A 50 year old male, resident of Nalgonda ,who works in an ice factory came with complaints of:
- weakness of right upper and lower limbs since 5 days
- slurred speech since 5 days.
History of presenting illness:
Patient was apparently asymptomatic 1 month back, then he developed weakness in left upper and lower limbs which was sudden in onset and was taken to local hospital when he was diagnosed to have hypertension and his condition improved with medication in about 3 days.
He took medication for 20 days and stopped for next 10 days when he developed sudden onset of weakness in right upper and lower limbs (which was 5 days ago). He also developed slurred speech and was taken to local hospital and then was referred to our hospital next day.
There is no history of loss of consciousness, altered sensorium,fever,headache,vomiting,seizures,behavioural abnormalities or abnormal movements.
Past history:
He is a known case of hypertension since 1 month.
There is no history of diabetes, asthma,TB,epilepsy,coronary artery disease or thyroid abnormalities.
Personal history:
The patient wakes up at 4:00am in the morning daily. He has tea and goes to work in the ice factory. He lives very close to the ice factory. He comes home and has breakfast at around 8 to 9 am. He usually has rice and curry for breakfast. He then goes back to work and comes home for lunch at around 2:00 pm. He usually has rice with curry and dal for lunch. He takes mixed- diet.He finishes work by around 6:00 pm, comes home, has tea and takes a bath. Sometimes he works until 9:00 pm. He sleeps by 9:00 pm.
The patient has history of chewing tobacco for around 10 years.
He consumes alcohol regulary since 30 years. He stopped for around 3 years and started again 6 months ago.
Bowel and bladder movements-regular.
Treatment history:
He took medication for hypertension- Amlodipine and Atenolol for 20 days and stopped for the past 15 days.
Family history:
No history of similar complaints in the family.
General examination:
Patient is conscious and cooperative.
He is well oriented to time,place and person.
Moderately built and nourished.
Vitals :-
Temp - afebrile
BP - 140/80 mm Hg
Pulse rate - 78 bpm
Respiratory rate - 14 cycles per minute
Pallor - absent
Icterus - absent
Cyanosis - absent
Clubbing - absent
Lymphadenopathy - absent
Oedema - absent
SYSTEMIC EXAMINATION:
CNS EXAMINATION:
Right handed person.
Higher mental functions are intact.
Speech- slurred
Behaviour-normal
Memory- intact
Intelligence-normal
No hallucinations or delusions
Gait:
CRANIAL NERVE EXAMINATION:
I - no alteration in smell
II -
Visual acuity- normal
Field of vision- normal
Color vision - normal
III, IV, VI -
EOM- normal
Diplopia- absent
Nystagmus absent
No ptosis
V - sensations of face normal, can chew food normally
VII - Deviation of mouth to the left side, upper half of right side and left side normal
Taste sensation over anterior 2/3 of tongue present
VIII - hearing is normal, no vertigo or nystagmus
IX,X - no difficulty in swallowing
XI - neck can move in all directions
XII - tongue movements normal, no deviation
Pupils - both are normal in size, reactive to light
Motor examination:
Tone:
RUL: increased
LUL: normal
RLL: increased
LLL: normal
Power:
RUL: 3/5
LUL: 4/5
RLL: 3/5
LLL: 4/5
Reflexes:
Superficial reflexes:
Right Left
Corneal : present present
Conjunctival: present present
Abdominal: present in all quadrants
Plantar : not elicited flexion
Deep tendon reflexes:
Right Left
Biceps ++ ++
Triceps ++ ++
Supinator ++ ++
Knee jerk +++ ++
Ankle jerk +++ ++
Sensory examination:
Pain, temperature, crude touch, pressure sensations- normal
A 50 year old man, resident of Nalgonda came to OPD on 16/3/23 morning with chief complaints of pain abdomen since 6hrs.
History of presenting illness:
He developed pain abdomen at 12 am on 15/3/23 which was sudden in onset and gradually progressive. Pain was diffusely present but more in umbilical and left lumbar region. It was colicky type and non radiating. Pain was continuous with no aggravating and relieving factors.
History of alcohol intake present.
No history of fever,nausea,vomiting or loose stools.
Past history:
Similar complaints in the past 2 years back and was diagnosed to have acute pancreatitis.
He is a known case of diabetes since 2 years and was on medication(?)
No history of Hypertension, Asthma,Tuberculosis, CAD.
Personal history:
Daily routine:
He wakes up at 8 am and does his daily routine and is not working ,takes 3 meals daily and drinks alcohol and smokes intermittently through the day and sleeps by 10 pm.
Diet- mixed
Appetite- normal
Bowel and bladder movements- regular
Sleep- disturbed since 2 days
Addictions- chronic alcoholic since 30 years(takes about 180 ml per day on average)
Smokes cigarettes 2-3 packs per day since 30 years
Family history:insignificant
General examination:
Patient is conscious,coherent and cooperative ,moderately built and nourished.
Pallor:absent
Icterus:absent
Cyanosis:absent
Clubbing:present
Lymphadenopathy:absent
Edema:absent
Vitals:
Blood pressure: 150/100 mm Hg
Pulse rate:65bpm
Respiratory rate:20 com
Temperature:afebrile
Systemic examination:
Per abdomen examination:
On inspection: abdomen is obese,umbilicus is central and inverted. All quadrants of abdomen are moving accordingly with respiration. No visible scars,sinuses,engorged veins.
On palpation: all inspectory findings are confirmed, abdomen is soft and tenderness is present in the umbilical and left lumbar lumbar region. No guarding or rigidity . No hepatospleenomegaly and hernial orifices are free.
On percussion: no shifting dullness
On auscultation: bowel sounds heard
CVS: S1,S2 heard,no murmurs
Respiratory system: bilateral air entry present,normal vesicular breath sounds heard
CNS: no neurological deficit.
Provisional diagnosis:
Acute on chronic pancreatitis secondary to alcohol intake.
Investigations:
Hemogram:
Hb 16.2 mg/dl
Total count 9,300 cells/cumm
Neutrophils 82%
Lymphocytes 10 %
MCV 91.9
MCH 32.5
MCHC 35.5
RBC count 4.96 millions/cumm
Smear:
Normocytic,normochromic-RBC
WBC within normal limits with neutrophils
Platelets- adequate
Serum Lipase: 230 IU/L
Serum Amylase: 471 IU/L
RBS: 246 mg/dl
LFT:
Total bilirubin :1.25 mg/dl
Direct bilirubin 0.52 mg/dl
SGOT: 32 IU/L
SGPT: 41 IU/L
Alkaline phosphatase : 322 IU/L
Total proteins 7.7 gm/ dl
Albumin : 4.45 gm/dl
Serum creatinine: 1.3 mg/dl
CUE:
Pale yellow,clear,acidic
Sp gravity: 1.010
Albumin ++
Sugar +
Bile salts nil
Bile pigments nil
Pus cells 4-5 /HPF
RBC nil
Casts nil
USG:
Grade I fatty liver
Left kidney not visualized in left renal fossa
CT:
Pancreas:
Bulky with heterogeneous parenchymal enhancement with peripancreatic fat stranding associated with fluid traversing along left paracolic gutter.
No parenchymal necrosis.
No peripancreatic collection or pseudo cyst
Splenic artery patent
Minimal ascites.
Spleen normal
Liver ,gall bladder normal
Impression: features suggestive of acute interstitial pancreatitis with modified CT severity score of 4. Minimal ascites
Treatment:
-NBM
- IV fluids : NS and RL ( 100ml/hr)
-Inj pantop 40mg IV OD
-Inj Thiamine 200mg in 100ml NS iv tid
- Inj HAI s/c tid premeal.
- BP, PR, RR, temperature monitoring and charting 4th hourly.
2K18 BATCH UNIVERSITY PRACTICAL EXAMS DEPARTMENT OF GENERAL MEDICINE MARCH 2023 S.NO HALL TICKET NO CASE PRESENTATION BLOG LINK CASE PRESENTATION VIDEO LINK 1. 1601006100 https://finalmbbspart2gmpracticals.blogspot.com/2023/03/1601006100-case-presentation.html https://youtu.be/RjXy6VRc0bc 2. 1701006039 https://finalmbbspart2gmpracticals.blogspot.com/2023/03/1701006039-case-presentation.html https://youtu.be/QsBFryWuMYQ 3. 1701006089 https://finalmbbspart2gmpracticals.blogspot.com/2023/03/1701006089-case-presentations.html https://youtu.be/4b-DBdCWoaY 4. 1701006131 https://finalmbbspart2gmpracticals.blogspot.com/2023/03/1701006131-case-presentation.html https://youtu.be/kSCJcPaBMR0 5. 1701006146 https
2K17 BATCH FINAL MBBS PART-II GM UNIVERSITY PRACTICAL S DEPARTMENT OF GENERAL MEDICINE DATE : 08-06-2022 S.NO HALL TICKET NO CASE PRESENTATION BLOG LINK CASE PRESENTATION VIDEO LINK 1 1601006065 https://finalmbbspart2gmpracticals.blogspot.com/2022/06/1601006065-case-presentation.html https://youtu.be/4tqOuzjgDfM 2 1601006100 https://finalmbbspart2gmpracticals.blogspot.com/2022/06/1601006100-case-presentation.html https://youtu.be/leKcWmqFzns 3 1601006158 https://finalmbbspart2gmpracticals.blogspot.com/2022/06/1601006158-case-presentation.html https://youtu.be/2BTdO77FeMU 4 1701006001 https://finalmbbspart2gmpracticals.blogspot.com/2022/06/1701006001-case-presentation.html https://youtu.be/rikMcUq48YA 5 1701006002 https://finalmbbspart2gmpracticals.blogspot.com/2022/06/1701006002-case-presentation.html https://youtu.be/kt9zFraK8vg 6 1701006003 https://finalmbbspart2gmpracticals.blogspot.com/2022/06/1701006003-case-presentation.html https://youtu.be/VgjsoEqNwTI 7 170
LONG CASE 50yr old male patient came to casuality with cheif complaints: Shortness of breath since -10days Swelling of upper and lower limbs since-6days Decreased urine output since - 6days HISTORY OF PRESENT IllNESS: -patient was apparently asymptomatic 1year back the he had shortness of breath which is intermittent type and then he was also diagnosed with CKD 1year back -10days back he had sudden onset of SOB which is gradeII gradually progressive to grade IV -orthopnea present -paroxysmal nocturnal dyspnea present swelling of both upper and lower limbs . Lower limb edema which is Pitting type upto thigh PAST HISTORY: -History of fall from tree 10 years ago and then onwards he developed backache and neckpain . -3yrs back he had fever ,cough,loss of appetite for 2months and had been diagnosed with tuberculosis and diabetes. -he took anti tuberculosis therapy for 6months and on OHA since then. -SOB with wheeze (since 3 years) on and off and with CKD 1 year ago.
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