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C/o alternated sensorium since 2 days pedal edema since 20 days

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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      
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General medicine Bimontly exam 2 MARCH 20

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  bimonthly examination - march 1) Please go through the patient data in the links below and answer the following questions: https://ashakiran923.blogspot.com/2021/03/60-years-old-male-fever-under-evaluation.html?m=1 a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?How specific is his dilated superficial Abdominal vein in making diagnosis? -Based on the clinical symptoms and signs, the clinical diagnosis of the patient can be-  UTI with cirrhosis of liver with portal hypertension.  b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? What is the cause of his hypoalbuminemia?Why is the SAAG low? -The etiology of the disease in this patient could be a chronic history of alcoholism. Chronic smoking leading to his apthous ulcers.  Based on his clinical finding there could be portal hypertension which could have been preceed
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55 years old female c/o pain in left shoulder and upper abdomen

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55 years old female c/o pain in left shoulder and upper abdomen since 4 days c/o nausea since 4 days  Pt was apparently normal one week ago  Then she developed fever intermittent type relieved on medication not associated with chills and rigors  Pain in left shoulder which is graduall in onset, progessive, restriction of shoulder movements  Upper abdomen pain - pain gradual and progressive. No h/o trauma are excessive load of left arm  K/c/o htn and on regular medication  On examination  Pt is c/c/c  General condition fair  Afebrile  Bp-140/90 mmhg  Pr-86bpm  Spo2- 99% L/E - Left shoulder skin normal  No swelling  No local rise temperature  Tenderness present diffuse movements restricted and painful  Per abdomen  Skin normal , no swelling  On palpation tenderness present in rt hypochondriac region  Cvs-s1s2 heard no murmurs  Rs- nvbs , BAE present  CNS- NAD. Diagnosis: pericardial effusion.cardiac tamponade- s/p pericardiocentesis ?metastasis Treatment  Day1  Inj. Tramadol 1 amp in 100
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46 year old with numbness and weekness

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46 Year old female came to the OPD with complaints of tingling sensation in both upper limbs and lower limbs since one month Patient was apparently a symptomatic Seven years ago gives a history of loss of consciousness for two days and was admitted also gives a history of weakness in both upper limb and lower limbHistory of tingling sensation both upper limb and lower limb along with numbnessOf both upper limbs and lower limbs since one monthShe was advised collar neck and she was diagnosed with cervical spondylitis she presented to casualty with Released weakness and numbness in both upper limb and lower limb . On further probing she gives a history of weakness in upper limb and lower limb 20 days bank and was told hypokalaemia patient denies history of fever and trauma no history of vomiting headache she is not a known case of hypertension and diabetes  Generall examination  Pt is c/c/c no pallor, icterus, cyanosis,clubbing,kylonechia,lymphadenopathy,edema Vitals  Bp- 120/80 mmhg  Pr
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BIMONTHLY ASSESSMENT FOR FEBRUARY

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  "This is my submission for the Bimonthly internal assessment for the month of February ." Most of the information here have been collected from different reference sites, links to which have been mentioned.The points copy pasted have been put in quotes. The questions to the cases being discussed are from the link below: https://medicinedepartment.blogspot.com/2021/02/medicine-paper-for-february-2021.html?m=0 1.) 50 year man, he presented with the complaints of Frequently walking into objects along with frequent falls since 1.5 years Drooping of eyelids since 1.5 years Involuntary movements of hands since 1.5 years  Talking to self since 1.5 years  More here: https://archanareddy07.blogspot.com/2021/02/50m-with-parkinsonism.html?m=1 Case presentation  links:  https://youtu.be/kMrD662wRIQ a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings? Change in behaviour and talking to self
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