GEN MED CASE

  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

  A 40 yr old unmarried female c/o Generalized weakness since 1yr Decreased appetite since 1 yr Bleeding PV since 4 days She is a second born child of her parents ( 3rd degree consanguinous marriage) Patient attained menarche at the age of 14, since then cycles were regular, with normal flow initially. 4-5 days /month, no clots, dysmenorrhea.  LMP- 05/02/2022 But since 6 months she has increased bleeding during her cycles.since 2 months  her cycles was 10days /month associated with clots 2x2 cm, no pain.  No h/o burning mictuition, white discharge,. 6months patient went to other private hospital where she was diagnosed with low Hb% and advised for blood transfusion which was not done and patient was not on any medication for anaemia. Not a k/c/C/o DM, HTN, thyroid, epilepsy, asthma. Appetite decreased since 2ys only 1 meal /day. Pica + Milestones - delayed and difficulty in learning.  General examination Patient is c/c/c thin built and malnourished Pallor ++,  no icterus, cyanosis, clu

  45 year old female patient came to casuality with c/o B/L left leg swelling since 1 and half year and right toe swelling and relieved treatment. Since 1 month she developed B/L upper limb and face along with abdominal distention with decreased urine output since 10 days. She started to experience dyspnea on exertion since 20 days which aggravated to dyspnea at rest since 3 days increased onlying down in supine position. Also C/o non productive cough since 5 days. Treatment history: 1. T. DYTOR 10 MG BD  2. T. MET XL 12.5 MG OD 3. T ATORVAS 40 MG OD 4. SYP ARISTOZYME 10 ML TID 5. T FRUSELAC 50 MG OD DAILY WITH T. METXL 3D 50 MG OD Patient is diagnosed with DM 2 since 2 years and is on T. Glimi M2 BD  Personal history: Passed stools 2 days back with reduced urine output. General Examination: Patient was C/C/C No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema Vitals at admission: PR- 80 bpm BP- 170/60 mmHg RR- 22 cpm SpO2- 98%  CVS: S1 S2 +, RS: B/L inspiratory