A 35 year old female,resident of miryalguda,worker in steel shop,came with chief complaints of shortness of breathe since 8days
HOPI:She was apparently asymptomatic 10 days back,and then she developed fever which was insidious in onset,continuous,high grade,no evening rise of temperature,not associated with chills and rigors,for which she went near local RMP and took injections and temperature decreased.
And then she developed breathlessness 8 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,blood tinged and subsided on medication.Cough aggravated on lying in supine position and relieved gradually on sleeping to one side.
History of chest pain since 8days,which is insidious in onset,gradually progressive,stabbing type,radiating from left lower rib upward to back,aggrevated on coughing.
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 2 SOB.
She is not a known case of DM,HTN,TB,Epilepsy,CAD.
She underwent tubectomy 18years back and hysterectomy 2years back for abnormal uterine bleeding.
PERSONAL HISTORY:
Diet:Mixed
Appetite:Normal and food taboos present for Brinjal as she belives that consumption may aggravate SOB.
Sleep: decreased since 8days d/t chest pain.
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 DNS,Nasal polyp
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.
Spinoscapular distance equal in 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.
A 55 year old male farmer by occupation resident of yadgirigutta came with chief complaints of
-deviation of mouth to left side since 7 days(11/3/2023)
-slurring of speech since 7 days
HISTORY OF PRESENTING ILLNESS:-
Patient was apparently asymptomatic 7 days ago then he had developed slurring of speech which was sudden in onset.On the same day his wife noticed deviation of mouth towards left side and was taken to local doctor for which he was given ORS but the symptoms has not subsided.
The next day his wife took him to another hospital for which he was given ORS.
On 13/3/2023 he came to our hospital.
At the time of presentation
Slurring of speech decreased
Slight deviation of mouth present
TIMELINE OF EVENTS:-
He is able to lift his hand, comb his hair, brush his teeth, able to wear his chappals, able to get up from bed
No history of vomiting,dizziness.
No history of blurring of vision
No history of drooling of saliva
No history of loss of consciousness
No drooping of eyelids
No history of difficulty in swallowing
PERSONAL HISTORY:-
Diet-mixed
Appetite-normal
Sleep-reduced
Bowel and bladder movements-regular
Addiction -no current addictions(used to drink sara 20 years back but he stopped later)
Daily routine:
Patient is a farmer by occupation resident of yadgirigutta.
Patient wakes up at 5am in the morning and does his daily work and prays for an hour.
He has rice for breakfast by 8 am.
He goes to the fields along with his wife on scooty by 9am.
He has his lunch by 1pm.
In the evening they return from work at 6pm.
He goes for bath
He has rice for dinner at 8pm and prays for an hour.
He goes to bed at 10pm
PAST HISTORY:
No historyof similar complaints in the past.
Known case of Tuberculosis 15 years back-used medication for 6 months
He is a known case of hypertension since 1 year and takes medicines irregularly(Tab.Amlodipine 5mg)
No history of diabetes,asthma,epilepsy.
FAMILY HISTORY:-
His father is a known case of of diabetes, hypertension and tuberculosis and he passed away due to covid.
Both his sisters are known case of diabetes and Hypertension.
Brother had history of stroke 3years ago
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
Respiratory rate- 18 cpm
Blood pressure-130/80mm of hg
Temperature- afebrile
Systemic examination-
Cns-
Higher mental function :-
Consiousness, coherent
Well 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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