GENERAL MEDICINE

27 Nagatarun Kumar
3rd semester

We have been given 5 questions as an assignment to analyze,asess , understand and write the preview of the given cases.


  ๐1.
๐‹๐จ๐ง๐  ๐œ๐š๐ฌ๐ž๐ฌ

๐‚๐š๐ฌ๐ž 1 ๐ฅ๐ข๐ง๐ค-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1


๐‚๐š๐ฌ๐ž ๐ข๐ง ๐›๐ซ๐ข๐ž๐Ÿ- A 44 year old man presented to OPD with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

๐‘ฐ๐’๐’”๐’Š๐’ˆ๐’‰๐’•๐’”- The case was taken in a very elaborative and instructive manner.
Each and every symptom of the patient was clearly mentioned being it the present or medical and personal history. An elaborative analyzing of the case has been done on the basis of all the symptoms and treatment was given appropriately.

And the questions which were asked regarding the case were very pertinent and answers were presented with tables and were collected from various articles.


๐‘ช๐’‚๐’”๐’† 2 ๐’๐’Š๐’๐’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

๐‘ช๐’‚๐’”๐’† ๐’Š๐’ ๐’ƒ๐’“๐’Š๐’†๐’‡-A 47 year male patient resident of Nalgonda came with chief complaints of abdominal distension and swelling of bilateral lower limbs since 6 months which is gradually increasing since 10 days and fluid discharge from the umbilical area since 2 days and fever since 2 days.

๐‘ฐ๐’๐’”๐’Š๐’ˆ๐’‰๐’•๐’”-
The scenario of the case was clearly presented. And also all the investigation reports were updated regularly. It would have been even better if the treatment is updated regularly.


๐‘ช๐’‚๐’”๐’† 3 ๐’๐’Š๐’๐’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006004-case-presentations.html


๐‘ช๐’‚๐’”๐’† ๐’Š๐’ ๐’ƒ๐’“๐’Š๐’†๐’‡-
26 year old male, construction worker by occupation presented to the casualty with the chief complaints of :-Fever since 3 months ,Cough with expectoration since 2 months ,Dyspnea on exertion since 2 months, Vomiting since 2 months, Decreased appetite and weight loss over last 2 months ,Dark coloured stools since 2 weeks. 



๐‘ฐ๐’๐’”๐’Š๐’ˆ๐’‰๐’•๐’”-
๐‘‡โ„Ž๐‘’ โ„Ž๐‘–๐‘ ๐‘ก๐‘œ๐‘Ÿ๐‘ฆ ๐‘œ๐‘“ ๐‘๐‘Ÿ๐‘’๐‘ ๐‘’๐‘›๐‘ก๐‘–๐‘›๐‘” ๐‘–๐‘™๐‘™๐‘›๐‘’๐‘ ๐‘  ๐‘ค๐‘Ž๐‘  ๐‘Ž๐‘๐‘๐‘ข๐‘Ÿ๐‘Ž๐‘ก๐‘’๐‘™๐‘ฆ ๐‘ค๐‘Ÿ๐‘–๐‘ก๐‘ก๐‘’๐‘› ๐‘ค๐‘–๐‘กโ„Ž ๐‘œ๐‘›๐‘ ๐‘’๐‘ก๐‘  ๐‘Ž๐‘›๐‘‘ ๐‘กโ„Ž๐‘’ ๐‘Ÿ๐‘’๐‘๐‘œ๐‘Ÿ๐‘ก๐‘  ๐‘ค๐‘’๐‘Ÿ๐‘’ ๐‘Ž๐‘™๐‘ ๐‘œ ๐‘ข๐‘๐‘‘๐‘Ž๐‘ก๐‘’๐‘‘ ๐‘œ๐‘› ๐‘Ž ๐‘Ÿ๐‘’๐‘”๐‘ข๐‘™๐‘Ž๐‘Ÿ ๐‘๐‘Ž๐‘ ๐‘–๐‘  .๐‘‡โ„Ž๐‘’ ๐‘–๐‘š๐‘Ž๐‘”๐‘’๐‘  ๐‘œ๐‘“ ๐‘กโ„Ž๐‘’ ๐‘”๐‘’๐‘›๐‘’๐‘Ÿ๐‘Ž๐‘™ ๐‘’๐‘ฅ๐‘Ž๐‘š๐‘–๐‘›๐‘Ž๐‘ก๐‘–๐‘œ๐‘› ๐‘ค๐‘Ž๐‘  ๐‘Ž๐‘™๐‘ ๐‘œ ๐‘Ž๐‘ก๐‘ก๐‘Ž๐‘โ„Ž๐‘’๐‘‘ ๐‘คโ„Ž๐‘–๐‘โ„Ž ๐‘ค๐‘–๐‘™๐‘™ ๐‘š๐‘Ž๐‘˜๐‘’ ๐‘กโ„Ž๐‘’ ๐‘๐‘Ž๐‘ ๐‘’ ๐‘š๐‘œ๐‘Ÿ๐‘’ ๐‘‘๐‘’๐‘๐‘–๐‘๐‘ก๐‘–๐‘ฃ๐‘’.๐ด๐‘›๐‘‘ ๐‘Ž๐‘™๐‘™ ๐‘กโ„Ž๐‘’ ๐‘–๐‘›๐‘ฃ๐‘’๐‘ ๐‘ก๐‘–๐‘”๐‘Ž๐‘ก๐‘–๐‘œ๐‘› ๐‘Ÿ๐‘’๐‘๐‘œ๐‘Ÿ๐‘ก๐‘  ๐‘ค๐‘’๐‘Ÿ๐‘’ ๐‘๐‘Ÿ๐‘’๐‘ ๐‘’๐‘›๐‘ก๐‘’๐‘‘ ๐‘–๐‘› ๐‘Ž ๐‘โ„Ž๐‘Ÿ๐‘œ๐‘›๐‘œ๐‘™๐‘œ๐‘”๐‘–๐‘๐‘Ž๐‘™ ๐‘š๐‘Ž๐‘›๐‘›๐‘’๐‘Ÿ.

๐’๐ก๐จ๐ซ๐ญ ๐‚๐š๐ฌ๐ž๐ฌ

๐‘ช๐’‚๐’”๐’† 1 ๐’๐’Š๐’๐’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006001-case-presentations.html

๐‘ช๐’‚๐’”๐’† ๐’Š๐’ ๐’ƒ๐’“๐’Š๐’†๐’‡-
A 45 year old female patient farmer by occupation resident of Nalgonda came to casuality with complaints of vomitings and abdominal pain since 4 days ,she was bitten by snake on her right lateral foot.

๐‘ฐ๐’๐’”๐’Š๐’ˆ๐’‰๐’•๐’”-
๐‘‡โ„Ž๐‘’ ๐‘๐‘Ž๐‘ ๐‘’ ๐‘ค๐‘Ž๐‘  ๐‘ค๐‘Ÿ๐‘–๐‘ก๐‘ก๐‘’๐‘› ๐‘Ž๐‘‘๐‘’๐‘ž๐‘ข๐‘Ž๐‘ก๐‘’๐‘™๐‘ฆ ๐‘Ž๐‘›๐‘‘ ๐‘๐‘œ๐‘š๐‘๐‘Ž๐‘๐‘ก๐‘™๐‘ฆ . ๐‘‡โ„Ž๐‘’ โ„Ž๐‘–๐‘ ๐‘ก๐‘œ๐‘Ÿ๐‘ฆ ๐‘œ๐‘“ ๐‘–๐‘™๐‘™๐‘›๐‘’๐‘ ๐‘  ๐‘ค๐‘Ž๐‘  ๐‘‘๐‘’๐‘ ๐‘๐‘Ÿ๐‘–๐‘๐‘’๐‘‘ ๐‘๐‘Ÿ๐‘’๐‘๐‘–๐‘ ๐‘’๐‘™๐‘ฆ .๐‘‡โ„Ž๐‘’ ๐‘ ๐‘–๐‘ก๐‘’ ๐‘œ๐‘“ ๐‘ ๐‘›๐‘Ž๐‘˜๐‘’ ๐‘๐‘–๐‘ก๐‘’ ๐‘ค๐‘Ž๐‘  ๐‘Ž๐‘™๐‘ ๐‘œ ๐‘Ž๐‘ก๐‘ก๐‘Ž๐‘โ„Ž๐‘’๐‘‘ ๐‘Ž๐‘™๐‘œ๐‘›๐‘” ๐‘ค๐‘–๐‘กโ„Ž ๐‘กโ„Ž๐‘’ ๐‘–๐‘›๐‘ฃ๐‘’๐‘ ๐‘ก๐‘–๐‘”๐‘Ž๐‘ก๐‘–๐‘œ๐‘› ๐‘Ÿ๐‘’๐‘๐‘œ๐‘Ÿ๐‘ก๐‘ .
๐ด๐‘›๐‘‘ ๐‘Ž ๐‘™๐‘–๐‘›๐‘˜ ๐‘ก๐‘œ โ„Ž๐‘–๐‘”โ„Ž ๐‘ฃ๐‘  ๐‘™๐‘œ๐‘ค ๐‘‘๐‘œ๐‘ ๐‘’ ๐‘Ž๐‘›๐‘ก๐‘–๐‘ ๐‘›๐‘Ž๐‘˜๐‘’ ๐‘ฃ๐‘’๐‘›๐‘œ๐‘š ๐‘ค๐‘Ž๐‘  ๐‘๐‘Ÿ๐‘œ๐‘ฃ๐‘–๐‘‘๐‘’๐‘‘ ๐‘คโ„Ž๐‘–๐‘โ„Ž ๐‘ค๐‘Ž๐‘  ๐‘ฃ๐‘’๐‘Ÿ๐‘ฆ ๐‘–๐‘›๐‘“๐‘œ๐‘Ÿ๐‘š๐‘Ž๐‘ก๐‘–๐‘ฃ๐‘’.

๐‘ช๐’‚๐’”๐’† 2 ๐’๐’Š๐’๐’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

๐‘ช๐’‚๐’”๐’† ๐’Š๐’ ๐’ƒ๐’“๐’Š๐’†๐’‡-
A 19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year ,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year ,Abdominal distension and facial puffiness since 6 months, Pedal edema since 3 months , Low back ache since 3 months .

๐‘ฐ๐’๐’”๐’Š๐’ˆ๐’‰๐’•๐’”-
The case is presented in a chronological order.The CNS examination was report was presented elaboratively and all the investigation reports are also provided.
The images of the purple striae were also attached and updated regularly.


๐‘ช๐’‚๐’”๐’† 3 ๐’๐’Š๐’๐’Œ-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html

๐‘ช๐’‚๐’”๐’† ๐’Š๐’ ๐’ƒ๐’“๐’Š๐’†๐’‡-
35 year old man working as a food caterer presented to our OPD with the chief complains of :-Dyspnea at rest since 5 days ,Cough with expectoration since 5 days ,Bilateral pedal edema since 4 days ,
Abdominal distension since 3 days.

๐‘ฐ๐’๐’”๐’Š๐’ˆ๐’‰๐’•๐’”- The examination images were provided along with the investigation reports and videos. And treatment protocol is also updated regularly


ANSWER 2 : 
•Long case :
A 44 year old stonemason from Miriyalguda, presented with a 3 day history of anasarca, frothy urine and gradually decreasing urine output, on a background of a 10 year history of chronic bilaterally symmetric polyarthritis (evidenced by severe pain, edema and limitation of joint movements).
Diagnosis : 
Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

*Final diagnosis is being done after excluding factors as in differential diagnosis . And Taking into all the possible scenarios around it. 

Treatment
Free water restriction for Hyponatremia
Tab. PREDNISOLONE P/O 20 mg OD
Tab FEBUXOSTAT P/O 80 mg OD
Haemodialysis for worsening renal dysfunction

•Shortcase : A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.

Diagnosis :
 6 months history of gradually progressive, asymmetric rest tremor with autonomic features is provisionally diagnosed with 

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.
2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

Treatment:
1. Tab. Syndopa Plus 125 mg QID
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD

•Shortcase 2 : 
19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :

-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .

-Abdominal distension and facial puffiness since 6 months.

- Pedal edema since 3 months.

- Low back ache since 3 months .

- Feeling low , not feeling to talk to anyone.

- Weight gain and decreased libido since 3months.

- Loss of libido and erectile dysfunction since 2 months .


Diagnosis : 
IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

TINEA CORPORIS

DENOVO HTN . 

Treatment: 
Ointment AMLORFINE 

FUSIDIC ACID CREAM.

SALINE COMPRESS OVER LEISONS.

Plan to start anti fungals on next visit once dose of steroids is reduced .
TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.

Tab Shelcal 500 OD and Tab Vit D 3 Od.

Tab ULTRACET /PO/SOS.

question 3:
Long case:-

Investigations done are:-
Current Admission - Blood tests
Blood work from previous presentations to hospital. RA factor was negative
24hrs urinary protein: 1500 mg
24hrs urinary creatinine: 0.8
Urine Microscopy - Freshly voided urine sample was centrifuged at high speed (> 2700 RPM) and sediment collected and fixed on glass slide and examined under microscope at 400 (10x * 40x) showed DYSMORPHIC RBCs (black circles) and occasional pus cells (red circles). Dysmorphic RBCs were those that had altered shape, microcytic or with membrane defects.
Efficacy of Treatment given:-
Tab. PREDNISOLONE P/O 20 mg OD:-It is used to treat conditions such as arthritis, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies. It decreases your immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.
Tab FEBUXOSTAT P/O 80 mg OD:-class of medications called xanthine oxidase inhibitors. It works by decreasing the amount of uric acid that is made in the body. Febuxostat is used to prevent gout attacks but not to treat them once they occur.
Haemodialysis for worsening renal dysfunction


Short case-1

Investigations done are:-
ECG:-Shows Sinus Tachycardia with pseudo infarct pattern in leads I and aVL with dagger q waves in the same leads,No late intrinsicoid deflection of R wave with modified Cornell criteria showing LVH.
2 D Echo :-Grade II diastolic dysfunction
Efficacy of Treatment given:-
Tab. Syndopa Plus 125 mg QID:- is a combination of two medicines used to treat Parkinson's disease. It is one of the most effective medications to relives symptoms of Parkinson's disease such as tremor, muscle stiffness and difficulty moving.
Tab. Syndopa 125 mg CR OD:-is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors , stiffness and slowness of movement.
 Tab. Telma 40 mg OD:- is a medicine used to treat high blood pressure and heart failure. Lowering blood pressure helps to prevent future heart attack and stroke. 

Short case -2

Investigations done are:-

CBP - HB - 13.4 g/dl 
TLC - 6,800
PLT - 1.5 lakhs.
RBS - 139 mg/dl 
CUE - ALBUMIN - +1 
SUGARS - NIL .
PUS CELLS - 3-4 
RBC - NIL .
LFT - TB -1.03
DB-0.21
ALBUMIN - 3.9
RFT - UREA - 22 
SERUM CREATININE -0.6
ELECTROLYTES - NA - 136 
K- 4 
CL-98 
USG ABDOMEN - NORMAL.
ECG - SINUS TACHYCARDIA 
LVH PRESENT.

Efficacy of Treatment given:-
Tab.Telma 20 mg od - due to low cortisol level
 TAB HIZONE 15 mg:- is prescribed for Severe allergic reactions,Allergic conditions,Cancer,Skin disorders,Eye disorders.
Tab Shelcal 500 OD and Tab Vit D 3 Od:-To treat vitamin D and Calcium deficiency.
Tab ULTRACET /PO/SOS:-is a combination of two medicines that are used for short term relief of pain, inflammation, and swelling in conditions that affect joints and muscles. 
Tab Itraconazole 100 mg bd.:-to treat a variety of fungal infections.
Tab levocitrixine 5mg od.:-relieve runny nose, sneezing, and redness, itching.

question 4:

I still dint get any case looking forward to investigate a case.

Question:5


I have learned many things during the online clinical sessions. I got a chance to log for a case, the experience was quite helpful for me in understand how the system works. Our assigned interns were very cooperative and helped in making the elogs. General Medicine department has put in lots of efforts to make the online teaching process much more effective and productive. This online experience will definitely make our offline postings easier. This way of learning helped us in getting exposure to different cases , their diagnosis and treatment. I am very thankful to the GM department for their efforts in making our learning process easier and more interesting. 



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