Gm final practicals (long case)

 Feb 6,2022

A 50 year male farmer ,manual labourer,brought  to casualty with h/o altered sensorium since 1 day
H/o fever since 4 days.

HISTORY OF PRESENT ILLNESS -
Patient was apparently asymptomatic 4 days ago,then he developed fever which is high grade,No diurnal variation, associated with chills.
No h/o cough and GE symptoms. 

Attenders tells h/o stoppage of  OHA for 3days, h/o decreased intake of food as he has fever.

H/o altered sensorium since 1 day.
Irrelevant talk,not recognising attenders since this morning .
Able to move all four limbs,No h/o vomitings, head ache, seizures.
Took him to nalgonda hospital
SHIFTED HERE FOR FURTHUR MANAGEMENT. 

PAST HISTORY - 
H/o TB 2YRS back used anti tubercular therapy for 6 months.
Diagnosed as Type -2 Diabetes mellitus on oral hypoglycemic medication 1 YR back.
No H/O Hypertension , CVA(cerebral vascular accident) , CAD(coronary artery disease), COVID-19.

PERSONAL HISTORY :

DIET - MIXED,
APPETITE -NORMAL ,
BOWEL MOVEMENT - REGULAR , 
BLADDER MOVEMENTS - REGULAR, 
ADDICTIONS-H/O  SMOKING 30yrs ago(1 pack per day)- 
ALCOHOL-REGULAR INTAKE OF 180ML  SINCE 30YRS,STOPPED SINCE 2YRS AFTER DIAGNOSIS OF TB.
RECENTLY ALCOHOL INTAKE ON JAN 15,2022.
FAMILY HISTORY:Non-significant.
TREATMENT HISTORY: on OHA SINCE 1YS.
ON ATT FOR 6MONTHS.
 
ON EXAMINATION -

PATIENT IS CONCIOUS , INCOHERENT  AND NON COOPERATIVE
 NO ICTRUS 
 NO PALLOR
CLUBBING : present.
 NO  CYANOSIS 
 NO LYMPHADENOPATHY
NO  EDEMA

VITALS - 

TEMPERATURE - 97' F
PULSE RATE - 126BPM
BLOOD PRESSURE - 190/80 MM OF HG 
RESPIRATORY RATE - 28 breadths/sec
SPO2 - 97 % AT ROOM AIR
 
GRBS(general random blood sugar)-HIGH.


SYSTEMIC EXAMINATION - 

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : 
BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
DYSPNOEA PRESENT.

P/A(per abdomen) - soft,non tenderness,
No organomegaly


CNS: 
Pt is conscious, inorientation ,non cooperative 

Reflexes:
Biceps,triceps,supinator,knee,ankle:can't be elicited.
    
BILATERAL PLANTAR EXTENSION PRESENT.
O/E(on examination)NECK STIFFNESS PRESENT,APPEARS TO BE SPONDYLOARTHROPATHY.


















PROVISIONAL DIAGNOSIS: CASE OF ALTERED SENSORIUM SECONDARY TO DKA.(diabetic ketoacidosis)

TREATMENT :
1.IVF 2 UNITS NS IV_BOLUS/STAT.
AND THEN IVF NS@100ML/HR
2.INJ.HAI 6U/IV/STAT
3.INJ.HUMAN ACTRAPID 1ML(40U) 
4.INJ.THIAMINE 1AMP IN 100ML NS/IV/OD
5.INJ.OPTINEURON 1 AMP IN 100ML NS/IV/OD
6.GRBS MONITORING-EVERY HOURLY.
7.INJ.MONOCEF 2GM/IV/BD.























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