GEN MED CASE

  40 year old female WITH   urethra stricture under evaluation CASE HISTORY A 40 year old female , house wife ,CAME from west bengal WITH  CHEIF COMPLAINTS OF - dysuria decreased frequency of urination post void urinary retention and slow urine stream since 6 months burning micturition since 5 months dysperunia since 4 months loin and lower back pain since 1 month HISTORY OF PRESENTING ILLNESS -   patient was apparently asymptomatic 6 month back then developed dysuria which was insidious in onset gradually progressive associated with burning micturation retention of urine and lower abdomen pain and distension the pain in abdomen gets relieved with medication and voiding urine  burning micturition not associated with any fever cough nausea vomiting patient developed dysperunia 4 months back and pain in the flanks and lower back 1 month back   no SIGNIFICANT PAST HISTORY , AND THEN CAME TO KIMS FOR FURTHER EVALUATION  PAST HISTORY -  n/k/c/o htn  6 months back was given medication for dm

13 YEAR OLD BOY COMPLAINTS OF HIGH GRADE FEVER SINCE 4 DAYS A 13 year old school going boy complaints of  - high grade fever since 4 days - vomitings since 4 days - giddiness ince 4 days - loose stools since 1 day Patient was apparently asymptomatic 4 days back then he developed fever associated with chillschills.  Complaints of vomiting since 4 days- 2-3 episodes/day with food particles as content Loose stools- 5 episodes in the past one day No history of burning micturition, melena, rashes, bleeding gums, hematuria VITALS Temp- 98.8 F PR- 90 bpm BP- 100/60 mmHg  RR- 18 cpm Spo2- 98% at RA GRBS- 118mg% GENERAL EXAMINATION Patient is conscious, coherent and cooperative.  No signs of Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy or Edema. SYSTEMIC EXAMINATION CVS: S1 S2 heard, no murmurs/thrills RS: BAE+, NVBS heard PA: Soft, non tender. Liver and Spleen not palpable. Bowel sounds heard. CNS: NFND PROVISIONAL DIAGNOSIS NS 1 + DENGUE INVESTIGATIONS Outside Reports: Platelets- 1020

  55 Y /M WITH HEART FAILURE , ? COPD , BELOW KNEEAMPUTATION  55 Y / M pt presented to casuality with c/o  Blurring of vision since 1 year  Decreased urine output since 2 months  Pedal edema since 1 month  SOB since 3 days  Distended abdomen since 2 days  Pt was apparently asymptomatic 10 yrs back , then he was diagnosed with DM type 2 , on has been using Glimi 2 mg tablets  Pedal edema was gradually progressive  SOB grade 4 was more during the night , PND  There are no aggregating and relieving factors  Pt is a k/c/o DM since 10 yrs , on Tab Glimi 2 mg  HTN since 2 yrs , on T. Telma 40 mg  Surgical history : Pt had below knee amputation 1 yr back , due to trauma to the left lower limb which developed cellulitis  Pt is an occasional alcoholic since 30 years  Chronic smoker since 20 years ( daily 1 pack of cigarette and 1 pack of beedi )  Medical h/o :  Pt is on T Atorvastatin 10 mg  T Pentoxifyllin 400 mg since 1 yr  Not a k/c/o tb , asthma  Occupation : Mason  Appetite : normal  Diet

  A 50 year old male patient is on maintainance haemodialysis since 10 months. HOPI: patient was apparently asymtomatic 4yrs back and then developed shortness of breath (on and off), pedal oedema (pitting type).Later diagnosed as chronic renal failure and underwent dialysis twice weekly for about 10 months. 6 years back he met with an accident. His right leg got fractured and it took nearly 1 year to heal for which he used few medication continuosly for 1 year. PAST HISTORY: k/c/o HTN since 1 year. Not a K/C/O of DM, thyroid disorders, TB PERSONAL HISTORY:He follows a mixed diet. Appetite -Normal, Bladder movements-normal, Bowel movements-constipation since few weeks. Sleep- decreased.consumes alcohol regularly(90ml ) and stoped consuming1 year back. He is a farmer and stopped working since 1 year. FAMILY HISTORY: No significant family history. DRUG HISTORY: No known drug allegies and patient uses Nicardia 10 mg. General examination : patient is conscious ,coherrent, co operative and w