𝐁𝐢𝐦𝐨𝐧𝐭𝐡𝐥𝐲 𝐚𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭- 𝐀𝐮𝐠𝐮𝐬𝐭

𝐆𝐄𝐍𝐄𝐑𝐀𝐋 𝐌𝐄𝐃𝐈𝐂𝐈𝐍𝐄 -𝐁𝐈𝐌𝐎𝐍𝐓𝐇𝐋𝐘 𝐀𝐒𝐒𝐄𝐒𝐒𝐌𝐄𝐍𝐓 -𝐀𝐔𝐆𝐔𝐒𝐓

𝙽𝙰𝙼𝙴:-𝙎𝙍𝙄𝙉𝘼𝙄𝙉𝙄

𝚁𝙾𝙻𝙻 𝙽𝙾:-33

𝙱𝙰𝚃𝙲𝙷:-2019

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


  𝐐1.
𝐋𝐨𝐧𝐠 𝐜𝐚𝐬𝐞𝐬

𝐂𝐚𝐬𝐞 1 𝐥𝐢𝐧𝐤-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1


𝐂𝐚𝐬𝐞 𝐢𝐧 𝐛𝐫𝐢𝐞𝐟- A 44 year old man presented to OPD  with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔- The case was taken in a very elaborative and instructive manner.
Each and every symptom of the patient was clearly mentioned being it the present or medical and personal history. An elaborative  analyzing of the case has  been done on the basis of all the symptoms and treatment was given appropriately.

And the questions which were asked regarding the case were very pertinent and answers were presented with tables and were collected from various articles.


𝑪𝒂𝒔𝒆 2 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

𝑪𝒂𝒔𝒆 𝒊𝒏 𝒃𝒓𝒊𝒆𝒇-A 47 year male patient resident of Nalgonda came with chief complaints of abdominal distension and swelling of bilateral lower limbs since 6 months which is gradually increasing since 10 days and fluid discharge from the umbilical area since 2 days and fever since 2 days.

𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔-
The scenario of the case was clearly presented. And also all the investigation reports were updated regularly. It would have been even better if the treatment is updated regularly.


𝑪𝒂𝒔𝒆 3 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006004-case-presentations.html


𝑪𝒂𝒔𝒆 𝒊𝒏 𝒃𝒓𝒊𝒆𝒇-
26 year old male, construction worker by occupation presented to the casualty with the chief complaints of :-Fever since 3 months ,Cough with expectoration since 2 months ,Dyspnea on exertion since 2 months, Vomiting since 2 months, Decreased appetite and weight loss over last 2 months ,Dark coloured stools since 2 weeks. 



𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔-
𝑇ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑖𝑛𝑔 𝑖𝑙𝑙𝑛𝑒𝑠𝑠 𝑤𝑎𝑠 𝑎𝑐𝑐𝑢𝑟𝑎𝑡𝑒𝑙𝑦 𝑤𝑟𝑖𝑡𝑡𝑒𝑛 𝑤𝑖𝑡ℎ 𝑜𝑛𝑠𝑒𝑡𝑠 𝑎𝑛𝑑 𝑡ℎ𝑒 𝑟𝑒𝑝𝑜𝑟𝑡𝑠 𝑤𝑒𝑟𝑒 𝑎𝑙𝑠𝑜 𝑢𝑝𝑑𝑎𝑡𝑒𝑑 𝑜𝑛 𝑎 𝑟𝑒𝑔𝑢𝑙𝑎𝑟 𝑏𝑎𝑠𝑖𝑠 .𝑇ℎ𝑒 𝑖𝑚𝑎𝑔𝑒𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑔𝑒𝑛𝑒𝑟𝑎𝑙 𝑒𝑥𝑎𝑚𝑖𝑛𝑎𝑡𝑖𝑜𝑛 𝑤𝑎𝑠 𝑎𝑙𝑠𝑜 𝑎𝑡𝑡𝑎𝑐ℎ𝑒𝑑 𝑤ℎ𝑖𝑐ℎ 𝑤𝑖𝑙𝑙 𝑚𝑎𝑘𝑒 𝑡ℎ𝑒 𝑐𝑎𝑠𝑒 𝑚𝑜𝑟𝑒 𝑑𝑒𝑝𝑖𝑐𝑡𝑖𝑣𝑒.𝐴𝑛𝑑 𝑎𝑙𝑙 𝑡ℎ𝑒 𝑖𝑛𝑣𝑒𝑠𝑡𝑖𝑔𝑎𝑡𝑖𝑜𝑛 𝑟𝑒𝑝𝑜𝑟𝑡𝑠 𝑤𝑒𝑟𝑒 𝑝𝑟𝑒𝑠𝑒𝑛𝑡𝑒𝑑 𝑖𝑛 𝑎 𝑐ℎ𝑟𝑜𝑛𝑜𝑙𝑜𝑔𝑖𝑐𝑎𝑙 𝑚𝑎𝑛𝑛𝑒𝑟.

𝐒𝐡𝐨𝐫𝐭 𝐂𝐚𝐬𝐞𝐬

𝑪𝒂𝒔𝒆 1 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

𝑪𝒂𝒔𝒆 𝒊𝒏 𝒃𝒓𝒊𝒆𝒇-
A 45 year old female patient farmer by occupation resident of Nalgonda came to casuality with complaints of vomitings and abdominal pain since 4 days ,she was bitten by snake on her right lateral foot.

𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔-
𝑇ℎ𝑒 𝑐𝑎𝑠𝑒  𝑤𝑎𝑠 𝑤𝑟𝑖𝑡𝑡𝑒𝑛  𝑎𝑑𝑒𝑞𝑢𝑎𝑡𝑒𝑙𝑦  𝑎𝑛𝑑 𝑐𝑜𝑚𝑝𝑎𝑐𝑡𝑙𝑦 . 𝑇ℎ𝑒 ℎ𝑖𝑠𝑡𝑜𝑟𝑦 𝑜𝑓 𝑖𝑙𝑙𝑛𝑒𝑠𝑠 𝑤𝑎𝑠 𝑑𝑒𝑠𝑐𝑟𝑖𝑏𝑒𝑑 𝑝𝑟𝑒𝑐𝑖𝑠𝑒𝑙𝑦 .𝑇ℎ𝑒 𝑠𝑖𝑡𝑒 𝑜𝑓 𝑠𝑛𝑎𝑘𝑒  𝑏𝑖𝑡𝑒 𝑤𝑎𝑠 𝑎𝑙𝑠𝑜 𝑎𝑡𝑡𝑎𝑐ℎ𝑒𝑑  𝑎𝑙𝑜𝑛𝑔 𝑤𝑖𝑡ℎ 𝑡ℎ𝑒 𝑖𝑛𝑣𝑒𝑠𝑡𝑖𝑔𝑎𝑡𝑖𝑜𝑛 𝑟𝑒𝑝𝑜𝑟𝑡𝑠.
𝐴𝑛𝑑 𝑎 𝑙𝑖𝑛𝑘 𝑡𝑜 ℎ𝑖𝑔ℎ 𝑣𝑠 𝑙𝑜𝑤 𝑑𝑜𝑠𝑒 𝑎𝑛𝑡𝑖𝑠𝑛𝑎𝑘𝑒 𝑣𝑒𝑛𝑜𝑚 𝑤𝑎𝑠 𝑝𝑟𝑜𝑣𝑖𝑑𝑒𝑑 𝑤ℎ𝑖𝑐ℎ 𝑤𝑎𝑠 𝑣𝑒𝑟𝑦 𝑖𝑛𝑓𝑜𝑟𝑚𝑎𝑡𝑖𝑣𝑒.

𝑪𝒂𝒔𝒆 2 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

𝑪𝒂𝒔𝒆 𝒊𝒏 𝒃𝒓𝒊𝒆𝒇-
A 19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year ,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year ,Abdominal distension and facial puffiness since 6 months, Pedal edema since 3 months , Low back ache since 3 months .

𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔-
The case is presented in a chronological order.The CNS examination was report was presented elaboratively and all the investigation reports are also provided.
The images of the purple striae were also attached and updated regularly.


𝑪𝒂𝒔𝒆 3 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html

𝑪𝒂𝒔𝒆 𝒊𝒏 𝒃𝒓𝒊𝒆𝒇-
35 year old man working as a food caterer  presented to our OPD with the chief complains of  :-Dyspnea at rest since 5 days ,Cough with expectoration since 5 days ,Bilateral pedal edema since 4 days ,
Abdominal distension since 3 days.

𝑰𝒏𝒔𝒊𝒈𝒉𝒕𝒔- The examination images were provided along with the investigation reports and videos. And treatment protocol is also updated regularly.

𝐐2.
𝐋𝐨𝐧𝐠 𝐜𝐚𝐬𝐞𝐬-
𝐂𝐚𝐬𝐞 1 𝐥𝐢𝐧𝐤-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

𝐂𝐡𝐞𝐢𝐟 𝐜𝐨𝐦𝐩𝐥𝐚𝐢𝐧𝐭𝐬-
• bilaterally symmetrical rapidly progressive generalized
• Severe joint pains
• Limitation of movements in his hands,wrists and feet.
• Burning eyes since 3days
• Subcutaneous swelling
• Involuntary weight loss and loss of appetite since 1yr.

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒊𝒔
• Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
• Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis.
• Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
• Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

𝑻𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕 𝒑𝒍𝒂𝒏
• Free water restriction for Hyponatremia

• Tab. PREDNISOLONE P/O 20 mg OD

• Tab FEBUXOSTAT P/O 80 mg OD

• Haemodialysis for worsening renal dysfunction

𝑪𝒂𝒔𝒆 2 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

𝑪𝒉𝒆𝒊𝒇 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕𝒔-
• Abdominal distension
• Swelling of bilateral lower limbs since 6 months which is gradually increasing since 10 days
•  Fluid discharge from the umbilical area since 2 days and fever since 2 days.
• High grade fever, intermittent in nature  not associated with chills, since 2 days.
• H/0 of anorexia, fatigue and generalized weakness since 3 months.
• H/0 of itching present since 3 months.
• H/0 of disturbed sleep since one month.

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒊𝒔
Decompensated chronic liver disease
Etiology -  chronic ethanol related
 Ascites , SBP,  Hepatic encephalopathy 
? Hepatorenal syndrome.

𝑻𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕 𝒑𝒍𝒂𝒏-
1.Tab PAN 40 MG OD
2. TAB . RIFAGUT 550 mg po BD
3. SYP.HEPAMERZ 10 ml Bd
4. SYP. Lactulose 10 ml H/ S
5. Tab udiliv 300 mg po  BD.
6. Inj . Ciprofloxacin 500mg iv Bd
7. Daily abdominal girth .
𝐴𝑛𝑑 𝑠𝑎𝑙𝑡 𝑟𝑒𝑠𝑡𝑟𝑖𝑐𝑡𝑒𝑑 𝑑𝑖𝑒𝑡 𝑖𝑠 𝑔𝑖𝑣𝑒𝑛 𝑡𝑜 𝑟𝑒𝑑𝑢𝑐𝑒 𝑡ℎ𝑒 𝑎𝑏𝑑𝑜𝑚𝑖𝑛𝑎𝑙 𝑑𝑖𝑠𝑡𝑒𝑛𝑠𝑖𝑜𝑛 𝑎𝑠 𝑟𝑒𝑡𝑎𝑖𝑛𝑖𝑛𝑔 𝑜𝑓 𝑡ℎ𝑒 𝑓𝑙𝑢𝑖𝑑 𝑖𝑠 𝑟𝑒𝑑𝑢𝑐𝑒𝑑 𝑏𝑦 𝑝𝑟𝑜𝑣𝑖𝑑𝑖𝑛𝑔 𝑎 𝑠𝑜𝑑𝑖𝑢𝑚 𝑟𝑒𝑠𝑡𝑟𝑖𝑐𝑡𝑒𝑑 𝑑𝑖𝑒𝑡.

𝑪𝒂𝒔𝒆 3 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006004-case-presentations.html

𝑪𝒉𝒆𝒊𝒇 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕𝒔
• Fever since 3 months 
• Cough with expectoration since 2 months 
• Dyspnea on exertion since 2 months 
• Vomiting since 2 months 
• Decreased appetite and weight loss over last 2 months 
• Dark coloured stools since 2 weeks. 

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒊𝒔
Amoebic liver abscess with rupturing into pleural cavity with Right lung basal consolidation. 

𝑻𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕 𝒑𝒍𝒂𝒏-
1.Inj. Metronidazole 750mg/iv/Tid
2.inj.Ceftriaxone 1gm/iv/bd
3.Inj.pantoprazole 40mg/iv/OD
4.inj paracetamol 1gm/Iv/sos
5.Tab.paromomycin 500mg/Tid
6.syp.Ambrolyte 5ml/Tid
7.Temperature/Respiratory rate /blood pressure/SpO2monitoring. 

𝑺𝒉𝒐𝒓𝒕 𝒄𝒂𝒔𝒆𝒔
𝑪𝒂𝒔𝒆 4 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

𝑪𝒉𝒆𝒊𝒇 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕𝒔-
• Vomitings
• Abdominal pain since 4days
• Swelling of right foot non pitting type
• Anorexia,myalgia,fatigue and anasarca since 5days

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒊𝒔
Acute kidney injury , secondary to acute tubular necrosis , due to snake bite . 



𝑻𝒓𝒆𝒂𝒕𝒎𝒆𝒏𝒕 𝒑𝒍𝒂𝒏

1. 4 sessions of haemodialysis
2. Inj zofer 4 mg TID
3. Inj pan 40 mg Od
4. Strict input / output    charting.

𝑪𝒂𝒔𝒆 5 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

𝑪𝒉𝒊𝒆𝒇 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕𝒔-
• Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year
•  Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year
•  Abdominal distension
•  Facial puffiness since 6 months
•  Pedal edema since 3 months
• Low back ache since 3 months .

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒊𝒔
Iatrogenic cushings syndrome
Tinea Corporis
Denovo HTN

𝑻𝑹𝑬𝑨𝑻𝑴𝑬𝑵𝑻 𝑷𝑳𝑨𝑵
• Ointment AMLORFINE 
• FUSIDIC ACID CREAM.
• SALINE COMPRESS OVER LEISONS.

This was the treatment given for tinea corporis.
• Tab. Telma 20 mg OD-for left ventricular hypertrophy
• Tab.Hizone 15mg TID-as there was suppresion of HPA Axis.

25/6/21
• Dose of tab. Hizone was reduced to 10mg.
• Tab. Shelcal 500mg OD
• Tab.Vitamin D3 OD
• Tab. Ultracet SOS

6/8/21
• Telma dose increased to 40mg OD
• Tab Itraconazole 100 mg BD
• lulifin cream
• Tab levocitrixine 5mg od.
• Ultracet tab.is continued


𝑪𝒂𝒔𝒆 6 𝒍𝒊𝒏𝒌-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html

𝑪𝒉𝒊𝒆𝒇 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕𝒔-
• Fever since 3 months 
• Cough with expectoration since 2 months 
• Dyspnea on exertion since 2 months 
• Vomiting since 2 months
• Decreased appetite
• weight loss over last 2 months 
• Dark coloured stools since 2 weeks. 

𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬
Heart failure with reduced ejection fraction-27%
Type 2 diabetes mellitus

𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐩𝐥𝐚𝐧
• Tab Lasix 80mg in the morning, 40mg in the afternoon and evening 
•  Tab Isosorbide mononitrate 10mg twice a day 
• Tab Hydralazine 25mg  
• Tab Telma 40mg 
• Tab Metformin 500mg once a day 

He was advised to take  fluids  less than 1 litre and salt restriction of less than 2grams/day to avoid retention of fluid in the abdomen.


𝐐3.

𝐋𝐨𝐧𝐠 𝐜𝐚𝐬𝐞

𝐂𝐚𝐬𝐞 𝐥𝐢𝐧𝐤-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

A 44 year old man presented to OPD  with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

The symptomatology of the case was accurately presented . All the positive findings of acute glomerulopathy and chronic problem were clearly discussed along with the favouring features of inflammatory pathology  were elaboratively diacussed before coming into the final diagnosis which is acute glomerulonephritis secondary to Amyloidosis, anaemia of chronic disease secondary to poorly treated rheumatoid arthritis.


Short cases-

Case link-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

A 19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year ,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year ,Abdominal distension and facial puffiness since 6 months, Pedal edema since 3 months , Low back ache since 3 months .

The case was presented in chronological order , he was diagnosed with Iatrogenic cushings syndrome which means raised cortisol levels due to over use of Clobetasol which is a corticosteroid.
The patient was also referred to dermatologist for the treatment of tinea corporis and also to the opthalmologist .
The patient has also lost his self esteem and was also referred to psychiatry department.

Case link-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html

35 year old man working as a food caterer  presented to our OPD with the chief complains of  :-
Dyspnea at rest since 5 days 
Cough with expectoration since 5 days 
Bilateral pedal edema since 4 days 
Abdominal distension since 3 days

The symptomatology was clearly and compactly explained.Upon examining the abdomen through ultrasound grade 1 fatty liver as he was an alcoholic,mild ascites so was advised salt restricted diet  and right pleural effusion. On analyzing all the investigation reports and examinations he is diagnosed with Heart failure  with reduced ejection fraction  and denovo detected type 2 diabetes mellitus.

𝗤4.𝗧𝗵𝗶𝘀 𝗶𝘀 𝘁𝗵𝗲 𝗹𝗶𝗻𝗸 𝘁𝗼 𝗺𝘆 𝗰𝗮𝘀𝗲 𝘄𝗵𝗶𝗰𝗵 𝗶 𝘄𝗮𝘀 𝗮𝘀𝘀𝗶𝗴𝗻𝗲𝗱 𝘁𝗵𝗶𝘀 𝗺𝗼𝗻𝘁𝗵.

𝗖𝗔𝗦𝗘 𝗟𝗜𝗡𝗞-http://srinaini25.blogspot.com/2021/08/genmedicine.html

𝗤5.Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 

𝐌𝐨𝐧𝐭𝐡 𝐛𝐲 𝐦𝐨𝐧𝐭𝐡 𝐰𝐞 𝐚𝐫𝐞 𝐠𝐞𝐭𝐭𝐢𝐧𝐠 𝐚 𝐧𝐮𝐦𝐛𝐞𝐫 𝐨𝐟 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭 𝐨𝐩𝐩𝐮𝐫𝐭𝐮𝐧𝐢𝐭𝐢𝐞𝐬 𝐭𝐨 𝐥𝐞𝐚𝐫𝐧 𝐭𝐡𝐞 𝐬𝐮𝐛𝐣𝐞𝐜𝐭 𝐛𝐞𝐭𝐭𝐞𝐫.𝐈𝐧 𝐭𝐡𝐞 𝐬𝐭𝐚𝐫𝐭𝐢𝐧𝐠 𝐨𝐟 𝐭𝐡𝐞 𝐦𝐨𝐧𝐭𝐡 𝐰𝐞 𝐰𝐞𝐫𝐞 𝐚 𝐛𝐢𝐭 𝐝𝐢𝐬𝐚𝐩𝐩𝐨𝐢𝐧𝐭𝐞𝐝 𝐭𝐡𝐚𝐭 𝐰𝐞 𝐰𝐞𝐫𝐞 𝐧𝐨𝐭 𝐚𝐛𝐥𝐞 𝐭𝐨 𝐚𝐭𝐭𝐞𝐧𝐝 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐩𝐨𝐬𝐭𝐢𝐧𝐠𝐬 𝐚𝐥𝐭𝐡𝐨𝐮𝐠𝐡 𝐰𝐞 𝐰𝐞𝐫𝐞 𝐢𝐧 𝐭𝐡𝐞 𝐜𝐨𝐥𝐥𝐞𝐠𝐞,𝐛𝐮𝐭 𝐢 𝐫𝐞𝐚𝐥𝐥𝐲 𝐭𝐡𝐚𝐧𝐤 𝐭𝐡𝐞 𝐠𝐞𝐧𝐞𝐫𝐚𝐥 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐝𝐞𝐩𝐚𝐫𝐭𝐦𝐞𝐧𝐭 𝐟𝐨𝐫 𝐚𝐥𝐥𝐨𝐰𝐢𝐧𝐠 𝐮𝐬 𝐭𝐨 𝐭𝐚𝐤𝐞 𝐭𝐡𝐞 𝐡𝐢𝐬𝐭𝐨𝐫𝐲 𝐨𝐟 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐝𝐢𝐫𝐞𝐜𝐭𝐥𝐲.𝐈𝐭 𝐰𝐚𝐬 𝐚𝐧 𝐞𝐱𝐜𝐞𝐩𝐭𝐢𝐨𝐧𝐚𝐥 𝐞𝐱𝐩𝐞𝐫𝐢𝐞𝐧𝐜𝐞 𝐨𝐟 𝐝𝐢𝐫𝐞𝐜𝐭𝐥𝐲 𝐭𝐚𝐥𝐤𝐢𝐧𝐠 𝐭𝐨 𝐚𝐧𝐝 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐚𝐧𝐝 𝐭𝐚𝐤𝐢𝐧𝐠 𝐭𝐡𝐞 𝐡𝐢𝐬𝐭𝐨𝐫𝐲!𝐀𝐧𝐝 ,𝐚𝐥𝐬𝐨 𝐭𝐡𝐞 𝐞-𝐥𝐨𝐠𝐬 𝐰𝐡𝐢𝐜𝐡 𝐰𝐞 𝐡𝐚𝐯𝐞 𝐛𝐞𝐞𝐧 𝐠𝐢𝐯𝐞𝐧 𝐭𝐨 𝐫𝐞𝐯𝐢𝐞𝐰 𝐭𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 𝐰𝐞𝐫𝐞 𝐯𝐞𝐫𝐲 𝐞𝐥𝐚𝐛𝐨𝐫𝐚𝐭𝐢𝐯𝐞𝐥𝐲 𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐞𝐝 ,𝐰𝐞 𝐠𝐨𝐭 𝐭𝐨 𝐥𝐞𝐚𝐫𝐧 𝐡𝐨𝐰 𝐛𝐫𝐢𝐞𝐟𝐥𝐲 𝐰𝐞 𝐚𝐫𝐞 𝐬𝐮𝐩𝐩𝐨𝐬𝐞𝐝 𝐭𝐨 𝐩𝐫𝐞𝐬𝐞𝐧𝐭 𝐭𝐡𝐞 𝐜𝐚𝐬𝐞 𝐚𝐧𝐝 𝐡𝐨𝐰 𝐰𝐞 𝐚𝐫𝐞 𝐬𝐮𝐩𝐩𝐨𝐬𝐞𝐝 𝐭𝐨 𝐜𝐨𝐦𝐞 𝐭𝐨 𝐭𝐡𝐞 𝐟𝐢𝐧𝐚𝐥 𝐝𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬.𝐒𝐨,𝐚𝐥𝐭𝐨𝐠𝐞𝐭𝐡𝐞𝐫 𝐭𝐡𝐢𝐬 𝐦𝐨𝐧𝐭𝐡 𝐡𝐚𝐬 𝐛𝐞𝐞𝐧 𝐯𝐞𝐫𝐲 𝐢𝐧𝐬𝐭𝐫𝐮𝐜𝐭𝐢𝐯𝐞.