๐๐ข๐ฆ๐จ๐ง๐ญ๐ก๐ฅ๐ฒ ๐๐ฌ๐ฌ๐๐ฌ๐ฌ๐ฆ๐๐ง๐ญ- ๐๐ฎ๐ ๐ฎ๐ฌ๐ญ
๐ฝ๐ฐ๐ผ๐ด:-๐๐๐๐๐ผ๐๐๐
๐๐พ๐ป๐ป ๐ฝ๐พ:-33
We have been given 5 questions as an assignment to analyze,asess , understand and write the preview of the given cases.
๐1.
๐๐จ๐ง๐ ๐๐๐ฌ๐๐ฌ
๐๐๐ฌ๐ 1 ๐ฅ๐ข๐ง๐ค-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
๐๐๐ฌ๐ ๐ข๐ง ๐๐ซ๐ข๐๐- A 44 year old man presented to OPD with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
๐ฐ๐๐๐๐๐๐๐- 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.
๐ช๐๐๐ 2 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html
๐ช๐๐๐ ๐๐ ๐๐๐๐๐-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.
๐ฐ๐๐๐๐๐๐๐-
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.
๐ช๐๐๐ 3 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006004-case-presentations.html
๐ช๐๐๐ ๐๐ ๐๐๐๐๐-
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.
๐ฐ๐๐๐๐๐๐๐-
๐โ๐ โ๐๐ ๐ก๐๐๐ฆ ๐๐ ๐๐๐๐ ๐๐๐ก๐๐๐ ๐๐๐๐๐๐ ๐ ๐ค๐๐ ๐๐๐๐ข๐๐๐ก๐๐๐ฆ ๐ค๐๐๐ก๐ก๐๐ ๐ค๐๐กโ ๐๐๐ ๐๐ก๐ ๐๐๐ ๐กโ๐ ๐๐๐๐๐๐ก๐ ๐ค๐๐๐ ๐๐๐ ๐ ๐ข๐๐๐๐ก๐๐ ๐๐ ๐ ๐๐๐๐ข๐๐๐ ๐๐๐ ๐๐ .๐โ๐ ๐๐๐๐๐๐ ๐๐ ๐กโ๐ ๐๐๐๐๐๐๐ ๐๐ฅ๐๐๐๐๐๐ก๐๐๐ ๐ค๐๐ ๐๐๐ ๐ ๐๐ก๐ก๐๐โ๐๐ ๐คโ๐๐โ ๐ค๐๐๐ ๐๐๐๐ ๐กโ๐ ๐๐๐ ๐ ๐๐๐๐ ๐๐๐๐๐๐ก๐๐ฃ๐.๐ด๐๐ ๐๐๐ ๐กโ๐ ๐๐๐ฃ๐๐ ๐ก๐๐๐๐ก๐๐๐ ๐๐๐๐๐๐ก๐ ๐ค๐๐๐ ๐๐๐๐ ๐๐๐ก๐๐ ๐๐ ๐ ๐โ๐๐๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐.
๐๐ก๐จ๐ซ๐ญ ๐๐๐ฌ๐๐ฌ
๐ช๐๐๐ 1 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html
๐ช๐๐๐ ๐๐ ๐๐๐๐๐-
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.
๐ฐ๐๐๐๐๐๐๐-
๐โ๐ ๐๐๐ ๐ ๐ค๐๐ ๐ค๐๐๐ก๐ก๐๐ ๐๐๐๐๐ข๐๐ก๐๐๐ฆ ๐๐๐ ๐๐๐๐๐๐๐ก๐๐ฆ . ๐โ๐ โ๐๐ ๐ก๐๐๐ฆ ๐๐ ๐๐๐๐๐๐ ๐ ๐ค๐๐ ๐๐๐ ๐๐๐๐๐๐ ๐๐๐๐๐๐ ๐๐๐ฆ .๐โ๐ ๐ ๐๐ก๐ ๐๐ ๐ ๐๐๐๐ ๐๐๐ก๐ ๐ค๐๐ ๐๐๐ ๐ ๐๐ก๐ก๐๐โ๐๐ ๐๐๐๐๐ ๐ค๐๐กโ ๐กโ๐ ๐๐๐ฃ๐๐ ๐ก๐๐๐๐ก๐๐๐ ๐๐๐๐๐๐ก๐ .
๐ด๐๐ ๐ ๐๐๐๐ ๐ก๐ โ๐๐โ ๐ฃ๐ ๐๐๐ค ๐๐๐ ๐ ๐๐๐ก๐๐ ๐๐๐๐ ๐ฃ๐๐๐๐ ๐ค๐๐ ๐๐๐๐ฃ๐๐๐๐ ๐คโ๐๐โ ๐ค๐๐ ๐ฃ๐๐๐ฆ ๐๐๐๐๐๐๐๐ก๐๐ฃ๐.
๐ช๐๐๐ 2 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html
๐ช๐๐๐ ๐๐ ๐๐๐๐๐-
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 .
๐ฐ๐๐๐๐๐๐๐-
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.
๐ช๐๐๐ 3 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html
๐ช๐๐๐ ๐๐ ๐๐๐๐๐-
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.
๐ฐ๐๐๐๐๐๐๐- The examination images were provided along with the investigation reports and videos. And treatment protocol is also updated regularly.
๐2.
๐๐จ๐ง๐ ๐๐๐ฌ๐๐ฌ-
๐๐๐ฌ๐ 1 ๐ฅ๐ข๐ง๐ค-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
๐๐ก๐๐ข๐ ๐๐จ๐ฆ๐ฉ๐ฅ๐๐ข๐ง๐ญ๐ฌ-
• 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.
๐ซ๐๐๐๐๐๐๐๐
• 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.
๐ป๐๐๐๐๐๐๐๐ ๐๐๐๐
• Free water restriction for Hyponatremia
• Tab. PREDNISOLONE P/O 20 mg OD
• Tab FEBUXOSTAT P/O 80 mg OD
• Haemodialysis for worsening renal dysfunction
๐ช๐๐๐ 2 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html
๐ช๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐-
• 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.
๐ซ๐๐๐๐๐๐๐๐
Decompensated chronic liver disease
Etiology - chronic ethanol related
Ascites , SBP, Hepatic encephalopathy
? Hepatorenal syndrome.
๐ป๐๐๐๐๐๐๐๐ ๐๐๐๐-
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 .
๐ด๐๐ ๐ ๐๐๐ก ๐๐๐ ๐ก๐๐๐๐ก๐๐ ๐๐๐๐ก ๐๐ ๐๐๐ฃ๐๐ ๐ก๐ ๐๐๐๐ข๐๐ ๐กโ๐ ๐๐๐๐๐๐๐๐๐ ๐๐๐ ๐ก๐๐๐ ๐๐๐ ๐๐ ๐๐๐ก๐๐๐๐๐๐ ๐๐ ๐กโ๐ ๐๐๐ข๐๐ ๐๐ ๐๐๐๐ข๐๐๐ ๐๐ฆ ๐๐๐๐ฃ๐๐๐๐๐ ๐ ๐ ๐๐๐๐ข๐ ๐๐๐ ๐ก๐๐๐๐ก๐๐ ๐๐๐๐ก.
๐ช๐๐๐ 3 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006004-case-presentations.html
๐ช๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐
• 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.
๐ซ๐๐๐๐๐๐๐๐
Amoebic liver abscess with rupturing into pleural cavity with Right lung basal consolidation.
๐ป๐๐๐๐๐๐๐๐ ๐๐๐๐-
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.
๐บ๐๐๐๐ ๐๐๐๐๐
๐ช๐๐๐ 4 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html
๐ช๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐-
• Vomitings
• Abdominal pain since 4days
• Swelling of right foot non pitting type
• Anorexia,myalgia,fatigue and anasarca since 5days
๐ซ๐๐๐๐๐๐๐๐
Acute kidney injury , secondary to acute tubular necrosis , due to snake bite .
๐ป๐๐๐๐๐๐๐๐ ๐๐๐๐
1. 4 sessions of haemodialysis
2. Inj zofer 4 mg TID
3. Inj pan 40 mg Od
4. Strict input / output charting.
๐ช๐๐๐ 5 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html
๐ช๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐-
• 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 .
๐ซ๐๐๐๐๐๐๐๐
Iatrogenic cushings syndrome
Tinea Corporis
Denovo HTN
๐ป๐น๐ฌ๐จ๐ป๐ด๐ฌ๐ต๐ป ๐ท๐ณ๐จ๐ต
• 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
๐ช๐๐๐ 6 ๐๐๐๐-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html
๐ช๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐-
• 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.
๐๐ข๐๐ ๐ง๐จ๐ฌ๐ข๐ฌ
Heart failure with reduced ejection fraction-27%
Type 2 diabetes mellitus
๐๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐ฉ๐ฅ๐๐ง
• 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.
๐3.
๐๐จ๐ง๐ ๐๐๐ฌ๐
๐๐๐ฌ๐ ๐ฅ๐ข๐ง๐ค-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.
๐๐จ๐ง๐ญ๐ก
๐๐ฒ ๐ฆ๐จ๐ง๐ญ๐ก ๐ฐ๐
๐๐ซ๐ ๐ ๐๐ญ๐ญ๐ข๐ง๐
๐ ๐ง๐ฎ๐ฆ๐๐๐ซ ๐จ๐
๐๐ข๐๐๐๐ซ๐๐ง๐ญ
๐จ๐ฉ๐ฉ๐ฎ๐ซ๐ญ๐ฎ๐ง๐ข๐ญ๐ข๐๐ฌ
๐ญ๐จ ๐ฅ๐๐๐ซ๐ง ๐ญ๐ก๐
๐ฌ๐ฎ๐๐ฃ๐๐๐ญ ๐๐๐ญ๐ญ๐๐ซ.๐๐ง
๐ญ๐ก๐ ๐ฌ๐ญ๐๐ซ๐ญ๐ข๐ง๐
๐จ๐ ๐ญ๐ก๐ ๐ฆ๐จ๐ง๐ญ๐ก
๐ฐ๐ ๐ฐ๐๐ซ๐ ๐ ๐๐ข๐ญ
๐๐ข๐ฌ๐๐ฉ๐ฉ๐จ๐ข๐ง๐ญ๐๐
๐ญ๐ก๐๐ญ ๐ฐ๐ ๐ฐ๐๐ซ๐
๐ง๐จ๐ญ ๐๐๐ฅ๐ ๐ญ๐จ
๐๐ญ๐ญ๐๐ง๐ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ
๐ฉ๐จ๐ฌ๐ญ๐ข๐ง๐ ๐ฌ ๐๐ฅ๐ญ๐ก๐จ๐ฎ๐ ๐ก
๐ฐ๐ ๐ฐ๐๐ซ๐ ๐ข๐ง ๐ญ๐ก๐
๐๐จ๐ฅ๐ฅ๐๐ ๐,๐๐ฎ๐ญ
๐ข ๐ซ๐๐๐ฅ๐ฅ๐ฒ ๐ญ๐ก๐๐ง๐ค
๐ญ๐ก๐ ๐ ๐๐ง๐๐ซ๐๐ฅ
๐ฆ๐๐๐ข๐๐ข๐ง๐ ๐๐๐ฉ๐๐ซ๐ญ๐ฆ๐๐ง๐ญ
๐๐จ๐ซ ๐๐ฅ๐ฅ๐จ๐ฐ๐ข๐ง๐
๐ฎ๐ฌ ๐ญ๐จ ๐ญ๐๐ค๐ ๐ญ๐ก๐
๐ก๐ข๐ฌ๐ญ๐จ๐ซ๐ฒ ๐จ๐
๐ญ๐ก๐ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ
๐๐ข๐ซ๐๐๐ญ๐ฅ๐ฒ.๐๐ญ
๐ฐ๐๐ฌ ๐๐ง ๐๐ฑ๐๐๐ฉ๐ญ๐ข๐จ๐ง๐๐ฅ
๐๐ฑ๐ฉ๐๐ซ๐ข๐๐ง๐๐
๐จ๐ ๐๐ข๐ซ๐๐๐ญ๐ฅ๐ฒ
๐ญ๐๐ฅ๐ค๐ข๐ง๐ ๐ญ๐จ
๐๐ง๐ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ
๐๐ง๐ ๐ญ๐๐ค๐ข๐ง๐
๐ญ๐ก๐ ๐ก๐ข๐ฌ๐ญ๐จ๐ซ๐ฒ!๐๐ง๐
,๐๐ฅ๐ฌ๐จ ๐ญ๐ก๐ ๐-๐ฅ๐จ๐ ๐ฌ
๐ฐ๐ก๐ข๐๐ก ๐ฐ๐ ๐ก๐๐ฏ๐
๐๐๐๐ง ๐ ๐ข๐ฏ๐๐ง
๐ญ๐จ ๐ซ๐๐ฏ๐ข๐๐ฐ ๐ญ๐ก๐ข๐ฌ
๐ฆ๐จ๐ง๐ญ๐ก ๐ฐ๐๐ซ๐
๐ฏ๐๐ซ๐ฒ ๐๐ฅ๐๐๐จ๐ซ๐๐ญ๐ข๐ฏ๐๐ฅ๐ฒ
๐ฉ๐ซ๐๐ฌ๐๐ง๐ญ๐๐
,๐ฐ๐ ๐ ๐จ๐ญ ๐ญ๐จ ๐ฅ๐๐๐ซ๐ง
๐ก๐จ๐ฐ ๐๐ซ๐ข๐๐๐ฅ๐ฒ
๐ฐ๐ ๐๐ซ๐ ๐ฌ๐ฎ๐ฉ๐ฉ๐จ๐ฌ๐๐
๐ญ๐จ ๐ฉ๐ซ๐๐ฌ๐๐ง๐ญ
๐ญ๐ก๐ ๐๐๐ฌ๐ ๐๐ง๐
๐ก๐จ๐ฐ ๐ฐ๐ ๐๐ซ๐ ๐ฌ๐ฎ๐ฉ๐ฉ๐จ๐ฌ๐๐
๐ญ๐จ ๐๐จ๐ฆ๐ ๐ญ๐จ ๐ญ๐ก๐
๐๐ข๐ง๐๐ฅ ๐๐ข๐๐ ๐ง๐จ๐ฌ๐ข๐ฌ.๐๐จ,๐๐ฅ๐ญ๐จ๐ ๐๐ญ๐ก๐๐ซ
๐ญ๐ก๐ข๐ฌ ๐ฆ๐จ๐ง๐ญ๐ก
๐ก๐๐ฌ ๐๐๐๐ง ๐ฏ๐๐ซ๐ฒ
๐ข๐ง๐ฌ๐ญ๐ซ๐ฎ๐๐ญ๐ข๐ฏ๐.
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