Manishgoud103

A 55 yr old male pt. came to the casualty with c/o chest pain , sob ( grade 3),nausea,loss of appetite and b/l pedal edema since 3 days.Reduced urine output since 1 day. Pt was apparently asymptomatic 3 days ago then he developed sob (grade 3) ,not associated with cough ,no h/o fever, no h/o orthopnea and no h/o PND , h/o B/L pitting edema , K/c/o pulmonary kochs (used ATT for 9 months 4 yrs back) K/c/o DM2  since 1 yr and is on GLIMY M1/ PO  O/E  Pt is c/c CVS - s1 s2 + R/S - BAE + , inspiratory crepts + in Rt MA IMA IAA , Rt. Sided wheeze + P/A soft and non tender CNS - E4V5M6 Vitals- Pr- 107bpm  Bp- 80/60  Spo2 - 93 % at RA. DIAGNOSIS - Anterior wall MI with pneumonia (REACTIVATION OF PULMONARY KOCH'S ) TREATMENT - INJ. Lasix 40 mg iv stat Inj. Noradrenaline 2ml in 45ml ns @ 8ml

A 55 yr old female Pt. Came to the casualty with the c/o SOB since 2 days and decreased urine output. c/o  B/L pedal edema since 2 days . Pt. was apparently asymptomatic 6 yrs back and then developed B/L pedal edema for which the patient visited the nearby hospital and was diagnosed with HTN and RENAL FAILURE.Since then the patient was in conservative management. But since two days patient is having SOB  (grade 4) not associated with chest pain, sweating , nausea , vomitings. H/O B/L pedal edema pitting type. H/O decreased urine output with increased frequency and has urinary hesistancy ,no h/o  burning micturition , no h/o urgency. K/C/O HTN since 6 yrs Not a K/C/O DM, Asthma , Tb, CAD, Epilepsy. O/E CVS - S1 S2 +  R/S - B/L diffused crepts present. CNS - NAD P/A - soft and non tender. Vitals -  Bp - 160 /80 mmHg  Hr - 106 bpm Rr- 30 cpm Spo2 - 92 % at RA. DIAGNOSIS - CHRONIC RENAL FAILURE.

A 20 yr old female degree student by occupation complaining of fever since 10 days  C/O cough dry cough 4-5 days  Pt stays in ladies hostel in Hyderabad ghatkesar wakes up at 6:00 Am in the morning she gets up and fresh up have her break fast at 7 :00 am and lunch at 1:30 pm and 8:00 pm dinner  back. HOPI : Patient was apparently asymptomatic 10 days back then she developed fever gradual in onset . there is evening rise of temperature associated with chills and rigors  NOH/O burning micturition  C/o cough ,dry cough which is aggravated in the evening  No H/O burning micturition No H/O loose motions  Not a k/c/o DM, HTN, thyroid, asthma, TB, CAD and, CVA. No h/o any bleeding manifestations (malena, hemoptysis, hematemesis).  No h/o nausea and vomitings.  No h/o loose stools, burning micturition, cough.  No h/o SOB, pedal edema, bowel disturbances.  Personal history : Diet -mixed sleep - adequate   appetite - normal  bowel and micturition - normal.  General examination : Patient is c/c/c