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70 yr old female with aspiration pneumonia (rt lung consolidation) , acute cva 20 days ago

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70 year female brought to casualty in a •unresponsive state which is since one day •no verbal response since 1 day  •fever since one day  5 years ago diagnosed with hypertension using Tab.Amlong 5mg OD 20 days ago complaints of giddiness followed by fall in bathroom injury to right   lower limb assc with displaced IT fracture Admitted outside hospital diagnosed with moderate size acute non hemorrhagic infract  in left caudate,lentiform nucleus ,chronic infarct left cerebellar hemisphere Age related atrophy with small v/s ischemic changes -FAZEKAS GRADE 3 On USG ABDOMEN AND PELVIS - NORMAL STUDY CAROTID AND VERTEBRAL DOPPLER STUDY — RIGHT CAROTID PARTIALLY CAROTID SMALL PLAQUE (7.5X2 MM)AT BIFURCATION CAUSING NO STENOSIS IMPRESSION —BILATERAL MILD ATHEROSCLEROTIC CHANGES .NO E/O THROMBOSIS. NO E/O SIGNIFICANT STENOSIS. PATIENT CAME TO CASUALTY IN UNRESPONSIVE STAGE WITH NO VERBAL RESPONSE ASSOCIATED WITH FEVER SINCE 1 DAY  NOT A K/C/O HTN , DM, ASTHMA GENERAL EXAMINATION:  No Pallor  ,
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60 yr old male with CRF , ? FLASH PULMONARY EDEMA SECONDARY TO CRF , ? CARDIOGENIC PULMONARY EDEMA SECONDARY TO HF WITH REF , UNCONTROLLED HTN , ? KOCHS

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60 year old male patient brought to casualty with c/o sob ( grade 4 ) since 5 days , decreased urine output , vomitings , pedal edema since 1 day HOPI :  Pt was apparently asymptomatic 5 days back then he developed sob which is gradual in onset and progressive which was associated with vomitings (watery), also developed pedal edema non pitting type and also presented with decreased urine output PAST HISTORY:  6 months back pt complained of giddiness and went for hospital dont know the reason but they have been tested for sputum for tb which turned out to be negative 3 months back in feb 2022 pt developed acute sob grade 4 associated with sweating , at this time the pt diagnosed with heart failure with decreased ejection fraction and  Renal failure ,  serum creatinine 2 to 3 , heart failure is acute on chronic  , at that time trop i is normal 0.1 ng/ml and Nt pro BNP test was > 3,500 pg/ml (normal = 450 pg/ml) , htn was also diagnosed , ct lung was done  In MARCH he compl
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18 yr old female with ? proximal myopathy under evaluation

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Patient came with c/o low backache radiating to both lower limbs since 1 month and bilateral knee joint pain since 1 month HOPI :  Patient was apparently asymptomatic one month back later she developed fever which is low grade not associated with chills and rigor , relieved on medication. Then  one week after accompanied by low backache which is gradual in onset followed by swelling of both lower limbs and after 2 days pain in both lower limbs , which is continuous in nature , relieving on medication and recurring on stopping medication. Generalised body pains and weakness also present since one month, difficulty in getting up from sitting and squatting position C/o hair fall since 1 year Ankle edema present in b/l lower limbs PAST HISTORY: No similar complaints in the past Not a k/c/o dm , htn , thyroid disorders No cold or heat intolerance PERSONAL HISTORY: Loss of appetite , no burning micturition , yellowish discoloration of urine is present GENERAL EXAMINATION:  Pallor - present ,
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pt with Ataxia secondary to ? alcoholic neuropathy

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A30 yr old male came with c/o weakness of both lower limbs since yesterday (4/4/22) Difficulty in walking since yesterday (4/4/22) HOPI :  Pt was apparently normal since 2 days back then he developed generalised weakness and difficulty in walking associated with weakness of both lower limbs PAST HISTORY :  Not a k/c/o htn , dm , epilepsy , asthma , tb PERSONAL HISTORY :  Chronic alcoholic , daily 360 ml of whisky per day , last binge 1 day back ( on 3/4/22) Bowel and bladder are regular No significant family history GENERAL EXAMINATION :  No pallor , icterus, cyanosis ,clubbing, lymphadenopathy, koilonychia Temp : afebrile Pr :86 bpm Bp:110/60 mmhg Spo2: 98% SYSTEMIC EXAMINATION : RS : Bilateral air entry present , normal vesicular breath sounds ,    P/A : soft , non tender , bowel sounds present   CVS : S1 S2 present , no murmurs  CNS : No abnormalities detected INVESTIGATIONS :  Hemogram Rft Lft C x ray ecg APRAXIA CHARTING
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55 yr old male with c/o fever , pedal edema , sob

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A 55 yr old daily wage labour came with c/o of : Fever  Pedal edema and Abdominal discomfort since 5 to 6 days  Sob since 1 day Constipation and decreased urine output since today HOPI :  Patient was apparently normal one week back then he had high grade fever associated with chills and pedal edema initially upto ankle level and later progressed upto knee Pain abdomen which is of mild severity with abdominal distension which is  gradually progressive and umbilicus everted Sob since 1 day which is of grade 2 yesterday which progressed to grade 4 today Decreased urine output constipation since today PAST HISTORY : No known case of htn , dm , epilepsy , tb , asthma PERSONAL HISTORY  :  loss of appetite No significant family history GENERAL EXAMINATION :  Oedema of foot is present No pallor , icterus, cyanosis ,clubbing, lymphadenopathy, koilonychia Temp :101f Pr :140 bpm Bp:100/60 mmhg Spo2: 98% SYSTEMIC EXAMINATION : RS : decreased air entry (rt>lft) , normal vesicular breath sounds ,
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1601006027

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Hall ticket :1601006027 35 year old male patient,  RESIDENT -ramchandrapuram, OCCUPATION-works as a daily wage labourer, a chronic smoker (1 pack of beedi every 2 days) and chronic alcoholic (90ml daily) since 20 years presented with a  3 month history of painless papules with erythema that started initially over the face then gradually extended to upper limb, low limbs and trunk  ~Patient got topical cream, soap and some oral drugs from nearby medical shop  ~He used them for 2 months, few lesions regressed but few persisted on nose, ear lobe, hands, legs and trunk. ~14 days ago patient developed blackish skin discolouration over hands and feet with skin peeling, cracking, ulcer formation associated with burning sensation and erythema all over the body. ~No new lesions were noted  Since 4 days patient developed continuous high grade fever associated with chills and rigors. Loss of appetite  There is no history of similar complaints in the past  EXAMINATION: Face: loss of eyebrows,(mada
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Hall ticket :1601006027

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This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. A 61 year old gentleman who is resident of Kangaal ,shepherd by occupation came with complaints of pain in abdomen from 10days,Fever from 2 days HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 10 days ago ,then he developed 1. Pain in abdomen      -from 10 days    -It is a diffuse type , insidious in onset , progressive, dragging associated with shortness of breath , it was non radiating, moderate pain with no diurnal variations , it was relieved by
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