05 Akula Vignesh

 Date of admission-12/09/23 Case scenario  A 70 yr old male resident of yadadri came to opd with  Chief complaints of -c/o burning micturition 15 days -c/o fever since 10 days -c/o blood in urine since a week -c/o urinary incontinence 1 week History of present illness Patient was apparently asymptomatic 15 days ago then he had burning micturition which is insidious in onset following he had fever which is associated with chills and rigor since 10 days which is relieved on medication  Pt complaints of blood in urine and urinary incontinence since 1 week Past history: *Details of patient's past history*  Pt was apparently symptomatic till 2014 then he developed blood in urine and urinary incontinence for which he visited hospital on 1st Feb 2014 following visit   *Ultrsonograpy of abdomen and pelvis done*  IMPRESSION; •diffuse urinary bladder wall thickening Significant right parailiac nodes  *CYSTOSCOPY EXM:* bladder growth specimen is collected IMPRESSION Urothelial(transitional) c

 Date of admission :  A 55 year old male resident of Nalgonda presented to the causality with lower back ache and radiating pain to the left leg  since 3 weeks  HISTORY OF PRESENT ILLNESS : Patient was apparently asymptomatic until 3 weeks ago after which he developed lower back ache which is sudden in onset, non progressive, aggravates on movement, relives on rest.  History of trauma (slip and fall from stairs) 3 weeks ago  The patient was taken to the local hospital where he was found to have L5 burst fracture on CT pelvis.  No history of lifting heavy weights, fever, burning micturition,  PAST HISTORY :  k/c/o DM T2 since last 30 years  K/c/o CAD since 2 years  N/k/c/o of HTN, epilepsy, TB, asthma.  History of  PCTA 2 years ago   TREATMENT HISTORY:  Tab. Metformin 500mg  Tab . Roglibose 0.2mg  Tab. glimidipine 2mg  PERSONAL HISTORY :  sleep : adequate  Bowel and bladder : regular  Appetite : normal  Addictions: alcohol occasionally  Allergies : none  GENERAL EXAMINATION:  Bilateral

Case scenario :- A 72 yr old male farmer by occupation resident of choutuppal came to the opd with chief complaints of □ tingling sensation over the right upper and lower limb since 30 days □ abdominal distension since 30 days  □ shortness of breath since 10 days □bilateral pedal edema since 10 days History of present of illness Patient was apparently asymptomatic 1 month ago then he had developed abdominal distension which is insidious in onset and gradually progressive associated with Decreased appetite Then he visited local hospital where he treated for indigestion with sodium and calcium bicarbonate syrup following then  the patient developed bilateral pedal which is insidious and gradually progressive in nature 10 days ago He also complains of shortness of breath(grade  II) since 10 days which is insidious in onset no aggregated on even doing daily activities.  

 35 years old female , daily wage worker  by occupation came presented with chief complaints of painful skin lesions on B/L upper and lower limbs since 2 months, fever and burning micturition since 4days.  Date of admission: 12/09/23 CHIEF COMPLAINTS  ➤ Painful  skin lesions over both hands and legs since 2 months .  ➤Fever since 4 days ➤Burning micturition since 4 days HISTORY OF PRESENTING ILLNESS Patient was apparently asymptomatic 2 months back. Then she developed complaints of painful skin lesions over the arms and the legs , which was sudden in onset , progressive , no aggravating and relieving factors . Vesicles later ruptured with purulent discharge Not associated with itching , fever and redness. Fever since 4 days coming on alternate day not associated with chills and rigor, diurnal variation, relieves with medication.  Burning micturition since 4 days. Not associated with increased frequency /urgency /hesitancy/decreased urine .  H/o deformity of hands , toes and fingers sin

 A 63year old female with c/o neck pain and b/l knee pain since 1 year. C/O decreases urine output since 1 year History of presenting illness:  Patient was apparently asymptomatic 1year back then developed neckpain,insidious ,gradually progressive, aggravated on bending forward and relieved with medication. C/O b/l knee pain since 1 year insidious in onset and gradually progressive relieved with medication.  C/o decreased urine output since 1 year, no burning micturition , no frequency/urgency /hesitancy. No pedal edema, no SOB, no palpitations, orthopnea,PND  C/o belching,burning sensation in epigatrium . Past history: K/c/o hypothyroidism since 2years and is on medication.  Not known case of DM ,HTN ,epilepsy, asthma, TB  Personal history:  Diet: mixed Appetite: normal Sleep: adequate  Bowel and bladder : regular Addictions: none  Daily rotinue: she wakes up by 6am in the morning freshens up and goes for a walk.  She has breakfast by 8am and watches TV.  Talks to neighbour's and

      General medicine case-icu bed no.1               Date of admission:-12/09/2023 Case scenario:   A 29 yr old female came to the opd with the chief complaints of shortness of breath since 3  days History of present illness   - Patient was apparently asymptomatic 5 years ago then she noticed loss of hair and patches over her head,which is associated with joint pains and uclers  Then she developed pedal edema and renal biopsy was done and diagnosed  with  lupus nephritis and was on conservative management. Patient was initiated on hemodialysis since February 2023 and is on MHD(maintenance hemodialysis).   Presently Patient presented with shortness of breath since 3 days which was sudden in onset and gradually progressive. No aggravating and relieving factors Past history :  K/c/o hypertension since February and is on medication :  Nicardia 10mg po/tid  Arkamine 0.1mg po/tid  K/C/O seizures : Patient had one episode of involuntary movements initially started left-hand followed by tot