40.K.Aishwarya ,13.B.Harika

 A 74 yr old female with fever

September 21 , 2021

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

Unit 1 admission 

Amc

Date of admission: September 14 , 2021

A 74 year old female came with complaints of fever since 4 days,generalised weakness since 4days

 two episodes of vomiting 1 day ago 


History of present illness:

Pt was apparently asymptomatic 4 days ago,c/o fever,highgrade,intermittent,not associated with chills and rigors 


Associated with generalized weakness, two episodes vomitings,subsided on its own


 Shortness of breath on exertion then progressed to shortness of breath on rest  

 pericardial effusion 1year ago,diagnosed,on medication for 6 months later subsided


No h/o orthopnea, dyspnea

No pain  abdomen,loose stools


Past history:


 Dm since 3 years


hypothyroidism since 10 years on regular medication


Personal history:


Diet:mixed


Appetite:normal


Bowel,Bladder:regular


No addictions 


General examination 


Pt is coherent, conscious and well oriented with place and person.


Pallor+,no icterus,cyanosis, clubbing, lymphadenopathy,edema

Vitals

Pr-86bpm

Bp-100/70mmhg

Rr-24cpm

Spo2-95%@RA

Grbs-146mg/dl



Systemic examination 

Cvs-s1,s2+

Rs-crepts+

Nvbs

P/a:

Soft,nontender

No palpable mass

Cns-intact



Provisional diagnosis:


 LEPTOSPIRA WITH RENAL AKI WITH UREMIC ENCPHALOPATHY WITH HEPATIC ENCEPHALOPATHY GRADE 1 ( RESOLVED)


WITH DM -2 , HTN  , HYPOTHYROIDISM


Investigations:

Plt at time of admission- 20,000/ cu.mm

Aptt-41.0

Inr-1.21

Dengue Ns1-negative

DengueIgG-negative

Dengue IgM-negative

Serology- negative

Chest x ray-


Crusting of lips-

Ecg-


2D echo




Peripheral smear-



Questions:

What is the cause for her diesease?
What is the final diagnosis of this case?


Comments

Post a Comment

Popular posts from this blog

Prefinals general medicine

Image
1) Define heart failure. Etiology and clinical features of heart failure? How do we diagnose heart failure clinically , physical examination and various modalities used in diagnosis of heart failure.    2) Define cirrhosis of liver. Etiopathogenesis of cirrhosis. Write a brief note on clinical features diagnosis and treatment of chirhosis of liver. 11) acitic fluid analysis  12) protein pump inhibitors  15) differential diagnosis of fever with rash 16) insulin therapy in diabetes mellitus 20) hormones secreted by pituitary gland 4)Etiology of plural effusion and diagnostic criteria 5)diagnosis and treatment in dengue fever 10)complications of dialysis  3) elaborate on clinical features and diagnostic modalities in diagnosis of renal calculi 9)etiology and treatment of pneumonia  7) treatment of acute pylonephritis 6)clinical features and diagnosis of peptic ulcer disease  8)treatment of abdominal tuberculosis  17) antihypertensive drugs in chronic renal failure
Read more

A 46 yr old male with chest pain-

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 A 46 yr old male patient presented to the opd with the chief complaint of chest pain, increased sweating and pounding of heart since one month. History of present illness: He was apparently normal 1 month back then he developed chest pain profuse sweating and palpitations.   Then he went to nearby hospital .There he was diagnosed with coronary artery disease , given medication and admitted for 4 days then discharged. They suggested him to get angiogram done. Now after one month he presented to the opd with the similar problems. He noticed that chest pain increased upon climbing stairs and brisk walk
Read more

Gastroenteritis

Image
  Case of Gastroenteritis December 05, 2021  Case of Gastroenteritis  A 70 year old female presented to opd with chief  complaints of lower back pain since 10 days and  Blebs on right foot since 20 days . Patient had a fever 15 years back,went to hospital for check up and got to know that she is hypertensive patient . 10 years ago patient had joint pains,mostly elbow joint (patient is not aware of sequence of the pain ) 8years back ,joint pains aggravated , started using medications , pain got subsided, stoped using medications and pains started again. 4 years ago underwent tooth extraction when she fell down doing some work. 3 years ago ,had fever ,admitted in our hospital, found that she had some renal problem (no records available ) and later discharged. One year ago ,patient had facial puffiness,generalized weakness with multiple joint pains. 5 months ago,had severe wrist joint pain with restricted movement, distal interphalangeal joint pain,proximal interphalangeal joint pain . 10
Read more