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55 yr /F with CKD

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Case: 55 yr female came with  Chief complaints : -Bilateral pedal oedema since 2 months -Shortness of breath since 10 days HOPI: Patient was apparently asymptomatic 2 months ago, then she developed bilateral pedal oedema,which is pitting type, extending upto knee .she developed SOB since 10 days , which is grade 2 Patient is on haemodialysis since 3 months Today she had sudden onset of decreased responsiveness  Past history: K/C/O DM since 5 yrs and on medication K/C/O HTN since 6 months and on medication (Nicardia 10 mg) Personal history: Appetite -Normal Diet-Mixed Bowel and bladder habits -Regular Sleep -Adequate Addictions - K/C/O smoker 20 beedis/ day General Examination: Patient is drowsy but arousable to deep pain No pallor, icterus, cyanosis, clubbing, lymphadenopathy Bilateral pedal oedema -present Vitals: PR:93 bpm BP:130/70 mm hg SpO2:82 on RA and 98 on 6l O2 CVS:S1S2 Present RS:BAE Present,NVBS P/A: Soft,non tender CNS:E3V5M6      POWER 
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Intern assessment

Name: Grandhi.N.D.L.S.Srujini Posted from 12/10/22 to 11/12/22 Case1: 45 yr male with pain abdomen  http://41srujini.blogspot.com/2022/10/40-m-with-pain-abdomen.html 1) what is the provisional Diagnosis  A) Inflammatory bowel disease 2)Causes of thrombocytopenia A)https://www.ncbi.nlm.nih.gov/books/NBK542208/ 3)Learnt how to take ABG Samples Case2: 70 yr male with fever http://41srujini.blogspot.com/2022/10/73-yr-male-with-fever.html 1) what is provisional Diagnosis A) Malaria fever 2) Learnt how to treat malaria https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036668/ Case3: 40 yr female with fever and pedal oedema  http://41srujini.blogspot.com/2022/11/40-yr-female-with-fever-and-pedal-oedema.html 1)What is provisional Diagnosis A)Fever secondary to AKI 2) Causes of fever with aki https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813127/ Case4: 70 yr female with generalized weakness  http://41srujini.blogspot.com/2022/11/70-yr-female-with-generalized-weakness.html 1)What is provisional Diag
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70 yr female with generalized weakness

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70 yr female presented with chief complaints of Generalized weakness from 2 days Decreased appetite from 2 days Vomiting from 1 day HOPI: patient was apparently asymptomatic 2 days back then she developed generalized weakness which is insidious in onset,gradually progressive. Vomiting since 1day,1 episode,non bilious,non blood stained Past history: K/C/O HTN from 2yrs,on medication DM from 2 yrs,not on regular medication Present history:  Appetite- normal Diet-Mixed Bowel and bladder habits -Regular Sleep- Adequate Addictions:Pan chewing from 40 yrs General Examination:  Patient is conscious,coherent, co-operative Well oriented to time, place and person moderately built and nourished No pallor, icterus, cyanosis, clubbing, pedal oedema, lymphadenopathy  Vitals: BP:130/80 mm Hg PR:100bpm Temp:98.1 F Systemic Examination: CVS: S1S2 Present RS:BAE Present,NVBS P/A:Soft, non tender CNS:NAD Investigations: Provisional D
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40 yr female with fever and pedal oedema

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40 yr female who is farmer by occupation resident of Masanepelli village,Janagam mandal ,Yadadri district  came with chief complaints of - Fever since 1 week,subsided 3 days ago - Pedal oedema since 1 week -Facial puffiness since 1 week -Burning micturition 1 week ago ,subsided 3 days ago -Head ache,neck pain - 1 day HOPI: Patient was apparently asymptomatic 1 week ago then she developed fever  which was for 3 days which is high grade , intermittent, relieved on medication.Then she developed pedal oedema 3 days ago extending upto knee,pitting type  Past history: Denovo HTN N/K/C/O DM, Asthma, TB, Epilepsy, CVA, CAD Present history: Appetite -Nornal Diet-Mixed Bowel and bladder habits -Burning micturition from 3 days No Addictions General Examination: Patient is conscious, coherent, co-operative,well oriented to time, place and person, moderately built and nourished No pallor, icterus, cyanosis, clubbing, pedal oedema, lymphadenopathy Vitals: PR:99bpm BP:170/100 RR:25 Temp:9
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73 yr male with fever

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Case: 73 yr male came with chief complaints of - Fever since 7 days - Cough since 7 days -SOB since 7 days HOPI: -Patient was apparently asymptomatic 7 days ago then he developed fever which is  intermittent,high grade associated with body pains - Cough since 7 days associated with expectoration,no haemoptysis -SOB since 7 days ,grade 2 - No history of vomiting,loose stools,orthopnea,PND Past history: K/C/O  HTN since 8 yrs on Telma 40 mg N/K/C/O DM,Asthma, epilepsy,CVA,CAD Patient has history of snake bite 30 yrs ago after which he developed hypopigmented patches on both lower limbs and upper limbs  Present history: Appetite -Normal Diet- Mixed Sleep -Adequate Bowel and bladder habits -Regular Addictions:Takes 10 beedis / day from 20 years Chronic alcoholic from 20 years  General Examination: Patient is conscious, coherent, co-operative Well oriented to time, place and person Moderately built and nourished No pallor , icterus, cyanosis, clubbing, pedal oedema, lymphadenopathy
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33 yr male with pain abdomen

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Case: 33 yr male came with chief complaints of  - Epigastric pain since 5 yrs HOPI: Patient was apparently asymptomatic 5 yrs ago then he developed epigastric pain he went to local hospital 5 yrs ago where he was given medication and again after 4 years he presented with loin pain went to local hospital where he was diagnosed with renal calculi and now presented with epigastric pain since 1 month ,insidious in onset ,pricking type,non radiating, reduced after taking food, burning sensation after taking spicy food,relieved after medication. -No fever , vomiting, burning micturition, diarrhoea  Past history: Not a known case of DM,HTN, Asthma, Epilepsy,CVA,CAD,TB Present history: Appetite -Nornal Diet-Mixed Sleep -Adequate Bowel and bladder habits -Regular No addictions General Examination: Patient is conscious, coherent, co-operative Well oriented to time, place and person Moderately built and nourished  - No pallor , icterus, cyanosis, clubbing,pedal oedema, lymphadenopathy
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62/M with CKD

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Case: 62 yr male with chief complaints -Loss of appetite from 1 month -SOB since 20 days -Cough since 15 days HOPI: -C/o shortness of breath since 20 days grade 4 ,no pnd and no orthopnea -Cough since 15 days ,non productive ,no haemoptysis Past history: K/C/O HTN from 5 years not on regular medication,DM from 5 yrs not on regular medication General Examination: Patient is conscious, coherent, co-operative Well oriented to time, place and person Moderately built and nourished No pallor, icterus, cyanosis , clubbing, pedal oedema, lymphadenopathy Vitals: PR:88bpm BP:160/90mm Hg RR:26 cpm Temp:98.7F Systemic Examination: CVS: S1S2 Present RS: BAE Present,NVBS P/A: Soft, non tender CNS:NAD Investigations: Provisional Diagnosis: CKD on MHD with diabetic nephropathy,K/C/O DM and HTN Treatment: 1)Salt and water restriction 2)INJ.CEFTRIAX
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