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General medicine internal examination 1


 















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  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 LE...
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OSCE PREFINAL EXAM

 OSCE- PREFINALS DEC 2023: Case report :    I have tried to answer some of the questions regarding case discussion of our patient    1. How to clinically differentiate between coarse and fine crepitations ? Ans-  well, crepitations or crackles  are adventitious respiratory sounds which occur when an obstructed airway due to accumulated  secretions opens in inspiratory phase. The sudden opening of an obstructed airway causes an immediate re-equilibration of the pressures on both sides creating vibrations in the airway walls.  Fine crackles --  A).  having a short duration and a higher pitch,           Often, fine crackles are repetitive, originate          in the basal part of the lung, and not altered          by coughing. B) Coarse crackles  appear to be a longer                     durati...
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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 TH...
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