2nd internal answersheet











 

























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 A 60 year old female resident of thakkellapally who is a housewife came with the complaints of fever since 10 days nausea and vomiting since 10 days and productive cough since 10 days  History of present illness  Patient was apparently asymptomatic 10 days back then she developed fever which is insidious in onset ,continuous with no diurnal variations and not associated with chills and rigors ,relived on medication ,no history of headache history of vomiting and nausea since 10 days almost 2 times a day which is non projectile, non bilious with loss of appetite  Complains of Bilateral knee pain for which she is taking NSAIDS since 5 years,no history of other body pains Cough with expectoration with mucoid sputum and associated with pain in back while coughingk No History of burning micturition ,loose stools, pain abdomen ,pedal edema,chest pain, Shortness of breath, palpitations  Past history Not a known case of diabetes ,hypertension ,asthma ,epilepsy,coronary...
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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.g...
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