Skip to main content

 


A 32 year old patient

December 28, 2020



A 32 year old male patient resident of suryapet came with 

C/o pedal odema from 1 month and sob at rest from 1 day.

Patient was apparently asymptotic 1 month back then developed B/l pedal edema sudden in onset,yellowish discolouration of eyes and decrease appetite with out any investigations they took herbal medications for jaundice for one day and got relieved from symptoms and patient started taking alcohol then after till yesterday.

Pedal edema - B/l , pitting type , sudden in onset , extended upto knee.

SOB - sudden in onset , . Palpitations , sweating and giddiness + , not associated with  chest pain ,Orthopnea and PND

No H/o Fever , cough , pain abdomen , nausea , vomitings, loose motions or decreased urine output.

N/k/c/o - HTN , DM II , TB , epilepsy, CVA , CAD.

H/o surgery 2 years back - for right inguinal hernia.

Personal history:

Appetite normal

Diet mixed

Bowel and bladder regular

Sleep adequate

Alcoholic from 20 years(daily intake of 90ml / day)

Smoker from 20 years ( 18/day)

General examination:

Patient is conscious, coherent and cooperative.

B/l pedal edema (pitting type upto knee ) +

No pallor icterus ,cyanosis ,clubbing , lymphadenopathy .

Vitals:

Temp 98.6F

Pr- 98bpm

Bp-150/90mmHg

Rr- 26cpm

SPO2 - 99%

GRBS- 104mg%

Systemic examination:

CVS - S1,S2 heard 

           Parasternal haeve +

           Jvp- Raised

           Apex beat : 6 thICS lateral  to mid clavicular line

         Ejection systolic  murmur

RS - vesicular breath sounds +

          Decreased on Right infraaxillary and infrascapular region

           No wheeze or adventitious sounds

P/A - Obese

         No tenderness

         Liver palpable below right costal region 1 finger

         No free fluid.

CNS - NAD









4 am ECG
ECG at 5 am 

 V3R and V34 ECG @10:30am




Day 2 after pleural tap for diagnostic purpose




provisional diagnosis : right heart failure with moderate PAH (wet beri beri) with? ASD  with ?alcohol liver disease with alcohol and tobacco dependence 






Comments



Comments

Post a Comment

Popular posts from this blog

THESIS

Image
TOPIC: PREDICTORS OF OUTCOMES IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AND HEART FAILURE ADMITTED TO A RURAL TERTIARY CARE HOSPITAL PROBLEM STATEMENT: HEART FAILURE is one of the leading cause of death at present all over the world. Inspite of the recent advances and extensive research being done in medical field we are unable to find the exact etiology and predictors of mortality and morbidity in many of the patients with HEART FAILURE and the current mode of treatment is only symptomatic. In a rural setup with limited resources: How far we can eliminate the diagnostic and therapeutic uncertainties that persist in a patient with heart failure and what best we can do to improve their outcomes. INTRODUCTION: Inspite of having advancement in field which helps in diagnosing pulmonary hypertension, it remains the disease that takes lot of time for diagnosis from the presence of first symptom, many patients are diagnosed only in advanced stage of disease. 1 Normal pressure in pulmon
Read more

BIMONTHLY INTERNAL ASSESSMENT - MAY 2021

Image
Section : 1  Please go through the patient data in the links below and answer the following questions: 1) Pulmonology (10 Marks)  A) Link to patient details: https:// soumyanadella128eloggm. blogspot.com/2021/05/a-55- year-old-female-with- shortness-of.html Questions: 1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem? Symptomatology & event time line: SOB  Grade-II  on & off since 20 Years (exacerbations once in a year) ! Increased frequency & severity of exacerbations since 12 Years ! T2DM since 8 Years ! Anemia 5 yrs back treated with iron sucrose ! Generalized weakness & SOB Grade-II since 30 days ! HTN since 20 days ! Pedal edema & Facial puffiness since 15 days ! SOB Grade-IV & decreased urine output since 2 days Anatomical localization:  Lungs - COPD - SOB Grade- II COPD - PAH - RHF - Pedal edema
Read more

BIMONTHLY INTERNAL ASSESSMENT - DECEMBER

Image
1) A 55 year old man with Recurrent Focal Seizures Detailed patient case report here:  http://ushaindurthi. blogspot.com/2020/11/55-year- old-male-with-complaints-of. html 1. What is the problem representation of this patient and what could be the anatomical site of lesion ? A 55 year old male construction worker with T2DM who is a chronic alcoholic & smoker came with c/o weakness of right upper limb with involuntary movements of both right UL & LL secondary to ? right temporal lobe epileptogenic focus. 2. Why are subcortical internal capsular infarcts more common that cortical infarcts? subcortical infarcts are caused by occlusion of a penetrating artery from a large cerebral artery, most commonly from the Circle of Willis. These penetrating arteries arise at sharp angles from major vessels and are thus, anatomically prone to constriction and occlusion.  So subcortical infarcts are more common than cortical infarcts. https://www.ncbi.nlm.nih.gov/books/NBK534206/#:~:text=Lacuna
Read more