G.VAMSI KRISHNA

40/M, LORRY DRIVER CAME WITH C/O PEDAL EDEMA SINCE 5-6DAYS ABDOMINAL DISTENTION SINCE 5-6 DAYS COUGH SINCE 5-6 DAYS SHORTNESS  OF BREATH ON WALKING FOR LONG DISTANCES NYHA GRADE 2 TO GRADE 4ABLE TO CLIMB 2 PLIGHT OF STAIRS, ON LIFTING WEIGHTS, PROGRESSED TO ORTHOPNEA IN 1 WEEK  PEDAL EDEMA DECREASING WITH LIMB ELEVATION  COUGH SINCE 6 DAYS ASSOCIATED WITH  SPUTUM SMALL AMOUNTS, WHITE COLOUR, NON FOUL SMELLING , NOT ASSOCIATED WITH BLOOD , NO COLD, NO FEVER ,NO WHEEZE, NO CHEST PAIN,NO PALPITATIONS , NO SYNCOPAL ATTACKS H/O HOSPITALIZATION FOR  RIGHT HEART FAILURE- WET BERI BERI 1 YEAR BACK 8 MONTHS BACK ADMITTED  IN OUR HOSPITAL  WITH  AIDP/?DRY BERI BERI  KNOWN  ALCOHOLIC SINCE7 YEARS TAKES 360 ml/day  3-4 TIMES  A WEEK C/O CONSTIPATION SINCE 1 MONTH  HIS FATHER IS KNOWN DM+ PATIENT  IS CONSCIOUS COHERENT COOPERATIVE  BP-140/90mmHg PR-94 BPM  RR -24CPM SPO2-98 AT RA GRBS -90mg/dl WEIGHT -72KG O/E  B/L PEDAL EDEMA +  NO PALLOR, NO ICTERUS ,NO CYANOSIS, NO CLUBBING, NO LYMPHADENOPATHY 

  A 60 year old male patient was apparently asymptomatic 2 months back then he developed shortness of breath . On exertion , which progressed to grade 4 associated with orthopnea and paroxysmal nocturnal dyspnea Pedal edema since 2 months , bilateral from ankle to knee associated with abdominal discomfort and tightness Decreased urine output since 2months associated with burning micturition Generalized weakness since 2 months associated with pain in bilateral lower limb History of past illness: Patient was apparently asymptomatic 2 years back then he developed weakness in the right upper and lower limb, loss of speech. He used medication for 6 months and his weakness improved on which he stopped medication and loss of speech persisted. Past history- N/K/C/O- Diabetes, asthma, tuberculosis. No H/o blood transfusions. H/o Tubectomy  done 23 years ago. Personal history- Normal appetite. Diet- vegeterian Bowel and bladder movements - constipated Addicted to alcohol. No known allergies. Fam

Case:1 50 year man, he presented with the complaints of Frequently walking into objects along with frequent falls since 1.5 years Drooping of eyelids since 1.5 years Involuntary movements of hands since 1.5 years  Talking to self since 1.5 years  More here:  https://archanareddy07.blogspot.com/2021/02/50m-with-parkinsonism.html?m=1 Case presentation  links:  https://youtu.be/kMrD662wRIQ   a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings? Problem presentation: A 50 year old male diabetic farmer by occupation who had an episode of seizure 10 yrs back presented with c/o f requently walking into objects along with frequent falls, Drooping of eyelids, Involuntary movements of hands & T alking to self since 1.5 years was diagnosed with progressive supranuclear palsy. Anatomical localization: Brain B/l ptosis : weakness of levator palbebral superioris (without loss of frowning) self talk :

A 54year old male patient Came to the OPD with chief c/o cough with expectoration since 6 days and low-grade fever since 6 days. Patient was Apparently asymptomatic 3yrs back then he developed shortness of breath initially grade-2 which progressed to grade 3-4 @ present B/L pedal oedema since 18 months which is of pitting type. Bendopnoea & PND since 6months. Palpitations since 6 months. ? episodes of syncopal attacks since 6months.  Orthopnea Since 3months. Nocturia since 2months and insomnia since 2 months and daytime somnolence present. No H/O chest pain, haemoptysis, vomiting, abdominal pain, Burning micturition no h/o increased frequency, urgency. History of TB 16 years back for which he was treated. Not a k/c/o DM/HTN/Asthma/Epilepsy/CAD Mixed diet, loss of appetite, regular bowel & bladder movements. Consumption of 180to 360 ML of alcohol daily for the past 10 years. No known allergies General examination: Patient is conscious, coherent, cooperative. Pallor +, B/L pedal