This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen:

CASE DISCUSSION

A 56 year old female patient came to the op with complaints of shortness of breath since 2 months

HISTORY OF PRESENTING ILLNESS

Patient was apparently alright 2months ago then she developed Shortness of Breath which was insidious in onset , aggravated on exertion like walking . Relieved on taking rest , associated with seasonal variation , not associated with diurnal variation . 

No orthopnea , pedal edema , Paroxysmal nocturnal dispneoa , decreased urine output .

No h/o fever , vomitings, loose stools , sore throat , chest pain , palpitations , blurring of vision 

She is a k/c/o HTN since 9years 

K/c/o Asthma since 10years and on Formeterol

K/c/o CVA (Acute infarct in left semi ovale ) 1 year back

She is a k/c/o psychiatric disorder in which she talks to herself and laughs at herself and she is on Amisulpride 

ON EXAMINATION

Pt is Concious, Coherent, co-operative 

No Pallor , Icterus , Clubbing, Cyanosis Lymphadenopathy, pedal oedema

VITALS:

 Temp: Afebrile

Pulse : 85/min irregularly irregular

Resp rate : 22/min

Bp: 150/90 mm hg

SYSTEMIC EXAMINATION

CVS : S1,S2 heard ,no murmurs 

CNS : No focal neurological deficits

RS: decreased air entry on right side

PA: soft, non tender
















Provisional diagnosis :

Paroxysmal Atrial fibrillation with k/c/o CVA - Right sided hemiparesis with acute infarct in the left semi ovale 

Treatment given :

O2 inhalation if saturation <90@ RA

TAB. ECOSPIRIN -AV 75/10mg OD

INJ. LASIX 40MG/IV/BD

INJ.PAN 40mg OD IV/OD

NEBULIZATION WITH BUDICORT 2 RESPULES AND IPRAVENT 2 RESPULES 6TH HRLY

TAB. AMIODARONE 100MG /OD 

TAB. MONTELEUKAST-LC H/S

TAB. RAMIPRIL 5MG /OD 

SYP. CREMAFFIN 15ML /TID

Comments

Post a Comment

Popular posts from this blog

Exam 16/11/2020

Image
 Question 1) pain in the epigastric region differentials Inferior wall MI(normal ecg and echo) Acute pancreatitis(radiation to the back)-usg finding and elevated serum amylase level Perforated peptic ulcer  Causes of acute pancreatitis- harrison pg no 2348 Gall stones : https://gi.org/topics/gallstone-pancreatitis/ This occurs at the level of the sphincter of Oddi, a round muscle located at the opening of the bile duct into the small intestine. If a stone from the gallbladder should travel down the common bile duct and get stuck at the sphincter, it blocks outflow of all material from the liver and pancreas. This results in inflammation of the pancreas that can be quite severe. 2)sob- acidosis due to renal failure          ? Ards secondary to sepsis/pancreatitis           Pleural effusion due to acute pancreatitis            3)decreased urine output-pre renal Aki secondary to volume loss(oliguric) 3rd space loss due to pancreatitis Sepsis induced aki 4) abdominal distention with consti
Read more

35 yr old with pain abdomen

Image
 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: CASE DISCUSSION A 35 year old male who is a farmer came with the complaint of pain in epigastric region(after his last binge of alcohol) from past 6 days which was burning type,radiating to peri umbilical and not aggravated or relieved with food intake but was associated with nausea and vomitings. Vomitings were non bilious,non projectile and was of food particles and not blood stained. No H/o fever,loose stools,constipation,pedal edema,abdo
Read more

Bimonthly internal assessment

  57 year old man with jaundice, pedal edema and abdominal distension since three years and bleeding gums since three days" https://swathibogari158. blogspot.com/2020/09/chronic- decompensated-liver-disease. html 1) What is the reason for this patient's ascites?  Ans.  The cause for ascitis might be cirrhosis of liver as the patient is history alcohol intake since 40 years. 2) Why did the patient develop bipedal lymphedema? What was the reason for the recurrent blebs and ulcerations and cellulitis in his lower limbs?   Ans. Bilateral pedal oedema may be due to the decrease in the levels of albumin because of improper functioning of liver (long standing cirrhosis).  The ulcerations are due to limited movements (improper dressings).  3) What was the reason for his asterixis and constructional apraxia and what was done by the treating team to address that?   Ans. Asterixis is a clinical sign that describes the inability to maintain sustained posture with subsequent brief, shock l
Read more