MEDICINE

  1) pain in the epigastric region differentials Inferior wall MI(normal ecg and echo) Acute pancreatitis(radiation to the back)-usg finding and elevated serum amylase level Perforated peptic ulcer  Causes of acute pancreatitis- harrison pg no 2348 Gall stones : https://gi.org/topics/gallstone-pancreatitis/ This occurs at the level of the sphincter of Oddi, a round muscle located at the opening of the bile duct into the small intestine. If a stone from the gallbladder should travel down the common bile duct and get stuck at the sphincter, it blocks outflow of all material from the liver and pancreas. This results in inflammation of the pancreas that can be quite severe. 2)sob- acidosis due to renal failure          ? Ards secondary to sepsis/pancreatitis           Pleural effusion due to acute pancreatitis            3)decreased urine output-pre renal Aki secondary to volume loss(oliguric) 3rd spac...

 46 year old , male resident of Devarkonda occupation : driver Came for regular dialysis  During dialysis , he developed cough with hemoptysis ( 200ml ) saturations: 60spo2, got intubated.  Past h/o : patient was apparently normal 8 months back, then he developed back pain , burning micturition, loss of appetite , decrease urine output.  Back pain which was insidious on onset , gradually progressive no reliving and aggrevating factors for which he went to a near by RMP , pain subsided.  After 2 months he developed sudden SOB, went to devarkonda hospital , For which they said he has kidney problem, had to go for dialysis.  Later, he came to Kamineni Narketpalli  Underwent dialysis , during dialysis he had COUGH, SOB, FEVER.  Totally 10 dialysis done till last month.  During the stay in hospital, he had one episode of seizures ( GTCS  type) not a k/c/o seizures  On tab: LEVIPIL.  Later he was discharged , he was sent to Hyderabad...

Q1 Reason for this ascites        The most common cause of Ascites is       Cirrhosis of liver        risk factors in this patient :       1. Chronic alcoholism since 40 years       2. Truncal obesity leading to metabolic syndrome causing NAFLD leading to cirrhosis           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092576/ Q2 Bilateral pedal oedema which is of pitting type is due to decrease in the albumin level trends due to course of the disease and long standing cirrhosis causing decrease in the production of proteins causing decrease in the oncotic pressure leading to accumulation of fluid. as per the given clinical data due to chronic liver disease there was increasing trend of INR which was as high as 4.7 causing bleeding manifestations ( bleeding gums, hematoma formation )  ulcerations are due his limited self practising manoeuvres done in inappropriat...

72YEAR OLD MALE CAME WITH COMPLAINTS OF SOB , COUGH AND PEDAL EDEMA SINCE 10 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK THEN DEVELOPED PEDAL  EDEMA PITTING TYPE, COUGH ASSOCIATED WUTH SPUTUM (GREENISH) FOUL  SMELLING. H/O OF FEVER,COLD 1 MONTH BACK  PATIENT NOTICED WEIGHT LOSS SINCE 1 MONTH FEVER WHICH WAS INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE NOT ASSOCIATED  WITH CHILLS AND RIGOR. NO COMPLAINTS OF CHEST PAIN, COUGH, SOB ,BURNING MICTURITION , CONSTIPATION, WEIGHT LOSS, HEAD ACHE, EGIGASTRIC PAIN, BLURRING OF VISION,  PALPITATIONS, LOOSE STOOLS  K/C/O HYPERTENSIVE AND DIABETES  ON REGULAR MEDICATION. K/C/O ALCOHOLIC SINCE 10 YEARS ( WHISKEY 90ML)  PROVISIONAL DIAGNOSIS  : AKI ON CKD WITH HYPERKALEMIA 

36 YEAR OLD FARMER BY OCCUPATION CAME WITH COMPLAINTS OF VOMITINGS SINCE MORNING AND GENERALISED WEAKNESS  PATIENT WAS APPARENTLY ASYMPTOMATIC TILL YESTERDAY THEN HE HAD  VOMITINGS (10-20 EPISODES SINCE MORNING) CONTAINS FOOD PARTICLES , NON BILIOUS, NON PROJECTILE , ASSOCIATED WITH STOMACH PAIN DIFFUSE TYPE. NO COMPLAINTS OF FEVER, CHEST PAIN, COLD, COUGH, SOB ,BURNING MICTURITION , CONSTIPATION, WEIGHT LOSS, HEAD ACHE, EGIGASTRIC PAIN, BLURRING OF VISION,  PALPITATIONS, LOOSE STOOLS NOT A K/C/O HYPERTENSIVE AND DIABETES  K/C/O ALCOHOLIC SINCE 10 YEARS ( WHISKEY 90ML) CHEWS TOBACCO SINCE 10 YEARS  NO SIMILAR COMPLAINTS IN THE PAST. ON EXAMINATION : PATIENT IS C/C/C ,  MODERATELY DEHYDRATED. AFEBRILE , NO PALLOR , CYANOSIS , CLUBBING, LYMPHADENOPATHY, EDEMA ICTERUS + BP:110/80 mmhg  PR: 80bpm /regular  P/A : SOFT, NO TENDERNESS PRESNT  INVESTIGATIONS: RFT: UREA: 29 CREATININE: 1.2 CALCIUM: 10.2 PHOSPHORUS: 3.9 SODIUM: 141 POTASSIUM: 3.0 CHLOR...

1.ANATOMICAL DIAGNOSIS: LIVER? CARDIAC? KIDNEY?  ETIOLOGICAL DIAGNOSIS -  ?? NEPHROTIC SYNDROME SECONDARY TO THE  DIABETIC  NEPHROPATHY OR CKD  2) REASONS FOR:  I) AZOTEMIA : IMPAIRED RENAL EXCRETION  OF UREA AND  CREATININE SECONDARY TO CKD.   II) ANEMIA : DECREASED ERYTHROPOIETIN   III) HYPOALBUNEMIA: CAPILLARY BASEMENT MEMBRANE AND PODOCYTES DAMAGE    IV) ACIDOSIS: ACIDIFICATION OF URINE LOST.   3. RATIONALE SYRUP. POTCHLOR WAS GIVEN BECAUSE OF HYPOKALEMIA. INJ. BICARBONATE WAS GIVEN BECAUSE OF METABOLIC ACIDOSIS. INSULIN AND HYPERTENSIVES ARE GIVEN BECAUSE KNOWN CASE OF DM AND HTN.  OROFER XT WAS GIVEN BECAUSE OF ANEMIA.  INJ.LASIX WAS GIVEN BECAUSE TO DECREASE HER VOLUME OVERLOAD. SPIRONOLACTONE WAS GIVEN BECAUSE IT WAS A POTASSIUM SPARING DIURETIC. CALCIUM WAS GIVEN TO THE PATIENT BECAUSE OF HYPOCALCEMIA SECONDARY TO CKD. 4. INDICATIONS OF DIALYSIS IN THIS PT : WORSENING OF SOB SECONDARY TO METABO...