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PATIENT CAME WITH C/O DISTENSION OF ABDOMEN, SHORTNESS OF BREATH, PEDAL EDEMA

 Case History and Clinical Findings PATIENT CAME WITH C/O DISTENSION OF ABDOMEN SINCE 3 MONTHS C/O SHORTNESS OF BREATH SINCE 3 MONTHS C/O PEDAL EDEMA SINCE 20 DAYS HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 3MONTHS BACK THEN DEVELOPED DISTENSION OF ABDOMEN WITH SHORTNESS OF BREATH , GRADE II , INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE , NO AGGREVATING AND RELIEVING FACTORS . C/O PEDAL EDEMA SINCE 20 DAYS, B/L PITTING TYPE , EXTENDING UPTO THE KNEE C/O DECREASED IN URINE OUTPUT SINCE 20 DAYS C/O FEVER SINCE 5 DAYS ON AND OFF, ASSOCIATED WITH CHILLS AND RIGORSNO C/O ORTHOPNEA ,PND , CHEST PAIN NO C/O ORTHOPNEA , PND, CHESTPAIN ,PALPITATIONS NO C/O PAIN ABDOMEN , VOMITINGS ,LOOSE STOOLS PAST HISTORY: K/C/O CLD K/C/O T2DM SINCE 6 MONTHS AND IS ON UNKNOWN MEDICATION H/O ALBUMIN TRASFUSION DONE N/K/C/O HTN, EPILEPSY, ASTHMA, THYROID DISORDERS PERSONAL HISTORY : DIET :MIXED APPETITE :DECREASED SLEEP: DISTURBED H/O ALCOHOL INTAKE SINCE 20 YEARS EVERY DAY ABOUT -50ML NO H/O TOBACCO INTAKE NO H/
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PATIENT CAME WITH THE C/O ALTERED SENSORIUM

 Case History and Clinical Findings C/O ALTERED SENSORIUM SINCE 6 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE STOPPED USING INJECTION MIXTARD SC/BD SINCE 3 DAYS.H/O OF IRRELEVANT TALK SINCE YESTERDAY BUT ABLE TO RECOGNISE ATTENDERS.PATIENT IS ABLE TO MOVE ALL LIMBS AND NO H/O INVOLUNTARY MOVEMENTS. H/O LOW GRADE FEVER SINCE 6 DAYS,INTERMITTENT IN NATURE,TEMPORARILY RELIEVED ON MEDICATION. NOT A/O WITH BURNING MICTURITION,COLD, COUGH,VOMITING,LOOSESTOOLS. NO C/O SOB,CHESTPAIN,PALPITATIONS,ORTHOPNRA,PND,PEDAL EDEMA OR DECREASED URINE OUTPUT. PAST H/O: H/O SIMILAR COMPLAINTS IN FEB 2022,PATIENT WAS ADMITTED IN OUR HOSPITAL AND WAS DIAGNOSED AS HHS WITH DIABETIC NEPHROPATHY. PATIENT HAD H/O HIGH GRADE FEVER WITH CHILLS FOR 4 DAYS AND H/O STOPPAGE OF OHAS FOR 3 DAYS. K/C/O DM2 SINCE 1.5 YEARS. K/C/O CHRONIC PANCREATITIS AND CHRONIC KIDNEY DISEASE SINCE 1 YEAR H/O PULMONARY TB 2 YEARS AGO,USED ATT FOR 6 MONTHS GENERAL EXAMINATION: PATIENT IS CONSIOUS NOT ORIENTED TO TIME ,P
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C/O SPASM OF FINGERS OF UPPER LIMBS WITH TREMORS ,EXCESSIVE SWEATING AND GENERALIZED WEAKNESS

 Case History and Clinical Findings C/O SPASM OF FINGERS OF UPPER LIMBS WITH TREMORS SINCE 3DAYS ,EXCESSIVE SWEATING AND GENERALIZED WEAKNESS SINCE 3DAYS . PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK ,THEN HE STARTED BINGE DRINKING AND SINCE 3DAYS HE DEVELOPED SPASM OF FINGERS OF UPPER LIMB WITH TREMORS . H/O SWEATING PRESENT . H/O ANXIETY IS PRESENT . NO H/O CHEST PAIN AND PALPITATIONS , ORTHOPNEA,PND NO H/O VOMITINGS,ABDOMINAL PAIN ,DIARRHEA . H/O COUGH WITH EXPECTORATION ,WHITISH IN COLOR SINCE 10 DAYS INCREASED IN SUPINE POSITION . K/C/O TOBACCO DEPENDENCY SYNDROME K/C/O DM 2 SINCE 6 YRS NOT A K/C/O HTN,CVA,CAD,TB,EPILEPSY . H/O 2 UNITS OF BLOOD TRANSFUSION H/O SURGERY FOR PANCREATITIS PERSONAL HISTORY APPETITE LOST SINCE 10 DAYS DIET MIXED BOWEL AND BLADDER REGULAR OCCASSIONAL ALCOHOLIC SMOKING TOBACCO SINCE 15 YRS WITH 10 CIGGARETES PER DAY GENERAL EXAMINATION PT IS CONSCIOUS,COHERENT ,CO OPERATIVE NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA VITALS TEMP : 99 F
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C/O SOB, FEVER, RASH OVER THE ABDOMEN

 Case History and Clinical Findings C/O SOB SINCE 2 HRS FEVER SINCE 8 HRS RASH OVER THE ABDOMEN SINCE 3 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 2 HRS BACK THEN SHE DEVELOPED SUDDEN ONSET SOB GRADE 4 NO ORTHOPNEA/PND ,CHEST PAIN,PALPITATIONS,PEDAL EDEMA ,EXCESSIVE SEATING,GIDDINESS,WHEEZE PT IS K/C/O TYPE 1 DM ,MISSED 2 DOSES OF INSULIN 1 EP OF FEVER HIOGH GRADE A/W CHILLS AND RIGORS RASH OVER THE ABDOMEN SINCE 3 DAYS INITIALLY SMLL IN SIZE LATER PROGRESSED TO CURRENT STATE .H/O APPLYING PCM PASTE TO LESION NO H/O VOMITING,LOOSE STOOLS ,PAIN ABDOMEN,GIDDINESS PAST HISTORY : K/C/O TYPE 1 DM SINCE 3 YRS ON NPH,HAI INSULIN H/O RT HUMERUS FRACTURE ,TREATED CONSERVATIVELY NOT K/C/O HTN,ASTHMA,TB O/E PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA VITALS ; TEMP-98.8 BP-110/60 MMHG PR-158 BPM GRBS-HIGH SPO2-98 ON RA CVS :S1,S2 HEARD,NO MURMURS RS:BAE +,NVBS CNS: NAD P/A :SOFT,NON TENDER ,BOWEL SOUNDS+ DERAMTOLOGY REFERRAL DONE
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CHIEF COMPLAINTS: FEVER AND INVOLUNTARY MOVEMENTS IN BOTH LEFT UPPERLIMB AND LOWER LIMB SINCE 2 DAYS

 CHIEF COMPLAINTS:  FEVER AND INVOLUNTARY MOVEMENTS IN BOTH LEFT UPPERLIMB AND LOWER LIMB SINCE 2 DAYS 2 DAYS BACK 1 EPISODE INVOLUNTARY MOVEMENT IN BOTH UPPER LIMB AND LOWER LIMB WITH DEVIATION OF MOUTH 7 TO 8 EPISODES YESTERDAY 2 EPISODES SINCE MORNING C/O WEAKNESS OF LEFT UPPERLIMB AND LEFT LOWER LIMB SINCE 2DAYSSHE WAS APPARENTLY ASYMPTOMATIC 15 YEARS BACK ,AFTER WHICH SHE SUDDENLY FELL DOWN AND HAD LOSS OF CONSCIOUSNESSAND INVOLUNTARY MOVEMENTS OF LEFT UPPER AND LOWER LIMBS,FROTHING ,UPROLLING OF EYEBALLS.PATIENT HAD PAINLESS SUDDEN LOSS OF VISION IN THE LEFT EYE ASSOCIATED WITH LEFT UPPER AND LOWER LIMB WEAKNESS.AFTER SOME TIME PATIENT HYAD 1 EPISODE OF INVOLUNTARY MOVEMENTS OF BOTH UPPER AND LOWER LIMBS ASSOCIATED WITH LOSS OF CONSCIOUSNESS FOR 1 MINUTE,FROTHING,DEVIATION OF MOUTH.ON SUNDAY SHE HAD SIMILAR 3-4 EPISODES OF SEIZURES CT SCAN WAS DONE SHOWING SUBACUTE INFARCT IN RIGHT POSTERIOR PARIETAL LOBE AND RIGHT FRONTAL LOBE.NO H/O HEAD TRAUMANO H/O VOMITINGSPAST HISTORYUSED M
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C/O ABDOMINAL DISTENSION SINCE 1WEEK C/O DECREASED APETTITE SINCE 1 WEEK C/O DECREASED URINE OUTPUT SINCE AFTERNOON

 C/O ABDOMINAL DISTENSION SINCE 1WEEK  C/O DECREASED APETTITE SINCE 1 WEEK  C/O DECREASED URINE OUTPUT SINCE AFTERNOON  PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE . NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING .  GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED  NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE  PR -120BPM  BP - 130/80 MMHG  RR - 20CPM  SPO2 - 98% AT ROOM AIR  GRBS - 108MG%  CVS - S1S2 HEARD , NO MURMURS  CNS-HMF INTACT . NFND  RS -BAE PRESENT , NO ADDED SOUNDS  P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL , FLANKS FULL , NO ORGANOMEGALY , SHIFTING DULLNESS PRESENT , FLUID THRILL A
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PATIENT WITH C/O SOB SINCE 7 DAYS

PATIENT WITH C/O SOB SINCE 7 DAYS  PATIENT WAS APPARENTLY ASYMPTOMATIC 7 DAYS AGO THEN HE DEVELOPED SOB OF INSIDIOUS ONSET GRADUALLY PROGRESSIVE AND AGGRAVATED SINCE PAST 2 DAYS COUGH + WITH EXPECTORATION,BLOOD TINGED + FEVER + SINCE 7 DAYS ,LOW GRADE NOT WITH CHILLS AND RIGOR,COLDSORE THROAT -, ABDOMINAL PAIN -,VOMITING -,LOOSE STOOLS - N/KC/O CVA,CAD,TB,EPILEPSY K/C/O TB SINCE 7 YEARS AGO USED MEDICATION K/C/O HTN AND DM II SINCE 2 YEARS ON MEDICATION PERSONAL HISTORY APETITE-DECREASED SLEEP-ADEQUATE BOWEL AND BLADDER- REGULAR NO ALLERGIES  GENERAL EXAMINATION; PATIENT IS CONSIOUS ,COHERENT,COOPERATIVE  NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,EDEMA  VTALS PR-108 BPM BP- 120/60 MMHG RR-22 CPM  TEMP AFEBRILE SYSTEMIC EXAMINATION :  CVS : S1 S2 HEARD , NO MURMURS  RS : BAE +,RHONCI ?  PER ABDOMEN : SOFT , NON TENDER , NO ORGANOMEGALY  CNS : HGHER MOTOR FUNCTIONS PRESENT , NO FND  PULMONOLOGY REFFERAL DONE I/V/O BLOOD TINGED SPUTUM AND PREVIOUS TB ADVISED TRUNAAT,HRC
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