Varsha Bandaru Roll no 07

 Case History and Clinical Findings C/O GIDDINESS SINCE 15 DAYS HOPI- PATIENT WS APPARENTLY ASYMPTOMATIC 15DAYS AGO THEN DEVELOPED EPISODES OF GIDDINESS A/W BLURRING OF VISION A/W SWEATING RELIEVED AFTER TAKING FOOD DAILY ONE EPISODE H/O CHEST PAIN SINCE 4DAYS PRICKING TYPE ON AND OFF ,NO PRECIPITATING FACTORS H/O TINGLING AND NUMBNESS OF LOWER LIMBS SINCE 10 YEARS EXTENDING FROM TIP OF TOES TO SHIN OF TIBIA H/O BURNING SENSATION OF FEET SINCE 5 YEARS H/O LOOSE STOOLS FOR 1 DAY WHICH WAS ONE WEEK AGO AND SUBSIDED ON MEDICATION FOLLOWED BY PAIN ABDOMEN IN UMBLICAL REGION SINCE THEN NO H/O LOSS OF APPETITE SINCE 1 WEEK NO H/O POLYURIA,POLYDIPSIA NO H/O PALPITATIONS ,SOB NO H/O HYPOGLYCEMIC EVENT AT NIGHT NO H/O DECREASED URINE OUTPUT ,BURNING MICTURITION NO H/O FEVER, PEDAL EDEMA ,FACIAL PUFFINESS PAST H/O- K/C/O HTN SINCE 30YRS AND ON T.TELMA AM 40/5 K/C/O DM SINCE 30 YRS ON INJ MIXTARD 20U(BBF)-X-15U(BBF) K/C/O CKD SINCE 13 YEARS ON EXAMINATION PT IS CONSCIOUS, COHERENT,COOPERATIVE TEM

 Case History and Clinical Findings CHIEF COMPLAINTS : DIFICULTY IN BREATHING SINCE 2 MONTHS, HARD STOOLS SINCE 1MONTH , BLOATING OF ABDOMEN SINCE 1MONTH , GIDDINESS SINCE 1 WEEK HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS BACK THEN HE DEVELOPED DIFFICULTY IN BREATHING WHICH IS OF GRADE 2 WITH NO AGGREVATING AND RELEIVING FACTORS COMPLAINTS OF HARD PELLET STOOLS WITHOUT ANY BLOOD TINGE SINCE 1 MONTH C/O BLOATING OF ABDOMEN SINCE 1 MONTH N/H/O CHEST TIGHTNESS N/H/O ORTHOPNEA PND N/H/O BLEEDING MANIFESTATIONS PAST HISTORY : K/C/O HYPERTENSIOPN ON TAB.CINOD 10 MG BD SINCE 10 YEARS K/C/O DM SINCE 30 YEARS ON INJ.HAI 8-10-8 K/C/O CKD SINCE 13 YEARS ON NODOSIS 500 MG PERSONAL HISTORY: DIET: MIXED APPETITE: NORMAL BOWEL AND BLADDER MOVEMENTS: REGULAR. NO KNOWN ALLERGIES AND ADDICTIONS. FAMILY HISTORY: NOT SIGNIFICANT. GENEREAL EXAMINATION: PATIENT IS C/C/C TEMP: AFEBRILE PR: 80 BPM RR: 20 CPM BP: 110/70 MMHG SPO2: 98 @ RA. SYSTEMIC EXAMINATION: CVS: S1 S2 HEARD. NO MURMURS RESPIRATORY

 Case History and Clinical Findings CHIEF COMPLAINTS ; PATIENT CAME WITH COMPLAINTS OF BEING UNRESPONSIVE SINCE 2 HOURS [6.00 AM] HOPI ; PATIENT WAS APPARENTLY ALRIGHT AT 6.00 AM WAS ABLE TO DO HER ROUTINE DAILY ACTIVITIES FOLLOWING WHICH SHE WAS FOUND UNRESPONSIVE AND NO C/O INVOLUNTARY MOVEMENTS ,INVOLUNTARY MICTURITION ,DEFECATION,UPROLLING OF EYES , TONGUE BITE PATIENT WAS TAKEN TO AREA HOSPITAL .GRBS WAS 32MG/DL SPO2 80% ON KA CONSERVATIVE WAS GIVEN [BLOOD GLUCOSE LEVELS WERE CORRECTED ,O2 INHALATION SUPPLEMENTATION INJ DERIPHYLLINE WAS GIVEN AND WAS SENT TO OUR HOSPITAL FOR FURTHER MANAGEMENT HISORY OF PAST ILLNESS ; NO H/O SIMILAR COMPLAINTS IN THE PAST NO C/O FEVER ,VOMITING,LOOSE STOOLS,PAIN ABDOMEN ,SOB ,CHESTPAIN , PALIPITATIONS PATIENT ATTENDARS GAVE HISTORY THAT PATIENT CONSUMED 6-8 TABLETS OF GLIMPIRIDE N/K/C/O HTN ,DM , CVA ,CAD ,TB, ASTHMA GENERAL EXAMINATION; GENERAL EXAMINATION PATIENT IS CONSCIOUS NO PALLOR ,ICTERUS, CYANOSIS ,CLUBBING ,LYMPHADENOPATHY ,OEDEMA OF FEE

 Case History and Clinical Findings C/O PAIN ABDOMEN SINCE 3 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN HE DEVELOPED PAIN ABDOMEN SINCE 3 DAYS INSIDIOUS IN ONSET, LEFT LUMBAR REGION, SPASTIC TYPE OF PAIN,NON RADIATING. A/W VOMITING 3 EPISODES PER DAY A/W LOSS OF APPETITE SINCE 3 DAYS H/O CONSTIPATION SINCE 3 DAYS,STEATORRHOEA H/O BLOATING NO H/O FEVER ,LOOSE STOOLS NO H/O BURNING MICTURITION NO H/O DECREASED URINE OUTPUT PAST HISTORY: H/O SIMILAR COMPLAINTS IN THE PAST N/K/C/O HTN,DM,CVA,CAD,EPILEPSY,ASTHMA NO PALLOR ,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA. VITALS: BP:130/80 TEMP:97 RR:31 COURSE IN HOSPITAL: THIS IS A CASE OF 36 YR OLD MALE CAME WITH C/O PAIN ABDOMEN SINCE 3 DAYS A/W VOMITINGS 3-4 EPISODES PER DAY.PATIENT WAS EVALUATED AND DIAGNIOSED WITH DIABETIC KETOACIDOSIS,ACUTE O CHRONIC PANCREATITIS PATIENT WAS ADVISED FOR CECT ABDOMEN I/V/O PANCREATITIS BUT PATIENT AND ATTENDR DENIED FOR IT. ANTIBIOTICS ADEQATE,REHYDRATION WITH FLUIDS,SUGAR CONTROL

 Case History and Clinical Findings CHIEF COMPLAINTS: WOUND OVER THE LEFT FOOT SINCE 4 MONTHS HISTORY OF PRESENT ILLNESS: PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK, AFTER WHICH SHE DEVELOPED BLACKISH DISCOLORATION OF LEFT GREAT TOE WHICH WAS INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE , ASSOCIATED WITH SWELLING OF THE INVOLVED LIMB TILL MID FOOT FOR WHICH SHE WENT TO A LOCAL RMP AND WAS TREATED WITH DRESSING .THERE WAS NO IMPROVEMENT, WITH PROGRESSION OF WOUND , ASSOCIATED WITH FOUL SMELLING DISCHARGE FOR WHICH SHE WAS TAKEN TO AN OUTSIDE HOSPITAL WHERE DISARTICULATON OF LEFT GREAT TOE WAS DONE UNDER REGIONAL ANESTHESIA ON 13/04/24. CAME ON LAMA TO OUR HOSPITAL FOR FURTHER MANAGEMENT NO H/O FEVER,COUGH,COLD. NO H/O CHEST PAIN,PALPITATIONS,BREATHLESSNESS,ORTHOPNEA,PND. NO H/O ABDOMINAL PAIN,BURNING MICTURITION,NAUSEA,VOMITING. HISTORY OF PAST ILLNESS: K/C/O TYPE 2 DIABETES MELLITUS SINCE 6 YEARS (ON TAB GLIMI M1/OD) NO H/O HYPERTENSION,ASTHMA,TB,EPILEPSY,CVA,CAD,CKD,CLD. TREATMENT

 Case History and Clinical Findings C/O FEVER SINCE 2WEEKS HISTORY OF PRESENT ILLNESS : PATIENT WAS APPARENTLY ASYMPTOMATIC 2 WEEKS BACK AND THEN SHE DEVELOPED FEVER 2 WEEKS A/W CHILLS AND RIGORS ANS RELIEVED IN BETWEEN BUT SINCE TODAY MORNING THE FEVER IS PRESENT ,HIGH GRADE ,CONTINOUS TYPE A/W CHILLS AND RIGORS ,HEADACHE +,NO AGGRAVATING AND RELIEVING FACTORS NO H/O BURNING MICTURATION NO H/O PAIN ABDOMEN , VOMMITINGS NO H/O CHEST PAIN , PALPITATIONS NO H/O COLD , COUGH NO H/O PEDAL EDEMA,DRUG NON COMPLIANCE HISTORY OF PAST ILLNESS : K/C/O DM SINCE 9 YEARS AND ON INJ HAI/SC/TID 16U-16U-16U INJ NPH SC /BD 14U-X-14U K/C/O HTN SINCE 6 DAYS AND ON TAB TELMA 20MG PO/OD N/K/C/O THYROID DISORDERS , ASTHMA , TB , EPILEPSY , CAD , CVA MENSTRUAL HISTORY : HYSTERECTOMY DONE 9 YEARS AGO ON EXAMINATION PT IS CONSCIOUS, COHERENT,COOPERATIVE TEMP-101 F PULSE RATE 92 BPM BP 140/90 MMHG GRBS -256MG/DL CVS-S1 S2 HEARD NO MURMURS RS- BAE PRESENT NVB P/A-SOFT,NON TENDER PROVISIONAL DIAGNOSIS ENTERIC FEV

 C/O SHORTNESS OF BREATH SINCE YESTERDAY 10PM HOPI PATIENT WAS APPARENTLY ASYMPTOMATIC BEFORE 10PM YESTERDAY SUDDENLY SHE HAD SHORTNESS OF BREATH WHICH IS SUDDEN IN ONSET GRADUALLY PROGRESIVE (GRADE 2 NYHA ) NO H/O FEVER, COUGH, COLD, VOMITINGS, DIARRHOEA, BURNING MICTURITION, DECREASE IN URINE OUTPUT SHE HAD SIMILAR COMPLAINTS ON 1/3/24 AND ADMITTED IN GOVERNAMENT HOSPITAL AND TREATED THERE DISCHARGED ON 3/3/24 AND THEN SHE RECOVERED K/C/O CKD WITH DIABETIC NEPHROPATHY AND ADMITTED IN OUR HOSPITAL WITH COMPLAINTS OF VOMITINGS AND EPIGASTRIC PAIN ON 16/9/23 AND DISCHARGED ON 19/9/24 PAST HISTORY K/C/O DM SINCE 10YRS ON TAB GLIMI M1 PO/OD NOT USING ANY MEDICATION SINCE NOV 2023 NO H/O DM, TB, ASTHMA. HTN, EPILEPSY GENERAL EXAMINATION PT IS C/C/C TEMP - 98.6F PR - 130BPM RR - 30CPM BP - 130/80MMHG SPO2 - 86% @ RA GRBS - 464MG % SYSTEMIC EXAMINATION CVS - S1, S2 +, NO MURMURS CNS - NFND RS - B/L DIFFUSE FINE CREPTS PRESENT P/A - SOFT NONTENDER PULMO REFERAL WAS DONE I/V/O ? PULMONARY TB A

 Case History and Clinical Findings PATIENT IS A KNOWN CASE OF GUILLATINE AMPUTATION CAME FOR CLOSURE OF FLAP PATIENT WAS ADMITTED TO THE IN GENERAL SURGERY KIMS FOR DIABEYES ULCER OVER THE LEFT 2ND TOE AND GOT THE 2ND TOE AMPUTATED ON DEC 2022 AND ADEQUATE BLOOD SUGARS CONTROLE HAS BEED DONE AND PATIENT WAS DISCHRES PATIENT HAS LOST FOLLOW UP AND FURTHER GOT ADMITTED IN GENERAL SURGERY KIMS SILENCER BURN OVER THE DORSUM OF THE FOOT ON NOVEMBER 2023 DEBRIDMENT DONE AND REFFERED TO THE NEPHROLOGY AND HE ADVISED TO DIALYSIS AND PATIENT AND PATIENT ATTENDERS WERE NOT WILLING HAD LEFT AGAINST MEDICAL ADVICE HE WENT TO YASHODHA AND UNDERWENT AMPUTATION AND PATIENT FURTHER CAME TO KIMS FOR FOR THER MANAGMENT AND CAME FOR STUMP CLOSURE ON 4 /1/24 TO GENERAL SURGERY NO COUGH AND VOMITING , NAUSEA NO H/O FEVER,COLD AND ALLERGIES. PAST HISTORY: K/C/O DM-II SINCE 3 YEAR ON REGULAR MEDICATION (GLYCOMET-M1 PLUS METFORMIN PO/OD) K/C/O HTN SINCE 10 YR ON TELMA 40 MG NOT A K/C/O HTN,ASTHMA,TB,EPILEPSY

 Case History and Clinical Findings C/OINVOLUNTARY MOVEMENTS ALL OVER THE BODY SINCE 4DAYS HOPI:PT WAS APPARENTLY ASYMPTOMATIC ALRIGHT 7 DAYS BACK THEN DEVELOPED SOB AND HEAVENESS OF CHEST FOR WHICH HE WAS ADMITTED AND GOT TREATED THEN AFTER HE WAS DEVELOPING INVOLUNTARY MOVEMENTS OF ALL OVER THE BODY PROGRESSING IN INTENSITY NO H/O TRAUMA TO HEAD NO H/O INVOLUNTARY FALLS NO H/O SPIPPAGE OF SLIPPERS NO H/O DIFFICULTY IN COMBING,NO H/O DIFFICULTY IN CHEWING NO H/O SQUINT,ANOSMIA,PAROAMIA,HICCUPS,DYSPHAGIA,ABDOMINAL PAIN,VOMITINGS,DIARRHOA K/C/O AD PCKD ,TB 30 YEARS BACK DM SINCE4YEARS ON GLIDAZIDE 80MG HTN SINCE 2 YEARS GENERAL EXAMINATION: PT IS C/C/C BP-140/80 PR-86BPM SPO-99 SYSTEMIC EXAMINATION CVS-S1S2+ RS-NVBS CNS-NFND P/A-SOFT NON TENDER PROVISIONAL DIAGNOSIS POLYCYSTIC KIDNEY DISEASE STAGE V CHRONIC KIDNEY DISEASE ANEMIA SECONDARY TO CKD K/C/O PULMONARY KOCHS 30 YEARS AGO DM+,HTN+ Investigation RFT 03-01-2024 03:57:PMUREA252 mg/dl42-12 mg/dlCREATININE11.0 mg/dl1.3-0.9 mg/dlURIC

 A 60 years old male patient came to casuality with loss of consciousness at 2 Am  HOPI :  Patient was apparently alright and asymptomatic 12 days and then he experienced slip and fall on 15/4/24 and was taken to government hospital there he was diagnosed as intertrochanteric hip fracture and then shifted to ot there they have undergone surgery . On 17/4/24 patient developed altered sensorium and is so irritable and for further four days he is under observation of doctors and the concerned doctors did not inform the accurate cause to the patient attenders and then he was discharged  After discharge patient was at home with same irritable condition and altered sensorium for four days and again on 24/4/24 he suddenly developed SOB and then the patient attenders  admitted him to hospital there he had undergone CT brain suggested age related changes and for SOB they followed conservative treatment and altered sensorium is present And on Saturday at 2 Am patient loss consciousness so they s