G.VAMSI KRISHNA

 A case of 31/F with SLE https://docs.google.com/presentation/d/1_LeBcR42xMU__BPFvxzhrknW3wFVlb4y/edit?usp=drivesdk&ouid=109331939192934520503&rtpof=true&sd=true

 80 year old female presented with  Increase in Shortness of breath since 3 days  Bilateral pedal edema since 3 days Generalized weakness since 20 days  History of fall 20 days back  Patient was apparently asymptomatic 20 days back then she suffered trauma due to slipping in the bathroom, she fell in sitting position and complained of left hip pain.  She could walk normally for 4 days but later complained of too much pain and was confined to bed.  She developed of Shortness Of Breath which was insidious in onset. She developed SOB after walking a certain distance since 1 week but on 21/3/22 she had Shortness of breath at rest and was taken to a local hospital where she was put on O2. She improved and was advised to come here.  H/o COVID 19 infection in April 2021, her symptoms were cold, Shortness of breath and generalized weakness, for which she isolated at home and used medication for 1 week. All her symptoms improved but the weakness took 3 months to subside.  10 days back, She was

  60 YEARS OLD FEMALE WITH SOB CASE DETAILS 60 year old female patient came with c/o SOB  since 3 days SOB ( grade III  progressed to grade IV ) over 3 days Aggravated while lying down (orthopnea ) HISTORY OF PRESENT ILLNESS  Pt. was apparently asymptomatic 3 days back then developed SOB  ( grade III  progressed to grade IV ) over 3 days Aggravated while lying down (orthopnea ) No c/o cough, fever, vomiting, loose stools No c/o pedal edema  PAST HISTORY    K/c/o HTN SINCE 10 YEARS and on medication ( metoprolol & Amlodipine tab. ) DM since 5 years and on medication ( metformin & glimiperide tab.) Not k/c/o CAD, TB, EPILEPSY PERSONAL HISTORY  DIET - MIXED APPETITE - NORMAL SLEEP - INADEQUATE BOWEL & BLADDER - REGULAR NO ADDICTIONS  GENERAL EXAMINATION  VITALS  Pt. Is c/ c/ c Temp - Afebrile  B.P. - 160/ 80 mm Hg P.R - 102 bpm R.R - 15 cpm GRBS - 340 mg /dl Spo2 - 95 % @ 5 lt o2 PHYSICAL EXAMINATION  PALLOR  - ICTERUS -  CYANOSIS - KOILONYCHIA -  LYMPHADENOPATHY - PEDAL EDEMA

  55 year old farmer came to the casualty with C/O of- -SOB grade IV since 4days -Abdominal distention with scrotal swelling since 1week -SOB on lying down since 3days with pedal edema Patient was apparently alright 6years back then developed SOB on doing routine work, progressing to even on walking for short distance, diagnosed as Right Heart Failure on treatment. Abdominal distention along with pedal edema since 1year, therapeutic tap was done in view of ascites twice before, last done 3months back. Symptoms aggravated since 1week associated with constipation, relieved on taking medication, associated with increasing SOB and Orthopnea. Associated with decreased urine output intermittently , facial puffiness and anasarca relieved on medication. Symptoms increased on intake of alcohol, non adherence to diet. PAST HISTORY- K/C/O COPD secondary to chronic smoker stopped 4years back gradually over a period of 2 years. 1pack beedi/day for 30years. K/C/O chronic occasional consumption of wh