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 Case History and Clinical Findings 43 YEAR OLD FEMALE PATIENT CAME WITH COMPLAINTS OF FEVER SINCE 1 WEEK, VOMITINGS AND LOOSE STOOLS SINCE 4 DAYS INVOLUNTARY MOVEMENTSOF BOTH UPPER LIMBS AND LOWER LIMBS SINCE 1 DASY HOPI: PATIENT WAS APPARENTL ASYMPTOMATIC 1WEEK BACK, THEN SHE DEVELOPED FEVER OF LOW GRADE INTERMITTENT, RELIEVED ON MEDICATION NOT ASSOCIATED WITH CHILLS AND RIGOR, BURNING MICTURITION, COUGH AND COLD PATIENT HAD VOMITINGS WHICH ARE BILIOUS, NON PROJECTILE, NON BLOOS TINGED, FILLED WITH FOOD PARTICLES(2-3 TIMES PER DAY)     C/O LOOSE STOOLS LOW VOLUME, WATERY CONSISTENCY, NON MCOPURUENT, NON BLOOD TINGED, NO H/O OUTSIDE FOOD CONSUMPTION PATIENT HAD 3 EPISODES OF INVOLUNTARY MOVEMENTS 9RIGIDITY OF BOTH UPPER LIMBS AD LOWER LIMBS) ASSOCIATED WITH UPROLLING OF EYES, INVOLUNTARY MICTURITION, TONGUE BITE AND IS IN POST ICTAL CONFUSION/IRRITABLE SINCE THEN PAST HISTORY: K/C/O HTN SINCE 3 MONTHS(ON IRREGULAR MEDICATION OF UNKNOWN DRUGS) NOT A K/C/O DM, ASTHMA, THYROID DISORDERS,
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23

  Case History and Clinical Findings 74 YEAR OLD FEMALE PATIENT WAS BOUGHT TO CASUALITY WITH GENERALISED WEAKNESS SINCE 3 DAYS HOPI: PATIENT WAS APPARENTLY ALRIGHT 3 DAYS BACK TODAY PATIENT ATTENDER SAW HER ON THE FLOOR WITH HER CLOTHES STAINED WITH FAECES AND MICTURTION NO FOOD INTAKE SINCE LAST 3 DAYS NO C/O CHEST PAIN , FEVER , SOB , PALPITATIONS NO VOMITINGS , LOOSE STOOLS SHE IS ABLE TO LIFT HER HANDS AND LEGS PAST HISTORY : N/K/C/O HTN , DM 2 , THYROID DISORDERS , CVA , CAD PERSONAL HISTORY: MIXED DIET APPETITE LOST BOWEL AND BLADDER - REGULAR ADDICTION : REGULAR 180 ML DAILY ALCOHOL CONSUMPTION SINCE 10 YEARS GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS ,LYMPHADENOPATHY,EDEMA VITALSTEMP- 99.9 F PR- 124 BP RR-22 CPM BP-120/70MMHG SPO2- 99% AT RA CVS- S1,S2 HEARD , NO MURMERS RS- BLAE PRESENT , NO ADDED SOUNDS P/A- SOFT, NON TENDER NO ORGANOMEGALY CNS- RIGHT LEFT TONE : UL N N LL N N POWER : UL 4/5 4/5 LL 4/5 4/5
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22

41 YEAR OLD FEMALE  Patient was brought with complaints of 2 episodes of involuntary movements of upper and lower limbs and hemoptysis .History of present illness :- Patient was apparently asymptomatic till 5 am then she developed sudden onset of movements of both upper and lower limbs at 5am in the morning which lasted for about 4-5mins , not associated with any trigger, no aura and the patient was confused after the episode she had an other similar episode while bringing to the hospital.She had two similar episodes at the hospital.Sequence of events :- 13 years ago she developed low back ache and generalised weakness started for which she went to local hospital.Then during the investigations was found to be having soft tissue overgrowth,(as said by attenders ,no documentation)and need to get operated, during routine investigations creatinine was elevated, then she was started on conservative management .(Sod bicarb,Shelcal,Omeprazole,Iron folate)Since then ,she is on routine followu
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21

  Case History and Clinical Findings 57 YEAR OLD MALE PATIENT CAME WITH C/O OF SLURRED SPEECH 4PM ON 5/08/2023 C/O RIGHT UPPER LIMB &LOWER LIMB WEAKNESS SINCE 4PM. PATIENT PRESENTED TO CASUALITY WITH ALTERED SENOSIRUM SINCE 4PM HOPI: PATIENT HAS A H/O SLURRED SPEECH AND H/O RIGHT UPPER LIMB AND LOWER LIMB WEAKNESS SINCE THEN ASSOCIATED WITH FALL. NO LOC, NO ENT BLEED NO H/O FEVER, BURNING MICTURITION, LOOSE STOOLS NO H/O SOB, PALPITATIONS, ORTHOPNEA, PND HISTORY OF PAST ILLNESS: NOT A K/C/O HTN,DM,EPILEPSY, THYROID DISORDERS. O/E: GCS-E5 V4 M5 BP- 90/60MMHG PR- 68BPM CVS- S1S2 + RS- NVBS + SPO2- 97% ON RA CNS- TONE: RIGHT LEFT UL INCREASED INCREASED LL INCREASED INCREASED POWER: UL &LL COULDNT ELICIT REFLEXES: B +++ ++ T + + S + + K - + A - - P FLEX FLEX PUPILS- B/L CONSTRICTED, SLUGGISH REACTIVE COURSE OF ADMISSION: PATIENT WAS ADMITTED I/V/O ABOVE MENTIONED COMPLAINTS. NECESSARY INVESTIGATIONS WERE DONE. MRI FINDINGS- ACUTE INFARCT IN LEFT CAUDATE AND LEFT L
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20

  Case History and Clinical Findings A 45 YEARS OLD MALE, CAME WITH COMPLAINTS OF ABDOMINAL DISTENSION AND SHORTNESS OF BREATH AND SWELLING OF BOTH LOWER LIMBS SINCE 1 WEEK HOPI: PATIENT WAS ASYMPTOMATIC,6 YEARS AGO AND THEN HE DEVELOPED A MINOR INJURY TO NECK WHICH WAS NOT HEALING AND THEN WENT FOR REGULAR CHECKUP AND WAS DIAGNOSED AS HAVING DIABETES AND STARTED ON OHA, AND 3 YEARS AGO HE WAS DIAGNOSED TO BE HAVING HYPERTENSION AND STARTED ON TAB. TELMISARTAN 40MG/OD,AND WAS ASYMPTOMATIC 7 MONTHS AGO AND THEN IN THE EVENING HE SUDDENLY BECAME ,UNRESPONSIVE AND IRRELEVANT TALK AND WAS TAKEN TO HOSPITAL AND WAS FOUND TO BE HAVING HYPOGLYCAEMIA AND WAS ASKED TO STOP OHA,AND WAS FOUND TO BE HAVING JAUNDICE AT THAT TIME AND WAS ASKED TO AVOID ALCOHOL BUT HE DIDN’T STOPPED ALCOHOL CONSUMPTION. AND 5 MONTHS AGO,HE DEVELOPED SIMILAR COMPLAINTS AND WAS ADMITTED HERE AND WAS DIAGNOSED TO BE HAVING,ACUTE DECOMPONSATED LIVER DISEASE AND WAS KEPT ON CONSERVATIVE MANAGEMENT, A DIAGNOSTIC AND THERAP
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19.

  Case History and Clinical Findings A 32 YEAR OLD MALE, CAME TO THE CASUALTY WITH THE CHIEF COMPLAINTS OF 1. PAIN ABDOMEN SINCE 10 DAYS 2. SOB SINCE 10 DAYS 3. B/L PEDAL EDEMA SINCE 10 DAYS 4. DECREASED URINE OUTPUT SINCE 1 DAY PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS AGO FOLLOWED BY HE DEVELOPED B/L PEDAL EDEMA WHICH IS OF PITTING TYPE INITIALLY ABOVE THE KNEES AND PROGRESSED TILL THIGH AND LATER TO ABDOMEN FOLLOWED BY WHICH HE DEVELOPED ABDOMINAL TIGHTNESS, PAIN ABDOME AND DIFFICULTY BREATHING SINCE 10 DAYS PAIN IN THE ABDOMEN WAS DIFFUSED TO WHOLE ABDOMEN AND GRADUALLY INCREASING INTENSITY AND IS SQUEEZING TYPE PAIN IS PERSISTENT THROUGHOUT THE DAY NO H/O RADIATION TO THE BACK H/O FEVER 10 DAYS AGO NO H/O NAUSEA ND VOMITINGS NO AGGREVATING AND RELIEVING FACTORS PATIENT HAD A HISTORY OF DECREASED URINE OUTPUT SINCE 10 DAYS AND NO URINE OUTPUT SINCE 1 DAY AND YESTERDAY EVENING HE HAD A H/O FALL DUE TO GIDDINESS AND NO LOC H/O VOMITINGS FOR 5 DAYS, 5 TO 6 EPISODES OF VOMIT
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