C/o alternated sensorium since 2 days pedal edema since 20 days
General examination:no pallor, Icterus ,cyanosis ,clubbing lymphademopathy,Edema. Cvs apex beat in 5th ICS medial to midclavicular line pan systolic murmur+ Rs bae + nvbs hears P/a soft ,nontender,bowels sound heard, Cns HMF- patient conscious Lobar function tests 1.Frontal:social behaviour:normal language:normal micturation:normal 2.parietal dominant: language, calculations normal, ideational apraxia:present right left orientation:present finger agnosia :absent simple and complex calculations normal 3.parietal non dominant constructional skills:? 4.Temporal: memory and language:normal 5.occipital visual memory:normal prosopagnosia:absent speech- normal MMSE- 28/30(No cognitive impairment) cranial nerves-1st normal 2nd Counting fingers at 6mts both eyes normal rt lf 3rd,4th,6th