General medicine internal examination 1

A case of a 78 yr old female with altered sensorium

My patient is a 78 year old female housewife hailing from a rural district in south india. She presented to us with chief complaints of : Patient was brought to casuality on 23/11/22 at 4:00 am early in the morning with complaints of loose stools since 5 days and pain as mentioned by the atttender as she was screaming and restless with altered sensorium. History of presenting illness : The patient was apparently asymptomatic 5 days ago. She passed loose stools- watery in consistency, foul smelling and blood tinged on consuming kaya churnam (an ayurvedic powder) , went to RMP nearby and was given medication, even upon which loose stools didnot stop . The attender mentions she became weak and then on 23rd nov, apparently after eating curd rice , when patient slept , suddenly in the middle of night patient was screaming due to pain and could not talk anything, as mentioned by the attender. She was then bought to casuality. History of past illness: The patient'...

10

Case History and Clinical Findings A 50 YEAR OLD MALE WITH C/O COUGH SINCE 20 DYAS,FEVER SINCE 1 WEEK SHORTNESS OF BREATH SINCE 5 DAYS BILATERAL PEDL EDEMA SINCE 30 DAYS DECERASED URINE OUTPUT SINCE 1 DAY ALTERED SENSORIUM SINCE 8 HRS PATIENT WAS APPARENTLY ASYMPTOMATIC 20 DAYS AGO THEN HE DEVELOPED COUGH SINCE 20 DAYS,PRODUCTIVE TYPE WITH YELLOWISH WHITE COLOURED SPUTUM,SCANTY IN NATURE,NOT BLOOD TINGED AND FOUL SMELLING FEVER SINCE 1 WEEK,LOW GRADE,NOTT ASSOCIATED WITH CHILLS AND RIGORS SHORTNESS OF BREATH SINCE 5 DAYS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE PROGRESSED FROM GRADE 2 TO GRADE 4.ORTHOPNEA PRESENT NO PND. BILATERAL PEDAL EDEMA SINCE 3 DAYS,DECREASED URINE OUTPUT ,N/H/O VOMITINGS,LOOSE STOOLS,PAIN ABDOMEN K/C/O HTN SINCE 3 YEARS NOT ON REGULAR MEDICATION CKD SINCE 6 MONTHS ON CONSERVATIVE MANAGEMENT PERSONAL HISTORY : DIET :MIXED APPETITE : GOOD SLEEP : ADEQUATE BOWEL:REGULAR ALCHOL ISTORY- OCASSIONAL SINCE 20 YEARS STOPPED 6 MONTHS BACK GENERAL EXAMINATI...

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...

E- LOGS OF MEDICINE

Search This Blog