General medicine elogs

85 year old male came to casualty with chief complaints of weakness of left upperlimb and lowerlimb since 15 days Difficulty in swallowing since 15 days  Deviation of mouth towards left side since 15 days No h/o of involuntary micturation No history of involuntary defecation K/C/O HTN and on medication On examination : Patient conscious , coherant , cooperative  Past history : Hypertensive and on medication No relevant family and personal history Temperature : afebrile Pulse rate: 100/ min Blood pressure : 140/90 mmhg Respiratory rate : 22 cycles per min SPO2 :99 % at room air GRBS: 198 mg/dl CVS : S1 and S2 heard  Respiratory system : NVBS present , BAE present CNS : Conscious  speech - normal no signs of meningeal irritation Tone :Increased  in left side power:      Right.         left                     4+/5.        4+/5 Reflexes :                        Right.              left Biceps:.         +.                     +++ Triceps:.        +.                      +++ Gait          S

Patient was apparently asymptomatic 1 day ago.32 year old male lorry driver by occupation came to casualty with chief complaints of pain in abdomen since one day. Patient had alcohol intake today morning (14/09/21), and had food in the afternoon.  Then he developed pain in abdomen at umbilical region, throbbing type, non radiating, aggravated after food intake, not associated with nausea, vomiting , constipation and loose stools, No History of fever and burning micturition. Not a known case of hypertension diabetes epilepsy tuberculosis asthma. O/E: vitals: temperature AFEBRILE, pulse rate 88 BPM, respiratory rate 16 CPM , BP 130/80 mm Hg, spo2 98% at Room air. CVS : S1 S2 heard RS: BAE+ NVBS + PA: obese abdomen, tenderness in gastric and hypochondrial region, bowel sounds present. Provisional diagnosis: Acute pancreatitis? Secondary to alcohol dependence INVESTIGATIONS :  HEMOGRAM : HB : 14.3 GM/ DL TLC : 11,400 CELLS/ CUMM RBC : 4.34 MILLION/ CUMM PCF : 2.05 PCV : 40.1 VOL %

A 75 year old male patient came to casualty with the complaints of fever  and cough since four days  Patient was apparently asymptomatic one week ago. Then , he developed pain abdomen ( generalised ) since 1 week , not associated with vomitings and difficulty in passing stools. He developed fever since 4 days which was high grade associated with chills and cough since 4 days associated with expectoration. H/O orthopnea present , H/O dribbling of urine . No H/O pedal edema, PND K/C/O DM and on OHAs  K/C/O HTN He is a known alcoholic and last intake was 15 days back. General examination: The patient is conscious coherent and cooperative Moderately built and moderately nourished.  Vitals: Temp: afebrile, PR 120bpm, RR 22 cpm, BP 110/60mm Hg , GRBS 208 mg% P/A:  Shape of abdomen: scaphoid Non tender Liver and spleen - not palpable Bowel sounds are present CVS: S1, S2 + RS: BAE + , NVBS + CNS: NFND Investigations: 8 /9 /10

45  female came to opd with chief complaints of fever since  15 days  which is low grade , intermittent and decreased on medication associated with dry cough , body pains  and generalized weakness since 10 days  h/o loose stools 4 to 5 episodes 4 days back which decreased on medication  no h/o pain abdomen , vomiting ,and burning micturation  no h/o cold / sob/ headache / rash and other complaints  h/o diabetes since 10 years and on OHA no h / o hypertension , CAD, asthma , Tuberculosis personal history: Appetite : lost bowel and bladder movements regular  no other addictions Family history : no relevent family history   General examination: No pallor , Icterus, cyanosis, clubbing and lymphadenopathy Temperature : 98.6 F PR: 84 bpm RR: 18 Cycles per min Spo2 : 98 % at RA CVS:  S 1 and S 2  heard  Per abdomen : no tenderness present  Respiratory system:  BAE + and NVBS + CNS :  Intact  Diagnosis:  Viral pyrexia  under evaluation    Treatment given : Day 1 1. IVF - NS ,RL @ 45ml/hr 2. TA