General medicine

             FORMATIVE ASSESSMENT

NAME: SRINAINI
ROLL NO: 33
3RD SEMESTER

We have been given 5 questions as an assignment  to analyze,asess , understand and write the preview of the given cases.

Question 1

    𝐶𝑎𝑠𝑒 𝑙𝑖𝑛𝑘- https://tejaswienduri.blogspot.com/

𝑰 𝒘𝒆𝒏𝒕 𝒕𝒉𝒓𝒐𝒖𝒈𝒉  𝑬𝒏𝒅𝒖𝒓𝒊 𝑻𝒆𝒋𝒂𝒔𝒘𝒊'𝒔 𝒂𝒔𝒔𝒊𝒈𝒏𝒎𝒆𝒏𝒕,𝒂𝒏𝒅 𝒃𝒓𝒊𝒆𝒇𝒍𝒚 𝒓𝒆𝒗𝒊𝒆𝒘𝒆𝒅 𝒂𝒍𝒍 𝒉𝒆𝒓 𝒂𝒏𝒔𝒘𝒆𝒓𝒔. 

•  𝑸1. 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒄𝒉𝒐𝒔𝒆𝒏 10 𝒄𝒂𝒔𝒆𝒔 𝒐𝒇 𝒅𝒊𝒇𝒇𝒆𝒓𝒆𝒏𝒕 𝒃𝒓𝒂𝒏𝒄𝒉𝒆𝒔 𝒂𝒏𝒅 𝒆𝒗𝒆𝒏 𝒊 𝒉𝒂𝒗𝒆 𝒈𝒐𝒏𝒆 𝒕𝒉𝒓𝒐𝒖𝒈𝒉 𝒂𝒍𝒍 𝒕𝒉𝒆 𝒄𝒂𝒔𝒆𝒔 𝒕𝒉𝒂𝒕 𝒔𝒉𝒆 𝒉𝒂𝒔 𝒑𝒊𝒄𝒌𝒆𝒅 𝒂𝒏𝒅 𝒊 𝒇𝒆𝒍𝒕 𝒉𝒆𝒓 𝒊𝒏𝒔𝒊𝒈𝒉𝒕𝒔   𝒇𝒐𝒓 𝒆𝒂𝒄𝒉 𝒄𝒂𝒔𝒆 𝒘𝒂𝒔 𝒗𝒆𝒓𝒚 𝒑𝒓𝒆𝒄𝒊𝒔𝒆𝒍𝒚  𝒂𝒏𝒅 𝒂𝒄𝒄𝒖𝒓𝒂𝒕𝒆𝒍𝒚  𝒘𝒓𝒊𝒕𝒕𝒆𝒏 𝒂𝒏𝒅 𝒘𝒂𝒔 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒆𝒅 𝒊𝒏 𝒂 𝒗𝒆𝒓𝒚 𝒓𝒆𝒍𝒆𝒗𝒂𝒏𝒕 𝒎𝒂𝒏𝒏𝒆𝒓.

• 𝑸2. 𝑺𝒉𝒆  𝒉𝒂𝒔 𝒎𝒂𝒅𝒆 𝒂 𝒆-𝒍𝒐𝒈 𝒐𝒇 40𝒚𝒓 𝒐𝒍𝒅 𝒇𝒆𝒎𝒂𝒍𝒆 ,𝒘𝒉𝒐 𝒉𝒂𝒔 𝒃𝒆𝒆𝒏 𝒅𝒊𝒂𝒈𝒏𝒐𝒔𝒆𝒅 𝒘𝒊𝒕𝒉 𝒕𝒓𝒂𝒏𝒔𝒗𝒆𝒓𝒔𝒆 𝒎𝒚𝒆𝒍𝒊𝒕𝒊𝒔.

• 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒘𝒓𝒊𝒕𝒕𝒆𝒏 𝒕𝒉𝒆 𝒄𝒂𝒔𝒆 𝒊𝒏 𝒂 𝒄𝒉𝒓𝒐𝒏𝒐𝒍𝒐𝒈𝒊𝒄𝒂𝒍 𝒎𝒂𝒏𝒏𝒆𝒓 𝒃𝒚 𝒇𝒐𝒍𝒍𝒐𝒘𝒊𝒏𝒈 𝒂𝒍𝒍 𝒕𝒉𝒆 𝒏𝒐𝒓𝒎𝒔 𝒐𝒇 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒊𝒏𝒈 𝒂 𝒄𝒂𝒔𝒆 𝒔𝒉𝒆𝒆𝒕.(𝒅𝒆𝒊𝒏𝒅𝒆𝒏𝒕𝒊𝒇𝒚𝒊𝒏𝒈 𝒕𝒉𝒆 𝒑𝒂𝒕𝒊𝒆𝒏𝒕 ,𝒕𝒂𝒌𝒊𝒏𝒈 𝒈𝒖𝒂𝒓𝒅𝒊𝒂𝒏𝒔 𝒄𝒐𝒏𝒔𝒆𝒏𝒕 )

• 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒂𝒍𝒔𝒐 𝒎𝒆𝒏𝒕𝒊𝒐𝒏𝒆𝒅 𝒕𝒉𝒆 𝒕𝒊𝒎𝒆 𝒕𝒐 𝒕𝒊𝒎𝒆 𝒅𝒆𝒕𝒂𝒊𝒍𝒔 𝒐𝒇 𝒕𝒉𝒆 𝒑𝒂𝒕𝒊𝒆𝒏𝒕 𝒂𝒏𝒅 𝒂𝒍𝒔𝒐 𝒕𝒉𝒆 𝒑𝒂𝒔𝒕,𝒇𝒂𝒎𝒊𝒍𝒚 𝒂𝒏𝒅 𝒑𝒆𝒓𝒔𝒐𝒏𝒂𝒍 𝒉𝒊𝒔𝒕𝒐𝒓𝒚 𝒊𝒏 𝒅𝒆𝒕𝒂𝒊𝒍.

• 𝑨𝒍𝒍 𝒕𝒉𝒆 𝒅𝒂𝒚 𝒕𝒐 𝒅𝒂𝒚 𝒊𝒏𝒗𝒆𝒔𝒕𝒊𝒈𝒂𝒕𝒊𝒐𝒏 𝒓𝒆𝒑𝒐𝒓𝒕𝒔 𝒘𝒆𝒓𝒆 𝒖𝒑𝒅𝒂𝒕𝒆𝒅 𝒂𝒏𝒅 𝒂𝒍𝒔𝒐 𝒕𝒉𝒆 𝒕𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕 𝒘𝒂𝒔 𝒖𝒑𝒅𝒂𝒕𝒆𝒅 𝒐𝒏 𝒂 𝒓𝒆𝒈𝒖𝒍𝒂𝒓 𝒃𝒂𝒔𝒊𝒔 . 

𝑸3 & 𝑸4-
•    𝑺𝒉𝒆 𝒉𝒂𝒔 𝒕𝒂𝒌𝒆𝒏 𝒂𝒏 𝒉𝒆𝒑𝒂𝒕𝒐𝒍𝒐𝒈𝒚 𝒄𝒂𝒔𝒆 𝒐𝒇  46𝒚𝒓 𝒐𝒍𝒅 𝒎𝒂𝒍𝒆 𝒘𝒉𝒐 𝒘𝒂𝒔 𝒂 𝒌𝒏𝒐𝒘𝒏 𝒄𝒂𝒔𝒆 𝒐𝒇 𝒍𝒊𝒗𝒆𝒓 𝒄𝒊𝒓𝒓𝒉𝒐𝒔𝒊𝒔 𝒂𝒏𝒅 𝒎𝒂𝒅𝒆 𝒂 𝒃𝒓𝒊𝒆𝒇 𝒂𝒑𝒑𝒓𝒂𝒊𝒔𝒂𝒍.
• 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒆𝒙𝒑𝒍𝒂𝒊𝒏𝒆𝒅 𝒂𝒃𝒐𝒖𝒕 𝒉𝒊𝒔 𝒑𝒓𝒆𝒔𝒆𝒏𝒕 𝒂𝒏𝒅  𝒑𝒂𝒔𝒕 𝒂𝒏𝒅 𝒅𝒓𝒖𝒈 𝒉𝒊𝒔𝒕𝒐𝒓𝒚 𝒊𝒏 𝒂 𝒗𝒆𝒓𝒚 𝒅𝒆𝒕𝒂𝒊𝒍𝒆𝒅 𝒂𝒏𝒅 𝒑𝒓𝒆𝒄𝒊𝒔𝒆𝒅 𝒎𝒂𝒏𝒏𝒆𝒓.
• 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒂𝒍𝒔𝒐 𝒂𝒕𝒕𝒂𝒄𝒉𝒆𝒅 𝒕𝒉𝒆 𝒊𝒏𝒗𝒆𝒔𝒕𝒊𝒈𝒂𝒕𝒊𝒐𝒏 𝒓𝒆𝒑𝒐𝒓𝒕𝒔 𝒂𝒏𝒅 𝒕𝒉𝒆 𝒕𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕 𝒑𝒓𝒐𝒕𝒐𝒄𝒐𝒍 𝒇𝒐𝒍𝒍𝒐𝒘𝒆𝒅 .

𝑸5.
      𝑺𝒉𝒆 𝒉𝒂𝒔 𝒔𝒉𝒂𝒓𝒆𝒅 𝒉𝒆𝒓 𝒑𝒐𝒔𝒊𝒕𝒊𝒗𝒆 𝒗𝒊𝒆𝒘𝒔  𝒐𝒏    𝒄𝒍𝒊𝒏𝒄𝒂𝒍 𝒐𝒏𝒍𝒊𝒏𝒆  𝒄𝒍𝒂𝒔𝒔𝒆𝒔 ,𝒉𝒆𝒓 𝒆𝒏𝒕𝒉𝒖𝒔𝒊𝒂𝒎 ,𝒉𝒆𝒓 𝒆𝒙𝒑𝒆𝒓𝒊𝒆𝒏𝒄𝒆 𝒐𝒇 𝒕𝒂𝒌𝒊𝒏𝒈 𝒉𝒊𝒔𝒕𝒐𝒓𝒚 𝒇𝒓𝒐𝒎 𝒕𝒉𝒆 𝒑𝒂𝒕𝒊𝒆𝒏𝒕 𝒇𝒐𝒓 𝒕𝒉𝒆 𝒇𝒊𝒓𝒔𝒕 𝒕𝒊𝒎𝒆  𝒂𝒏𝒅 𝒉𝒆𝒓 𝒈𝒓𝒐𝒘𝒊𝒏𝒈 𝒄𝒖𝒓𝒊𝒐𝒔𝒊𝒕𝒚 𝒕𝒐 𝒌𝒏𝒐𝒘 𝒎𝒐𝒓𝒆 𝒂𝒃𝒐𝒖𝒕  𝒕𝒉𝒆 𝒔𝒖𝒃𝒋𝒆𝒄𝒕 𝒊𝒏 𝒂 𝒃𝒆𝒂𝒖𝒕𝒊𝒇𝒖𝒍 𝒎𝒂𝒏𝒏𝒆𝒓 .𝑺𝒉𝒆 𝒉𝒂𝒔 𝒂𝒍𝒔𝒐 𝒄𝒐𝒏𝒗𝒆𝒚𝒆𝒅 𝒉𝒆𝒓 𝒈𝒓𝒂𝒕𝒊𝒕𝒖𝒅𝒆 𝒕𝒐 𝒕𝒉𝒆 𝒈𝒆𝒏𝒆𝒓𝒂𝒍 𝒎𝒆𝒅𝒊𝒄𝒊𝒏𝒆 𝒅𝒆𝒑𝒂𝒓𝒕𝒎𝒆𝒏𝒕 𝒆𝒔𝒑𝒆𝒄𝒊𝒂𝒍𝒍𝒚 𝑫𝒓.𝑹𝒂𝒌𝒆𝒔𝒉 𝒃𝒊𝒔𝒘𝒂𝒔 𝑺𝒊𝒓 𝒇𝒐𝒓 𝒑𝒓𝒐𝒗𝒊𝒅𝒊𝒏𝒈  𝒐𝒑𝒑𝒐𝒓𝒕𝒖𝒏𝒊𝒕𝒊𝒆𝒔 𝒆𝒗𝒆𝒏 𝒅𝒖𝒓𝒊𝒏𝒈 𝒕𝒉𝒆 𝒐𝒏𝒍𝒊𝒏𝒆 𝒄𝒍𝒂𝒔𝒔𝒆𝒔.

𝑄𝑢𝑒𝑠𝑡𝑖𝑜𝑛 2-

𝐶𝑎𝑠𝑒 𝑙𝑖𝑛𝑘 -https://srinaini25.blogspot.com/

𝑄𝑢𝑒𝑠𝑡𝑖𝑜𝑛 3-

𝐶𝑎𝑠𝑒 1 𝑙𝑖𝑛𝑘- https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

𝐂𝐚𝐬𝐞 𝐢𝐧 𝐛𝐫𝐢𝐞𝐟

𝐼𝑡 𝑖𝑠 𝑎 𝑐𝑎𝑠𝑒 𝑜𝑓 58𝑦𝑟 𝑜𝑙𝑑 𝑚𝑎𝑙𝑒 𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑤ℎ𝑜 𝑐𝑎𝑚𝑒 𝑡𝑜 𝑡ℎ𝑒 𝑐𝑎𝑠𝑢𝑎𝑙𝑖𝑡𝑦 𝑤𝑖𝑡ℎ 𝑙𝑜𝑤𝑒𝑟 𝑎𝑏𝑑𝑜𝑚𝑖𝑛𝑎𝑙 𝑝𝑎𝑖𝑛 ,𝑏𝑢𝑟𝑛𝑖𝑛𝑔 𝑚𝑖𝑐𝑡𝑢𝑟𝑖𝑡𝑖𝑜𝑛 ,𝑙𝑜𝑤𝑒𝑟 𝑏𝑎𝑐𝑘𝑎𝑐ℎ𝑒 𝑓𝑒𝑣𝑒𝑟 𝑎𝑛𝑑 𝑑𝑟𝑖𝑏𝑏𝑙𝑖𝑛𝑔 𝑢𝑟𝑖𝑛𝑒 𝑎𝑛𝑑 𝑤𝑎𝑠 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑒𝑑 𝑤𝑖𝑡ℎ 𝐴𝐾𝐼 2° 𝑡𝑜 𝑈𝑇𝐼.

I𝑁𝑆𝐼𝐺𝐻𝑇𝑆-

𝑇ℎ𝑒 𝑐𝑎𝑠𝑒 𝑠𝑐𝑒𝑛𝑎𝑟𝑖𝑜 𝑎𝑛𝑑 𝑐𝑜𝑚𝑝𝑙𝑎𝑖𝑛𝑡𝑠  𝑤𝑎𝑠 𝑒𝑥𝑝𝑙𝑎𝑖𝑛𝑒𝑑 𝑖𝑛 𝑑𝑒𝑡𝑎𝑖𝑙 𝑤𝑖𝑡ℎ 𝑡ℎ𝑒 𝑑𝑢𝑟𝑎𝑡𝑖𝑜𝑛 ,𝑒𝑣𝑒𝑛 𝑡ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑖𝑒𝑠( 𝑝𝑒𝑟𝑠𝑜𝑛𝑎𝑙,𝑝𝑟𝑒𝑠𝑒𝑛𝑡,𝑝𝑎𝑠𝑡,𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 ℎ𝑖𝑠𝑡𝑜𝑟𝑦) 𝑤𝑒𝑟𝑒 𝑡𝑎𝑘𝑒𝑛 𝑖𝑛 𝑐ℎ𝑟𝑜𝑛𝑜𝑙𝑜𝑔𝑖𝑐𝑎𝑙 𝑜𝑟𝑑𝑒𝑟 𝑤𝑖𝑡ℎ 𝑒𝑎𝑐ℎ 𝑎𝑛𝑑 𝑎𝑙𝑙 𝑡ℎ𝑒 𝑑𝑒𝑡𝑎𝑖𝑙𝑠 𝑎𝑏𝑜𝑢𝑡 𝑡ℎ𝑒 𝑒𝑥𝑎𝑚𝑖𝑛𝑎𝑡𝑖𝑜𝑛𝑠 𝑤𝑒𝑟𝑒 𝑤𝑟𝑖𝑡𝑡𝑒𝑛 .
𝐴𝑛𝑑 𝑡ℎ𝑒 𝑖𝑛𝑣𝑒𝑠𝑡𝑖𝑔𝑎𝑡𝑖𝑜𝑛 𝑟𝑒𝑝𝑜𝑟𝑡𝑠 𝑎𝑛𝑑 𝑎𝑛𝑑 𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 𝑤𝑒𝑟𝑒 𝑢𝑝𝑑𝑎𝑡𝑒𝑑 𝑟𝑒𝑔𝑢𝑙𝑎𝑟𝑙𝑦.

𝐶𝑎𝑠𝑒 2 𝑙𝑖𝑛𝑘-https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

𝐂𝐚𝐬𝐞 𝐢𝐧 𝐛𝐫𝐢𝐞𝐟-

𝐴 49𝑦𝑟 𝑜𝑙𝑑 𝑓𝑒𝑚𝑎𝑙𝑒 𝑐𝑎𝑚𝑒 𝑡𝑜 𝑐𝑎𝑠𝑢𝑎𝑙𝑖𝑡𝑦 𝑤𝑖𝑡ℎ 𝑐ℎ𝑒𝑖𝑓 𝑐𝑜𝑚𝑝𝑙𝑎𝑖𝑛𝑡𝑠 𝑜𝑓 𝑎𝑛𝑎𝑠𝑎𝑟𝑐𝑎 ,𝑣𝑜𝑚𝑖𝑡𝑖𝑛𝑔𝑠 𝑠𝑖𝑛𝑐𝑒 3𝑑𝑎𝑦𝑠 ,𝑦𝑒𝑙𝑙𝑜𝑤𝑖𝑠ℎ 𝑑𝑖𝑠𝑐𝑜𝑙𝑜𝑢𝑟𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑡𝑜𝑜𝑙𝑠.
𝑆ℎ𝑒 ℎ𝑎𝑠 𝑝𝑎𝑠𝑡 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 ℎ𝑎𝑒𝑚𝑜𝑟𝑟ℎ𝑜𝑖𝑑𝑠 𝑤ℎ𝑖𝑐ℎ 𝑖𝑠 𝑜𝑝𝑒𝑟𝑎𝑡𝑒𝑑 ,𝑁𝑜𝑤 𝑠ℎ𝑒 ℎ𝑎𝑠 𝑏𝑒𝑒𝑛 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑒𝑑 𝑤𝑖𝑡ℎ 𝐶𝐾𝐷 2° 𝑡𝑜 𝑝𝑙𝑎𝑠𝑚𝑎 𝑐𝑒𝑙𝑙 𝑑𝑦𝑠𝑐𝑎𝑟𝑖𝑎𝑠𝑖𝑠.

𝐼𝑛𝑠𝑖𝑔ℎ𝑡𝑠-

𝑇ℎ𝑒 𝑠𝑐𝑒𝑛𝑎𝑟𝑖𝑜 𝑜𝑓 𝑡ℎ𝑒 𝑐𝑎𝑠𝑒 𝑤𝑎𝑠 𝑐𝑙𝑒𝑎𝑟𝑙𝑦 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑒𝑑 𝑎𝑛𝑑 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 𝑝𝑎𝑠𝑡 𝑖𝑙𝑙𝑛𝑒𝑠𝑠 ,𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 ,𝑜𝑏𝑠𝑡𝑒𝑡𝑟𝑖𝑐 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑤𝑒𝑟𝑒 𝑐𝑙𝑒𝑎𝑟𝑙𝑦 𝑤𝑟𝑖𝑡𝑡𝑒𝑛 ,𝑖𝑡 𝑤𝑜𝑢𝑙𝑑 ℎ𝑎𝑣𝑒 𝑏𝑒𝑒𝑛 𝑏𝑒𝑡𝑡𝑒𝑟 𝑖𝑓 𝑡ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 𝑝𝑟𝑒𝑠𝑒𝑛𝑡 𝑖𝑙𝑙𝑛𝑒𝑠𝑠 𝑤𝑎𝑠 𝑎𝑙𝑠𝑜 𝑐𝑙𝑒𝑎𝑟𝑙𝑦 𝑚𝑒𝑛𝑡𝑖𝑜𝑛𝑒𝑑 𝑓𝑜𝑟 𝑏𝑒𝑡𝑡𝑒𝑟 𝑢𝑛𝑑𝑒𝑟𝑠𝑡𝑎𝑛𝑑𝑖𝑛𝑔 𝑜𝑓 𝑡ℎ𝑒 𝑐𝑎𝑠𝑒 .𝑇ℎ𝑒 𝑖𝑛𝑣𝑒𝑠𝑡𝑖𝑔𝑎𝑡𝑖𝑜𝑛𝑠 𝑤𝑒𝑟𝑒 𝑢𝑝𝑑𝑎𝑡𝑒𝑑 𝑟𝑒𝑔𝑢𝑙𝑎𝑟𝑙𝑦 𝑤𝑖𝑡ℎ 𝑡ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑙𝑜𝑔𝑖𝑐𝑎𝑙 𝑠𝑙𝑖𝑑𝑒𝑠.

𝐶𝑎𝑠𝑒 3 𝑙𝑖𝑛𝑘- https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

𝐶𝑎𝑠𝑒 𝑖𝑛 𝑏𝑟𝑖𝑒𝑓-

𝐼𝑡 𝑖𝑠 𝑎 𝑐𝑎𝑠𝑒 𝑜𝑓 𝑎 35𝑦𝑟 𝑜𝑙𝑑 𝑓𝑒𝑚𝑎𝑙𝑒 𝑝𝑎𝑡𝑖𝑒𝑛𝑡  𝑤ℎ𝑜 𝑤𝑎𝑠 𝑎𝑑𝑚𝑖𝑡𝑡𝑒𝑑 𝑖𝑛 𝑎𝑛 𝑢𝑛𝑐𝑜𝑛𝑐𝑖𝑜𝑢𝑠 𝑠𝑡𝑎𝑡𝑒  𝑤𝑖𝑡ℎ 𝑐ℎ𝑒𝑖𝑓 𝑐𝑜𝑚𝑝𝑙𝑎𝑖𝑛𝑡𝑠 𝑜𝑓 𝑓𝑒𝑣𝑒𝑟,𝑑𝑖𝑎𝑟𝑟ℎ𝑒𝑎  𝑎𝑛𝑑 𝑏𝑎𝑐𝑘 𝑝𝑎𝑖𝑛 𝑠𝑖𝑛𝑐𝑒 5𝑑𝑎𝑦𝑠 𝑤𝑖𝑡ℎ 𝑎𝑏𝑑𝑜𝑚𝑖𝑛𝑎𝑙 𝑎𝑛𝑑 𝑐ℎ𝑒𝑠𝑡 𝑝𝑎𝑖𝑛 𝑎𝑛𝑑 𝑤𝑎𝑠 𝑎 𝑘𝑛𝑜𝑤𝑛 𝑑𝑖𝑎𝑏𝑒𝑡𝑖𝑐 𝑠𝑖𝑛𝑐𝑒 3𝑦𝑟𝑠 𝑎𝑛𝑑 𝑤𝑎𝑠 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑒𝑑 𝑤𝑖𝑡ℎ 𝐷𝐾𝐴 𝑤𝑖𝑡ℎ 𝐴𝐾𝐼 𝑎𝑛𝑑 𝑠𝑒𝑝𝑡𝑖𝑐 𝑠ℎ𝑜𝑐𝑘.

𝐼𝑁𝑆𝐼𝐺𝐻𝑇𝑆-
𝑇ℎ𝑒 𝑐𝑎𝑠𝑒 𝑤𝑎𝑠 𝑤𝑟𝑖𝑡𝑡𝑒𝑛 𝑖𝑛 𝑎 𝑐ℎ𝑟𝑜𝑛𝑜𝑙𝑜𝑔𝑖𝑐𝑎𝑙 𝑜𝑟𝑑𝑒𝑟 𝑎𝑛𝑑 𝑤𝑎𝑠 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑒𝑑 𝑖𝑛 𝑒𝑙𝑎𝑏𝑜𝑟𝑎𝑡𝑖𝑣𝑒 𝑚𝑎𝑛𝑛𝑒𝑟 𝑎𝑛𝑑 𝑎𝑙𝑙 𝑡ℎ𝑒 𝑑𝑎𝑦 𝑡𝑜 𝑑𝑎𝑦 𝑖𝑛𝑣𝑒𝑠𝑡𝑖𝑔𝑎𝑡𝑖𝑜𝑛𝑠,𝑟𝑒𝑝𝑒𝑎𝑡𝑠,𝑎𝑛𝑑 𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 𝑤𝑎𝑠 𝑢𝑝𝑑𝑎𝑡𝑒𝑑 .𝐵𝑢𝑡 𝑡ℎ𝑒 𝑙𝑜𝑔 𝑤𝑜𝑢𝑙𝑑 ℎ𝑎𝑣𝑒 𝑏𝑒𝑒𝑛 𝑒𝑣𝑒𝑛 𝑚𝑜𝑟𝑒 𝑖𝑚𝑝𝑟𝑒𝑠𝑠𝑖𝑣𝑒 𝑖𝑓 𝑡ℎ𝑒 𝑒𝑙𝑎𝑏𝑜𝑟𝑎𝑡𝑖𝑣𝑒 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑖𝑠 𝑤𝑎𝑠 𝑔𝑖𝑣𝑒𝑛 .

𝐂𝐚𝐬𝐞 4 𝐥𝐢𝐧𝐤-https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

 CASE BRIEF
𝑨 52𝒚𝒓 𝒐𝒍𝒅 𝒎𝒂𝒍𝒆 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒆𝒅 𝒕𝒐 𝒕𝒉𝒆 𝒐𝒑𝒅 𝒘𝒊𝒕𝒉 𝒄𝒉𝒆𝒊𝒇 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕𝒔 𝒐𝒇 𝒂𝒃𝒅𝒐𝒎𝒊𝒏𝒂𝒍 𝒅𝒊𝒔𝒕𝒆𝒏𝒔𝒊𝒐𝒏 𝒇𝒓𝒐𝒎 𝒑𝒂𝒔𝒕 7𝒅𝒂𝒚𝒔 .

𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔-
𝑻𝒉𝒆 𝒆𝒍𝒐𝒈 𝒘𝒂𝒔 𝒗𝒆𝒓𝒚 𝒆𝒍𝒂𝒃𝒐𝒓𝒂𝒕𝒊𝒗𝒆𝒍𝒚  𝒂𝒏𝒅 𝒂𝒄𝒄𝒖𝒓𝒂𝒕𝒆𝒍𝒚 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒆𝒅 .𝑬𝒗𝒆𝒏 𝒕𝒉𝒆 𝒆𝒙𝒂𝒎𝒊𝒏𝒂𝒕𝒊𝒐𝒏 𝒑𝒊𝒄𝒕𝒖𝒓𝒆𝒔 𝒘𝒆𝒓𝒆 𝒂𝒍𝒔𝒐 𝒂𝒕𝒕𝒂𝒄𝒉𝒆𝒅 𝒂𝒏𝒅 𝒂𝒍𝒍 𝒕𝒉𝒆 𝒅𝒂𝒚 𝒕𝒐 𝒅𝒂𝒚  𝒊𝒏𝒗𝒆𝒔𝒕𝒊𝒈𝒂𝒕𝒊𝒐𝒏 𝒓𝒆𝒑𝒐𝒓𝒕𝒔 𝒘𝒆𝒓𝒆 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒆𝒅 𝒘𝒊𝒕𝒉 𝒕𝒉𝒆 𝒅𝒊𝒔𝒄𝒉𝒂𝒓𝒈𝒆 𝒔𝒖𝒎𝒎𝒂𝒓𝒚 .

𝐂𝐚𝐬𝐞 5𝐥𝐢𝐧𝐤- https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

𝐂𝐚𝐬𝐞 𝐢𝐧 𝐛𝐫𝐢𝐞𝐟-

 𝐀 52𝐲𝐫 𝐨𝐥𝐝 𝐦𝐚𝐥𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐰𝐡𝐨 𝐢𝐬 𝐟𝐚𝐫𝐦𝐞𝐫 𝐛𝐲 𝐨𝐜𝐜𝐮𝐩𝐚𝐭𝐢𝐨𝐧 𝐰𝐚𝐬 𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐞𝐝 𝐰𝐢𝐭𝐡 𝐜𝐡𝐞𝐢𝐟 𝐜𝐨𝐦𝐩𝐥𝐚𝐢𝐧𝐭𝐬 𝐨𝐟 𝐟𝐞𝐯𝐞𝐫 𝐬𝐢𝐧𝐜𝐞 4𝐝𝐚𝐲𝐬 𝐚𝐧𝐝 𝐩𝐮𝐬 𝐜𝐞𝐥𝐥𝐬 𝐢𝐧 𝐮𝐫𝐢𝐧𝐞.𝐇𝐞 𝐰𝐚𝐬 𝐝𝐢𝐚𝐠𝐧𝐨𝐬𝐞𝐝 𝐰𝐢𝐭𝐡 𝐀𝐊𝐈 2° 𝐭𝐨 𝐔𝐫𝐨𝐬𝐞𝐩𝐬𝐢𝐬.

𝐈𝐍𝐒𝐈𝐆𝐇𝐓𝐒-
𝐓𝐡𝐞 𝐡𝐢𝐬𝐭𝐨𝐫𝐲 𝐨𝐟 𝐩𝐫𝐞𝐬𝐞𝐧𝐭 𝐚𝐧𝐝 𝐩𝐚𝐬𝐭 𝐢𝐥𝐥𝐧𝐞𝐬𝐬 𝐰𝐚𝐬 𝐜𝐥𝐞𝐚𝐫𝐲 𝐦𝐞𝐧𝐭𝐢𝐨𝐧𝐞𝐝  𝐛𝐲 𝐞𝐥𝐚𝐛𝐨𝐫𝐚𝐭𝐢𝐧𝐠 𝐞𝐚𝐜𝐡 𝐩𝐨𝐢𝐧𝐭.
𝐀𝐧𝐝 𝐛𝐲 𝐡𝐢𝐠𝐡𝐥𝐢𝐭𝐢𝐧𝐠  𝐭𝐡𝐞  𝐢𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐩𝐨𝐢𝐧𝐭𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐛𝐥𝐨𝐠 𝐡𝐚𝐬 𝐛𝐞𝐜𝐨𝐦𝐞 𝐞𝐯𝐞𝐧 𝐦𝐨𝐫𝐞 𝐢𝐦𝐩𝐫𝐞𝐬𝐬𝐢𝐯𝐞.
𝐈𝐭 𝐰𝐨𝐮𝐥𝐝 𝐡𝐚𝐯𝐞 𝐛𝐞𝐞𝐧 𝐞𝐯𝐞𝐧 𝐦𝐨𝐫𝐞 𝐛𝐞𝐭𝐭𝐞𝐫 𝐢𝐟 𝐭𝐡𝐞 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐡𝐚𝐬 𝐛𝐞𝐞𝐧 𝐮𝐩𝐝𝐚𝐭𝐞𝐝 𝐫𝐞𝐠𝐮𝐥𝐚𝐫𝐥𝐲 𝐚𝐧𝐝 𝐚𝐭𝐭𝐚𝐜𝐡𝐞𝐝 𝐭𝐡𝐞 𝐝𝐢𝐬𝐜𝐡𝐚𝐫𝐠𝐞 𝐬𝐮𝐦𝐦𝐚𝐫𝐲.

𝐂𝐚𝐬𝐞 6 𝐥𝐢𝐧𝐤https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
𝐶𝑎𝑠𝑒 𝑖𝑛 𝑏𝑟𝑖𝑒𝑓-
𝐴 48𝑦𝑟 𝑜𝑙𝑑 𝑚𝑎𝑙𝑒 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑒𝑑 𝑡𝑜 𝑡ℎ𝑒 𝑜𝑝𝑑 𝑤𝑖𝑡ℎ 𝑐ℎ𝑒𝑖𝑓 𝑐𝑜𝑚𝑝𝑙𝑎𝑖𝑛𝑡𝑠 𝑜𝑓 𝑆𝑂𝐵-𝑔𝑟𝑎𝑑𝑒 2 𝑓𝑟𝑜𝑚 1𝑤𝑒𝑒𝑘 𝑎𝑛𝑑 𝑐𝑜𝑣𝑒𝑟𝑡𝑒𝑑 𝑡𝑜 𝑔𝑟𝑎𝑑𝑒 3 𝑎𝑛𝑑 4 𝑓𝑟𝑜𝑚 𝑝𝑎𝑠𝑡 4𝑑𝑎𝑦𝑠.
𝐈𝐍𝐒𝐈𝐆𝐇𝐓𝐒-
𝑇ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑖𝑛𝑔 𝑖𝑙𝑙𝑛𝑒𝑠𝑠 𝑤𝑎𝑠 𝑎𝑐𝑐𝑢𝑟𝑎𝑡𝑒𝑙𝑦 𝑤𝑟𝑖𝑡𝑡𝑒𝑛 𝑤𝑖𝑡ℎ 𝑜𝑛𝑠𝑒𝑡𝑠 𝑎𝑛𝑑 𝑡ℎ𝑒 𝑟𝑒𝑝𝑜𝑟𝑡𝑠 𝑤𝑒𝑟𝑒 𝑎𝑙𝑠𝑜 𝑢𝑝𝑑𝑎𝑡𝑒𝑑 𝑜𝑛 𝑎 𝑟𝑒𝑔𝑢𝑙𝑎𝑟 𝑏𝑎𝑠𝑖𝑠 .𝐴𝑛𝑑 𝑎𝑙𝑠𝑜 𝑡ℎ𝑒 𝑑𝑎𝑦 𝑡𝑜 𝑑𝑎𝑦  𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 𝑤𝑎𝑠 𝑢𝑝𝑑𝑎𝑡𝑒𝑑.𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝐸𝑣𝑒𝑟𝑦𝑡ℎ𝑖𝑛𝑔 𝑤𝑎𝑠 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑒𝑑 𝑖𝑛 𝑎 𝑐ℎ𝑟𝑜𝑛𝑜𝑙𝑜𝑔𝑖𝑐𝑎𝑙 𝑜𝑟𝑑𝑒𝑟.

𝐶𝑎𝑠𝑒 7 𝑙𝑖𝑛𝑘- https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

𝑪𝒂𝒔𝒆 𝒊𝒏 𝒃𝒓𝒊𝒆𝒇-
𝐴 43𝑦𝑟 𝑜𝑙𝑑 𝑚𝑎𝑙𝑒 𝑐𝑎𝑚𝑒 𝑡𝑜 𝑐𝑎𝑠𝑢𝑎𝑙𝑖𝑡𝑦 𝑤𝑖𝑡ℎ 𝑐ℎ𝑖𝑒𝑓 𝑐𝑜𝑚𝑝𝑙𝑎𝑖𝑛𝑡𝑠 𝑜𝑓 𝑙𝑜𝑜𝑠𝑒 𝑠𝑡𝑜𝑜𝑙𝑠,𝑝𝑒𝑑𝑎𝑙 𝑒𝑑𝑒𝑚𝑎 𝑎𝑛𝑑 𝑎𝑏𝑑𝑜𝑚𝑖𝑛𝑎𝑙 𝑑𝑖𝑠𝑡𝑒𝑛𝑠𝑖𝑜𝑛 𝑠𝑖𝑛𝑐𝑒 20𝑑𝑎𝑦𝑠 𝑎𝑛𝑑 𝑤𝑎𝑠 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑒𝑑 𝑤𝑖𝑡ℎ 𝑎𝑙𝑐𝑜ℎ𝑜𝑙𝑖𝑐 ℎ𝑒𝑝𝑎𝑡𝑖𝑡𝑖𝑠 , 𝐴𝐾𝐼 2° 𝑡𝑜 𝐴𝑐𝑢𝑡𝑒 𝐺𝑎𝑠𝑡𝑟𝑜𝑒𝑛𝑡𝑒𝑟𝑖𝑡𝑖𝑠 .

𝐼𝑁𝑆𝐼𝐺𝐻𝑇𝑆-

𝑇ℎ𝑒 𝑒𝑙𝑜𝑔 𝑤𝑎𝑠 𝑎𝑑𝑒𝑞𝑢𝑎𝑡𝑒 𝑎𝑛𝑑 𝑐𝑜𝑚𝑝𝑎𝑐𝑡. 𝑇ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 𝑖𝑙𝑙𝑛𝑒𝑠𝑠 𝑤𝑎𝑠 𝑑𝑒𝑠𝑐𝑟𝑖𝑏𝑒𝑑 𝑝𝑟𝑒𝑐𝑖𝑠𝑒𝑙𝑦 .𝑇ℎ𝑒 𝑔𝑒𝑛𝑒𝑟𝑎𝑙  𝑒𝑥𝑎𝑚𝑖𝑛𝑎𝑡𝑖𝑜𝑛𝑠 𝑖𝑚𝑎𝑔𝑒𝑠 𝑤𝑒𝑟𝑒 𝑎𝑙𝑠𝑜 𝑎𝑡𝑡𝑎𝑐ℎ𝑒𝑑 𝑤ℎ𝑖𝑐ℎ 𝑚𝑎𝑑𝑒 𝑡ℎ𝑒 𝑏𝑙𝑜𝑔 𝑒𝑣𝑒𝑛 𝑚𝑜𝑟𝑒 𝑑𝑒𝑝𝑖𝑐𝑡𝑖𝑣e.

Question 4

𝘾𝙖𝙨𝙚 1 𝙡𝙞𝙣𝙠- https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

𝘾𝙝𝙚𝙞𝙛 𝘾𝙤𝙢𝙥𝙡𝙖𝙞𝙣𝙩𝙨-

• 𝘽𝙪𝙧𝙣𝙞𝙣𝙜 𝙢𝙞𝙘𝙩𝙪𝙧𝙞𝙩𝙞𝙤𝙣

• 𝙇𝙤𝙬𝙚𝙧 𝙗𝙖𝙘𝙠𝙖𝙘𝙝𝙚 𝙖𝙛𝙩𝙚𝙧 𝙡𝙞𝙛𝙩𝙞𝙣𝙜 𝙬𝙚𝙞𝙜𝙝𝙩𝙨 

• 𝙇𝙤𝙬𝙚𝙧 𝙖𝙗𝙙𝙤𝙢𝙞𝙣𝙖𝙡 𝙥𝙖𝙞𝙣 -1𝙬𝙚𝙚𝙠

• 𝘿𝙧𝙞𝙗𝙗𝙡𝙞𝙣𝙜 𝙤𝙛 𝙪𝙧𝙞𝙣𝙚 𝙨𝙞𝙣𝙘𝙚 1𝙬𝙚𝙚𝙠

• 𝙎𝙊𝘽 𝙖𝙩 𝙧𝙚𝙨𝙩 . 

𝙋𝙧𝙤𝙫𝙞𝙨𝙞𝙤𝙣𝙖𝙡 𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙨 

Acute kidney injury( AKI)  2° to UTI, associated with Denovo - DM -2

-With ? Right HEART FAILURE,

-With K/C/O - HTN ( Not on Rx) 

𝙏𝙧𝙚𝙖𝙩𝙢𝙚𝙣𝙩

IVF : -RL @ UO+ 30ml/hr

      -NS 

2)SALT RESTRICTION < 2.4gm/day 

3)INJ TAZAR 4.5gm IV/TID reduced to      2.25gm IV/ TID on 2nd day 

4) INJ PANTOP 40mg IV / OD 

5)INJ THIAMINE 1AMP IN 100ml NS IV/TID 

6)INJ HAI S/C ACC TO SLIDING SCALE

              8AM - 2PM - 8PM 

7)SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]

8) GRBS - 6th Hourly

# Strict I/O Charting and monitoring of BP,PR, Temperature are done 4th hourly.

𝐂𝐚𝐬𝐞 2 𝐥𝐢𝐧𝐤- http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

𝐂𝐡𝐞𝐢𝐟 𝐂𝐨𝐦𝐩𝐥𝐚𝐢𝐧𝐭𝐬 -

• 𝐋𝐨𝐰𝐞𝐫 𝐛𝐚𝐜𝐤 𝐩𝐚𝐢𝐧 𝐚𝐟𝐭𝐞𝐫 𝐥𝐢𝐟𝐭𝐢𝐧𝐠 𝐰𝐞𝐢𝐠𝐡𝐭𝐬-10𝐝𝐚𝐲𝐬 

• 𝐃𝐫𝐢𝐛𝐛𝐥𝐢𝐧𝐠 𝐨𝐟 𝐮𝐫𝐢𝐧𝐞

• 𝐏𝐞𝐝𝐚𝐥 𝐞𝐝𝐞𝐦𝐚 -3𝐝𝐚𝐲𝐬

• 𝐈𝐧𝐜𝐫𝐞𝐚𝐬𝐞𝐝 𝐢𝐧𝐯𝐨𝐥𝐮𝐧𝐭𝐚𝐫𝐲 𝐦𝐨𝐯𝐞𝐦𝐞𝐧𝐭𝐬 𝐨𝐟 𝐛𝐨𝐭𝐡 𝐮𝐩𝐩𝐞𝐫 𝐥𝐢𝐦𝐛𝐬 𝐬𝐢𝐧𝐜𝐞 3𝐝𝐚𝐲𝐬 

𝐏𝐫𝐨𝐛𝐚𝐛𝐥𝐞 𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬

Acute renal failure (intrinsic)

 Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis

Hyperuricemia 2° to Renal failure 

Uraemia induced tremors( resolved)

Delerium 2° to septic /Uremic encephalopathy (resolving)

𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭

IVF -    NS-0.9%  @100ml/hr

• Inj. Tazar 2.25gm I.V -TID 

J Inj. Lasik 40mg IV -BD 

•Nebulization Salbutamol -4th hourly 

• Inj. Pantop 40mg IV -OD 

• Tab. PCM 650mg -TIME 

• Foleys catheterization 

• Temperature ,Bp, PR Charting  hourly 

• St𝐫ict IO Charting

•GRBS -12th hourly 

• Inj.25% D with 10units of insulin IV -slow for 1hr 

• To prevent acidity mucaine gel syrup has been added from the 3rd day and the upper limb has also been elevated using crepe bandage and from 5th day the NS IV was stopped.

𝐂𝐚𝐬𝐞 3 𝐥𝐢𝐧𝐤 : https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

𝐂𝐡𝐞𝐢𝐟 𝐂𝐨𝐦𝐩𝐥𝐚𝐢𝐧𝐭𝐬 

• Anasarca since 20days

• Vomitings since 3days with food as content, non-projectile

• Fever 

H/o muscles aches treated with NSAIDS,And H/o haemorrhoids which is operated . 

𝐏𝐫𝐨𝐛𝐚𝐛𝐥𝐞 𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬

CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis). 

𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭

• 𝐓𝐚𝐛.PAN 40mg / PO / OD 

• oral fluids upto 1.5 - 2 lit / day

•  Protein - x ( plant based ) 2 tablespoon in 1 glass of milk 

•   Donot give IV fluids unless instructed

• T𝐚𝐛. ZOFER 4mg / PO / SOS

• Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved ) 

• TAB NODOSIS 550 BD

Case 4 link-https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

Chief complaints

Fever and Diarrhea since 5 days.

Back pain( 5 days ago).

 abdominal pain and chest pain.

 Probable Diagnosis 

DKA with AKI ( ? Pre renal) 

-Pyelonephritis. 

Treatment  

Inj. Norad 2amp in 50ml NS

Inj. Piptaz 2.25gm.

Inj. Dopamine 2amp in 50ml

Inj. Hai 1ml in 39ml NS

 Inj. Clexane 40gm. 

Iv infusion NS RL @100ml/hr.

Inj. Noradrenaline (2 amp+46ml NS) 

Inj. levoflox

Inj. Vanomycin

Inj. Meropenem

Inj. Fosfomycin

Inj. LASIX was administered additionally.

Case 5 link : https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

 Chief Complaints

 Abdominal distension ( past 7 days)

tingling in upper limbs and lower limbs ( 2years ago complaint)

Provisional  Diagnosis

Alcoholic Liver Disease,

AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,

Hepatic encephalopathy grade 2

Probable Diagnosis  

Infective endocarditis

AV vegetations with moderate as severe AR

WHO

Uremic encephalopathy? Septic encephalopathy 

Ulcer over sole of right leg 

Hypoalbuminemia? Alcoholic Liver disease

Acute multiple infaracts in bilateral cerebral and cerebellar hemispheres.

 

Treatment : 

1. Inj. Monocef 1gm IV/BD

2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr

3. Procto clysis enema

4. Inj. Pan 40 mg Iv / OD

5. Inj. Thiamine 200mg in 100ml NS /BD

6. Inj. HAI 6U S / C TID

Same treatment followed except Inj. Monocef.

Inj. Augmentin 1.2 gm IV / TID

Tab. Ecospirn 150mg PO/HS/SOS

Tab. Clopidogrel 75mg PO/HS/SOS

Tab. Atorvas 20mg PO/HS/OD added

 he had sudden cardiac arrest. CPR was initiated, intubation was done, but couldn't be revived.

Case 6 link :  https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

Chief complaints 

fever (4 days)

urine contained with pus 

 

Probable Diagnosis

Renal AKI 2* to Urosepsis

diabetic nephropathy(5 yrs ago)

Treatment : 

Inj. Pantop 40mg IV / OD

Inj. Piptaz 4.5 stat and 2.25 gm IV/ TID

Inj. LASIX 40mg IV/BD

Inj.optineuron 1AMP in 100ml NS slow IV/OD

Inj. NEDMOL 100ml IV/SOS

Tab PCM 650mg TIME

Insulin Human actrapid - 16 IU/TID

Case 7 link: https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

 

 chief complaints

 Shortness of Breath grade -II (past 1 week) converted into grade -III-IV from the past 4 days .

Probable Diagnosis 

HFrEF   2°to CAD; CRF

Treatment

1. Tab. Bisoprolol 5mg OD

2.Tab. Nitrohart  20/37.5mg 1/2 T/D

3.Tab. Nicardia XL 30mg OD

4.Tab. Gliciazide 80mg BD

5.Tab. Nodosis 500 mg TD

6.Cap. BIO-D3 OD

7.Cap. GEMSOLINE OD

8.Tab. ECOSPRIN-AV 150 / 20mg OD

9.Tab.Lasix 40mg BD

10. SYP. Lactulose 15ml

Case 8 link: https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

Chief complaints 

 Pedal edema since 3 days.

Decreased urine output since 3 days.

Vomitings (5 days)

loose stools 5 days ago.

Probable Diagnosis

Anasarca 

shortness of breath

Treatment : 

1. IV fluids

2 Tab. Pan 40 mg after the OD 

3. Inj. Lasix 80 mg IV BD

4. Thiamin 200 mg in 100 ml NS IV BD

5.Tab. Levocet 5 mg PO B

6.Liquid paraffin for LIA

7.Grbs 6 th hrly

I / o charting, temp. Charting 

Case 9 link :  https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

 

 Chief complaints

loose stools since 20 days 

Pedal edema since 20 days

Abdominal distension since 20 days 

Diagnosis : 

Alcoholic hepatitis

AKI 2° to Acute gastoenteritis 

HFrEF 2° to CAD 

Alcoholic and tobacco dependence syndrome

Treatment : 

Inj. Thiamine 100 mg in 100 ml NS slow IV / TID

Inj. Optineuron 1AMP in 100 ml NS slow IV / OD

Inj. Lasix 40 mg

TAB. ALDACTONE 50 mg PO / BD

INJ Pantoo 40 mg IV / OD

ABDOMINAL GIRTH MEASUREMENT DAILY

BP /PR/TEMP/ RR  charting (4 hourly) 

I / O CHARTHING

Case 10 link : https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

 

chief complaints 

pedal edema since 10 days

 decreased urine output since 10 days

 fever since 10 days.

 Probable Diagnosis: 

Acute kidney injury 2° to urosepsis with hyperkalemia ( resolved)

 anenmia of chronic disease 

Treatment: 

 Inj lasix  40 mg IV / TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj Magnexforte 1.5 gm/IV/BD

 Tab NODOSIS - 500 mg PO / OD

 Tab OROFEA - XT PO / OD

 Inj HAI s/c

 Neb plain Asthalin 2 respules QID

 Strict I/O charting

 Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]

GRBS charting is introduced and daily monitoring of vitals is done .

Case 11 link : http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

Chief complaints

 Pain in abdomen since a week

Vomiting since a week

Sob since 2 days.

Diagnosis : 

Acute pancreatitis with AKI 

with ?B/L pleural effusion and moderate ascitis . 

Currently in ?Alcohol withdrawal

.

Treatment : 

Iv fluids : NS 40 ml /hr.

IV lasix 40 mg BD .

Tab Nodosis.

IV PIPTAZ 4.5 Gms. BD 

Iv 25%Dextrose. 100 ml BD 

Tab . Nicardia 10 mg TID.

Question 5

𝐓𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 𝐡𝐚𝐬 𝐛𝐞𝐞𝐧 𝐯𝐞𝐫𝐲 𝐢𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐯𝐞 𝐚𝐧𝐝 𝐈 𝐡𝐚𝐯𝐞  𝐥𝐞𝐚𝐫𝐧𝐭 𝐭𝐡𝐢𝐧𝐠𝐬 𝐢𝐧 𝐚 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐞𝐥𝐲 𝐮𝐧𝐢𝐪𝐮𝐞 𝐰𝐚𝐲.𝐀𝐭 𝐟𝐢𝐫𝐬𝐭 𝐰𝐡𝐞𝐧 𝐢 𝐠𝐨𝐭 𝐦𝐲 𝐟𝐢𝐫𝐬𝐭 𝐜𝐚𝐬𝐞 𝐭𝐨 𝐝𝐨 𝐢 𝐰𝐚𝐬 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐞𝐥𝐲 𝐧𝐞𝐫𝐯𝐨𝐮𝐬 𝐚𝐬 𝐢 𝐝𝐢𝐝𝐧𝐭 𝐡𝐚𝐯𝐞 𝐚𝐧𝐲 𝐢𝐝𝐞𝐚 𝐡𝐨𝐰 𝐭𝐨 𝐠𝐨 𝐚𝐛𝐨𝐮𝐭 𝐰𝐡𝐚𝐭 𝐰𝐞𝐫𝐞 𝐭𝐡𝐞 𝐧𝐨𝐫𝐦𝐬 𝐨𝐟 𝐰𝐫𝐢𝐭𝐢𝐧𝐠 𝐚𝐧𝐝 𝐨𝐫𝐝𝐞𝐫 𝐨𝐟 𝐝𝐨𝐢𝐧𝐠 𝐚 𝐜𝐚𝐬𝐞𝐬𝐡𝐞𝐞𝐭 ,𝐛𝐮𝐭 𝐦𝐲 𝐦𝐞𝐧𝐭𝐨𝐫 𝐃𝐫.𝐑𝐢𝐬𝐡𝐢𝐤 𝐬𝐢𝐫 𝐡𝐚𝐯𝐞 𝐠𝐮𝐢𝐝𝐞𝐝 𝐦𝐞 𝐭𝐡𝐫𝐨𝐮𝐠𝐡𝐨𝐮𝐭 𝐛𝐥𝐨𝐠 𝐚𝐧𝐝 𝐞𝐱𝐩𝐥𝐚𝐢𝐧𝐞𝐝 𝐭𝐡𝐞 𝐢𝐧 𝐝𝐞𝐭𝐚𝐢𝐥 𝐚𝐧𝐝 𝐰𝐚𝐬 𝐯𝐞𝐫𝐲 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐚𝐧𝐝 𝐜𝐥𝐞𝐚𝐫𝐞𝐝 𝐚𝐥𝐥 𝐦𝐲 𝐝𝐨𝐮𝐛𝐭𝐬 .𝐁𝐮𝐭 𝐬𝐭𝐢𝐥𝐥 𝐢 𝐡𝐚𝐯𝐞 𝐦𝐚𝐝𝐞 𝐚 𝐛𝐢𝐠 𝐛𝐥𝐮𝐧𝐝𝐞𝐫 𝐨𝐟 𝐧𝐨𝐭 𝐝𝐞𝐢𝐝𝐞𝐧𝐭𝐢𝐟𝐲𝐢𝐧𝐠 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 ,𝐛𝐮𝐭 𝐃𝐫.𝐑𝐚𝐤𝐞𝐬𝐡 𝐛𝐢𝐬𝐰𝐚𝐬 𝐬𝐢𝐫 𝐡𝐚𝐬 𝐡𝐮𝐦𝐛𝐥𝐲 𝐞𝐱𝐩𝐥𝐚𝐢𝐧𝐞𝐝 𝐚𝐧𝐝 𝐥𝐞𝐭 𝐠𝐨 𝐦𝐲 𝐦𝐢𝐬𝐭𝐚𝐤𝐞 ,𝐈 𝐬𝐩𝐞𝐜𝐢𝐚𝐥𝐥𝐲 𝐭𝐡𝐚𝐧𝐤 𝐬𝐢𝐫 𝐟𝐨𝐫 𝐛𝐞𝐢𝐧𝐠 𝐬𝐨 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐚𝐧𝐝 𝐠𝐢𝐯𝐢𝐧𝐠 𝐮𝐬 𝐦𝐨𝐫𝐞 𝐚𝐧𝐝 𝐦𝐨𝐫𝐞 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬 𝐚𝐧𝐝 𝐦𝐚𝐤𝐢𝐧𝐠 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐟𝐮𝐧!𝐓𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 𝐈 𝐡𝐚𝐯𝐞 𝐠𝐨𝐭 𝐥𝐞𝐚𝐫𝐧 𝐭𝐨 𝐭𝐚𝐤𝐞 𝐭𝐡𝐞 𝐜𝐚𝐬𝐞 𝐡𝐢𝐬𝐭𝐨𝐫𝐲 𝐚𝐧𝐝 𝐢 𝐜𝐚𝐧 𝐧𝐞𝐯𝐞𝐫 𝐟𝐨𝐫𝐠𝐞𝐭 𝐭𝐡𝐢𝐬 𝐚𝐬 𝐢𝐭 𝐢𝐬 𝐦𝐲 𝐟𝐢𝐫𝐬𝐭 𝐭𝐢𝐦𝐞 .𝐋𝐨𝐨𝐤𝐢𝐧𝐠 𝐟𝐨𝐫𝐰𝐚𝐫𝐝 𝐭𝐨 𝐝𝐨 𝐠𝐞𝐭 𝐦𝐨𝐫𝐞 𝐚𝐧𝐝 𝐦𝐨𝐫𝐞 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬!𝐈 𝐬𝐩𝐞𝐜𝐢𝐚𝐥𝐥𝐲 𝐭𝐡𝐚𝐧𝐤 𝐬𝐢𝐫 𝐟𝐨𝐫 𝐛𝐞𝐢𝐧𝐠 𝐬𝐨 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐚𝐧𝐝 𝐠𝐢𝐯𝐢𝐧𝐠 𝐮𝐬 𝐦𝐨𝐫𝐞 𝐚𝐧𝐝 𝐦𝐨𝐫𝐞 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬 𝐚𝐧𝐝 𝐦𝐚𝐤𝐢𝐧𝐠 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐟𝐮𝐧!𝐓𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 𝐈 𝐡𝐚𝐯𝐞 𝐠𝐨𝐭 𝐥𝐞𝐚𝐫𝐧 𝐭𝐨 𝐭𝐚𝐤𝐞 𝐭𝐡𝐞 𝐜𝐚𝐬𝐞 𝐡𝐢𝐬𝐭𝐨𝐫𝐲 𝐚𝐧𝐝 𝐢 𝐜𝐚𝐧 𝐧𝐞𝐯𝐞𝐫 𝐟𝐨𝐫𝐠𝐞𝐭 𝐭𝐡𝐢𝐬 𝐚𝐬 𝐢𝐭 𝐢𝐬 𝐦𝐲 𝐟𝐢𝐫𝐬𝐭 𝐭𝐢𝐦𝐞 .𝐋𝐨𝐨𝐤𝐢𝐧𝐠 𝐟𝐨𝐫𝐰𝐚𝐫𝐝 𝐭𝐨 𝐝𝐨 𝐠𝐞𝐭 𝐦𝐨𝐫𝐞 𝐚𝐧𝐝 𝐦𝐨𝐫𝐞 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬!𝐈 𝐬𝐩𝐞𝐜𝐢𝐚𝐥𝐥𝐲 𝐭𝐡𝐚𝐧𝐤 𝐬𝐢𝐫 𝐟𝐨𝐫 𝐛𝐞𝐢𝐧𝐠 𝐬𝐨 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐚𝐧𝐝 𝐠𝐢𝐯𝐢𝐧𝐠 𝐮𝐬 𝐦𝐨𝐫𝐞 𝐚𝐧𝐝 𝐦𝐨𝐫𝐞 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬 𝐚𝐧𝐝 𝐦𝐚𝐤𝐢𝐧𝐠 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐟𝐮𝐧!𝐓𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 𝐈 𝐡𝐚𝐯𝐞 𝐠𝐨𝐭 𝐥𝐞𝐚𝐫𝐧 𝐭𝐨 𝐭𝐚𝐤𝐞 𝐭𝐡𝐞 𝐜𝐚𝐬𝐞 𝐡𝐢𝐬𝐭𝐨𝐫𝐲 𝐚𝐧𝐝 𝐢 𝐜𝐚𝐧 𝐧𝐞𝐯𝐞𝐫 𝐟𝐨𝐫𝐠𝐞𝐭 𝐭𝐡𝐢𝐬 𝐚𝐬 𝐢𝐭 𝐢𝐬 𝐦𝐲 𝐟𝐢𝐫𝐬𝐭 𝐭𝐢𝐦𝐞 .𝐋𝐨𝐨𝐤𝐢𝐧𝐠 𝐟𝐨𝐫𝐰𝐚𝐫𝐝 𝐭𝐨 𝐝𝐨 𝐠𝐞𝐭 𝐦𝐨𝐫𝐞 𝐚𝐧𝐝 𝐦𝐨𝐫𝐞 𝐨𝐩𝐩𝐨𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬!