Medicine log book by kyasa Sai Brigisha admin no 1601006107

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May 01, 2021

This is an onlineE log book to discuss our patients de- identified health data shared after taking his / her guardian' s signed informed consent . Here we discuss our individual patients problems through series of inputs from available global online community of experts with with an aim to solve those patients clinical problems with collective current best evidence based inputs . This E log book also reflects my patient my patient- centered online learning portfolio and your inputs are welcome

May 2 2021

SHORT CASE

This is an online elogbook to discuss our patient's deidentified health data shared after taking her/guardian's informed consent.

A 46 year old female agriculturer by occupation hailing from miryalaguda presented with chief complaints of

1. Shortness of breath since 5 days

2.Generalised swelling of the body since 5 days

HISTORY OF PRESENTING ILLNESS

The patient was apparently assymptomatic 5 days back and then she developed shortness of breath with was insidious in onset and gradually progressive grade 4. which aggravated by lying down and relieved by medication.

It was associated with wheeze and paroxysmal nocturnal dyspnea.

She also complains of generalised swelling of the body which started on the same day which was noted in the legs initially and later involving the whole body.

She has cough with mucoid expectoration since 5 days.

No history of fever,jaundice,palpitations.

PAST HISTORY

She is a known case of COPD since 8 years and is using inhalers

Similar complaints were present in the past.

Known case of hypertension since 2 years and is on telmisartan 80 mg OD.

GENERAL EXAMINATION

Patient is conscious ,coperative ,moderately bulit and well nourished

Pallor - present

Icterus - absent

Cyanosis- absent

Clubbing - absent

Koilonychia - absent

Lymphadenopathy - absent

Edema of feet - bilateral pitting edema upto the level of knee

Raised JVP

SYSTEMIC EXAMINATION

RESPIRATORY SYSTEM

Inspection - shape and symmetry of chest is normal

Trachea appears to be central

Respiratory movements - rate is increased

Palpation - no tenderness or local rise of temperature

Trachea is central

Apical impulse in the left 5 th intercostal space lateral to midclavicular line.

Increased vocal fremitus is noted in the inframammary areas.

Percussion - dull notes were felt in the infraaxillary and infrascapular areas

Auscultation - bilateral decreased breath sounds and bilateral rhonchi and crepitations present in the infraaxillary and infrascapular areas

CARDIOVASCULAR EXAMINATION

Inspection - precordium appears to be normal.

Palpation -

Left parasternal heave

Palpable P2

Apex beat in the 5th intercostal space lateral to midclavicular line.

Auscultation

S1, S2 heard

Loud P2

No murmurs

PROVISIONAL DIAGNOSIS

A 46 year old female complaining of shortness of breath and generalised edema from 5 days is provisionally diagnosed to be a case of Right heart failure secondary to COPD ( cor pulmonale)

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Comments

A18yr old male patient with bilateral lower limb weakness since 20dsys

May 26, 2020

KYASA SAI BRIGISHA roll no 95 I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment Complaint of patient priority wise 1) bilateral lower limb weakness since 20 days Progressive weakness intially in the proximal muscles and at present distal muscles are involved 2) swelling of the lower limbs in calf region 3) difficulty in getting up from squatting position CNS examination patient is conscious, coherent, coperative patient well oriented to time, place and person higher mental functions= normal Cranial nerves- intact Motor system- tone - normal power - 4-/5 in both lower limbs reflexes absent in both lower limbs sensory system-normal No meningeal signs No cerebellar signs B...

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HYPOKALEMIC PERIODIC PARALYSIS

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HYPOKALEMIC PERIODIC PARALYSIS A 62 year old male presented with weakness in both lower limbs extending upto thigh unable to lift and walk. He is the eldest of 5 sons and owns 4 acres of land ,grows rice and owns and drives a tractor to plough the field. He is an alcoholic since 30 years , daily intake (90-180 ml whisky) and denies smoking 5 years ago ,On an occasion, he was made to drink herbal medication in order to make him quit drinking .He developed fever the same night with chills and was taken to hospital and he even recollects that his voice was getting low and starting from paralysis of lower limbs in an ascending manner and was referred to Kims,Nkp.He stayed for 3 days and was discharged on potassium supplementation. 6-10 days later he developed paralysis of lower limbs and was again brought to Kims ,Nkp, and was corrected and was symptom free for one month He developed paralysis for third time later ,after 1-2 months ,he was taken to Gandhi hospital for the same a...

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