A 35 year old female,resident of miryalguda,worker in steel shop,came with chief complaints of
•Fever since 12 days
•Shortness of breath since 10 days
•Cough since 8 days
●HISTORY OF PRESENTING ILLNESS:-
She was apparently asymptomatic 12 days back,and then she developed fever which was insidious in onset,continuous,high grade and not associated with chills and rigors,for which she went near local RMP and took some medications and temperature decreased.
And then she developed breathlessness 10 days back,which was insidious in onset,gradually progressive,SOB is of grade 1 i.e when climbing stairs.SOB aggravated on exposure to dust and cool air,seasonal variation is present.
History of cough since 8days,which is productive,mucopurulent,non foul smelling, and subsided on medication.Cough aggravated on lying in supine position and relieved gradually on sleeping to one side.
No h/o tightness in chest,No H/0 palpitations ,sweatings,syncopal attacks,b/l pedal edema.
No h/o wheeze,hemoptysis,decrease urinary output,burning micturition,weight loss
●PAST HISTORY:
She is a known case of Asthma since 6years, which was aggravated on dusting the house for which she used inhaler(ASTHALIN),2-3 times in a month.
She develops SOB on climbing 20 steps upstairs i.e grade 1 SOB.
She is not a known case of Diabetes mellitus,Hypertension,Tuberculosis,Epilepsy.
●PERSONAL HISTORY:
Diet:Mixed
Appetite:Normal
Sleep: Adequate
Bowel,bladder:regular movements.
No addictions.
●FAMILY HISTORY:No significant family history.
Not allergic to any drugs.
●GENERAL PHYSICAL EXAMINATION:
Patient is conscious, coherent,cooperative,well oriented to time,place,person.She is moderately built and nourished.
No signs of pallor,icterus,cyanosis,clubbing,lymphedenopathy,generalised edema.
Vitals:PR-86bpm,RR-23cpm,BP-130/90mm hg and afebrile.
SYSTEMIC EXAMINATION:
●RESPIRATORY SYSTEM:
-Upper respiratory tract: No polyps and DNS
Oral cavity:Good oral hygiene.No loss of tooth/caries.
Posterior pharyngeal wall-normal.
-Lower respiratory tract:
On inspection:
Shape of chest: Elliptical,b/l symmetrical chest.
Trachea appears to be central
Chest moves on respiration and equal on both sides.
No accessory respiratory muscles are used in respiration.
Apical impulse is not visible.
No scars, sinuses,engorged veins.
No kyphosis, scoliosis.
Palpation:
No local rise of temperature, tenderness.All inspectory findings are confirmed by palpation.
Trachea-central position
Apex beat-5th ICS medial to midclavicular line
Tactile vocal fremitus:Decreased in Left Infra scapular,Infra axillary area.
A55 year old male patient came to opd with chief complaints of slurring of speech since 10days (11-03-23) and deviation of mouth to left side was observed by his wife on 11-03-23 and came to kims on 13-03-23 i.e.,8days ago
Date of admission:13/03/23
●HISTORY OF PRESENTING ILLNESS:-
Patient was apparently asymptomatic 10days back then he developed slurring of speech and deviation of mouth towards left side which were sudden in onset.
No h/o drooling of saliva and ptosis.
No h/o trauma
No h/o difficulty of combing hair,mixing food, squatting,climbing stairs, rolling in bed,lifting up neck.
No h/o of upper and lower limb weakness.
No h/o blurring of vision.
No h/o loss of consiousness.
No h/o altered sensorium.
●PAST HISTORY:-
no similar complaints in the past.
He is a known case of hypertension since 1 year and is on medication of atenelol and amlodipine(once a day ,morning after food 2tablets)
History of perforation of tympanic membrane 15 years ago.
History of tuberculosis 21 years ago and took medication for 6 months.
●PERSONAL HISTORY:-
Diet-mixed
Appetite-normal
Sleep-Adequate
Bowel and bladder movements-regular
Addiction -no current addictions(used to drink Toddy 20 years back but he stopped later)
◆Daily routine:- patient is farmer by occupation
He wakes up at 5 am and does his routine work and have his break fast(rice )at 8 am goes to work.
Has lunch at 1 -2 pm ( rice and curry) .
He reaches home at around 8 pm has dinner ( rice) and goes to sleep.
●FAMILY HISTORY:-
Father is a known case of Diabetes , Hypertension and Tuberculosis and he passed away due to COVID.
Both the sons of the patient were also affected with tuberculosis at the same time
Both his sisters are known case of diabetes and Hypertension
Brother , sister in law,and both their children were affected with tuberculosis.
Brother had history of stroke 3 years back.
●GENERAL EXAMINATION:-
patient was consious ,coherent ,cooperative and well oriented to time place and person.
No pallor,no icterus, no cyanosis, no clubbing, no lymphadenopathy,no edema
VITALS:-
pulse rate-60 bpm regular and normal in volume and character
Respiratory rate- 18 cpm, abdominothoracic type
Blood pressure-130/80mm of Hg in left brachial artery
Temperature- afebrile
●SYSTEMIC EXAMINATION:
◆CENTRAL NERVOUS SYSTEM EXAMINATION-
Handedness-Right
Higher mental function -
Consiousness
Oriented to time place and person
Speech-comprehension present,repetation present, no fluency*
Memory- immediate,recent and remote present
No delusions or hallucinations
CRANIAL NERVE EXAMINATION:-
I- Olfactory nerve- sense of smell present
II- Optic nerve-direct and indirect light reflex present
III- Oculomotor nerve, IV- Trochlear and VI- Abducens- direct and consenual light reflex, accomodation reflex present, no diplopia, no nystagmus, no ptosis.
V- Trigeminal nerve- sensory: sensation present over face.
motor-Masseter, temporalis and pterygoid muscles are normal.
Reflex- Corneal reflex, conjunctival reflex and jaw jerk is present.
VII- Facial nerve- face is symmetrical
Motor-forehead wrinkling present , nasolabial folds prominent on both sides.
Sensory- taste sensation on ant 2/3 of tongue present.
Reflex-corneal and conjunctival reflex present
VIII- Vestibulocochlear nerve- decreased hearing of the left ear ( rinner’s negative for 256 Hz and 512 Hz) and normal hearing of the right ear.
No nystagmus
IX- Glossopharyngeal nerve- palatal movements present and equal.
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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