY CLAV 625 MG TID
TAB.AZITHROMYCIN 500 MG PO OD
SYP.ASCORYL-L8 10 ML TID
Advice at Discharge
TAB.AMOXY CLAV 625 MG TID X 3 DAYS
TAB.AZITHROMYCIN 500 MG PO OD X 3 DAYS
TAB.SHELCAL PO OD X 1 MOONTH
TAB.NEUROBION FORTE OD X 1 MOONTH
TAB.PAN 40 MG PO OD X 1 WEEK
TAB.TECZINE 10 MG/ OD X 10 DAYS
SYP.ASCORYL-L8 10 ML TID X 1WEEK
CALOSOFT-AF LOTION L/A BD X 10 DAYS
Case III
Patient - 46 Year Female
Diagnosis
ACUTE GASTROENTERITIS
DM II
Case History and Clinical Findings
C/O PAIN ADBOMEN SINCE 4 DAYS
PATIENT WAS APPARENTLY ASYMTOMATIC4 DAYS AGO THEN SHE DEVELOPED PAIN
ABDOMEN , SUDDEN ONSET , GRADUALLY PROGRESSIVE . AGGRAVATED ON TAKING
MEALS , RELIEVED ON TAKING REST . ASSOCIATED WITH LOOSE STOOLS ( 5-6 EPISODES ) .
ASSOCIATED WITH FEVER
NO H/O VOMITINGS , NAUSEA , CONSTIPATION
NO H/O TRAUMA
NO H/O SIMIRAL COMPLAINTS IN THE PAST
N/K/C/O HTN , DM , ASTHAMA, THYROID, CVA, CAD , EPILEPSY
H/O HYSTRECTOMY DONE 18 YRS AGO
H/O SPINE SURGERY DONE 4 YRS AGO
H/O SURGERY FOR RENAL CALCULI DONE 3 YEARS AGO
Investigation
HBsAg-RAPID Negative
Anti HCV Antibodies - RAPID Non Reactive
COMPLETE BLOOD PICTURE (CBP)
HAEMOGLOBIN 12.1 gm/dl
TOTAL COUNT 5400 cells/cumm
PLATELET COUNT 2.33
SMEARNormocytic
normochromic
COMPLETE URINE EXAMINATION (CUE) COLOURPaleyellow
APPEARANCEClear
REACTIONAcidic
SP.GRAVITY1.010
ALBUMIN+
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 3-4
EPITHELIAL CELLS 2-3
REDBLOODCELLS Nil
CRYSTALSNil
CASTSNil
AMORPHOUS DEPOSITS
Absent
OTHERSNil
BLOOD UREA 25 mg/dl
SERUM CREATININE 0.8 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM
SODIUM 135 mEq/L
POTASSIUM 3.7 mEq/L
CHLORIDE 98 mEq/L
CALCIUM IONIZED 1.19 mmol/L
LIVER FUNCTION TEST (LFT)
Total Bilurubin 0.37 mg/dl
Direct Bilurubin0.16 mg/d
SGOT(AST)66 IU/L
SGPT(ALT)42 IU/L
ALKALINE PHOSPHATE 110 IU/L
TOTAL PROTEINS 6.1 gm/dl
ALBUMIN3.5 gm/dl
A/G RATIO1.36
POST LUNCH BLOOD SUGAR 137 mg/dl
USG
IMPRESSION
TYPHILITIS
GRADE 2 FATTY LIVER
2D ECHO
EF 60%
NO MR/AR/TR
NO RWMA NO AS/MS, SCLEROTIC AV
GOOD LV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION
NO PAH/PE
Treatment Given(Enter only Generic Name)
IV FLUIDS NS AT 75 ML / HR
INJ METROGYL 500 MG IV TID
INJ TAXIM 1 GM IV BD
INJ BUSCOPAN IV / OD
INJ PAN 40 MG IV OD
INJ ZOFER 4 MG IV BD
Under
Dr. SAI SATYANARAYAN SIR
( HOD OF EMD MEDICINE)
DR. MANASA (SR)
DR. PAVANI PGY3
DR.NAVYA PGY2
DR. MANOHITH PGY1
DR. SREEJA INTERN
DR. SNITHA REDDY INTERN
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