General medicine 1st internal examination










 













 







 






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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 clinical problems with collective current best evidence based inputs 25 yr old female patient resident of miryalguda,housewife by occupation came to OPD with chief complaints of fever since 5 days and giddiness since 5 days. History of presenting illness: Patient was apparently asymptomatic 5 days back the she developed fever  which is sudden in onset, continuous ,high grade fever, associated with chills and rigors relieved on medication . Fever is associated with headache,retro orbital pain. History of generalized weakness, body pains. History of nausea and vomitings(non bilious) 3 to 4 times a day projectile History of cough (non productive) History of abdominal pain, burning mict
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OSCE and learning points

  Study on IV and oral paracetamol efficacy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783910/#:~:text=Patients%20who%20received%20intravenous%20paracetamol%20had%20a%20higher%20mean%20first,SD%201.76%2C%20p%20%3D%200.1593 https://scholar.unair.ac.id/en/publications/efficacy-and-tolerability-of-intravenous-paracetamol-compared-to-#:~:text=Normal%20temperature%20achievement%20were%20higher,in%20reducing%20fever%20in%20children Inference Both the studies say that IV paracetamol takes lesser time to reduce the symptoms but also the adverse effects similar with the both IV and oral treatment  Mortality due to  dengue haemorrhage  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862602/ Study done on deaths in dengue patients between 2009 and 2010 - autopsy findings in 6 patients out of 12 deaths among 1032 dengue patients revealed that death is due to multiorgan dysfunction secondary to bleeding diathesis and hypotension IV fluid management in dengue fever. https://www.google.com/url?sa=t&
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   A 50yr old female resident of suryapet came to the op with chief complaints of  back pain Fever  Bilateral pedal edema  Puffiness of face History of present illness Patient was asymptomatic 6months back then she developed the back pain ,fever and pedal edema Past history k/c/o HTN since 7yrs Medication not known No History of DM,TB, epilepsy Personal history Appetite - decreased Diet- mixed Sleep-inadequate No addictions Bladder movements are normal  But she has c/o constipation Family history No significant family history General examination No icterus, pallor,cyanosis,clubbing,lymphadenopathy Bilateral pedal edema and facial puffiness are present Vitals BP 180/110mmhg Pulse-88 beats/min Temp-97°F RR -18 CPM Systemic examination RS :B/L inspiration crestfallen over lung fields CVS:S1 and S2 are heard, no murmurs CNS:No focal deformities Investigations Haemogram Hb: 7.5gm/dl TLC:7800/cumm PCV:23.3 RCB:2.6million /cumm PLT:1.54lakh/cumm RFT urea:46mg/dl Creatinine:3.6mg/dl Uric acid:
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