2nd internal assessment

49 years old male with CHRONIC KIDNEY DISEASE associated with osteoarthritis of knee

chief complaints: A 49-yr-old patient came with OPD with chief complaints of -bilateral knee pain and Lower bach ache since 2 months. -pedal edema since 1 week. -shortness of breath since 1week. -decreased appetite since 1 week. history of presenting illness: -Pt was apparently assymptomatic 2 months ago, then he devoleped B/L knee pain which was insidious in onset ,gradually progressive ,pain increase on work for which he used NSAID’s prescribed by local RMP for 15-30 days and stopped -he devoleped pedal edema 1 week ago which was insidious in onset and initially restricted to below ankle then progressed above ankle level which is not relieving on rest and not associaed with fever -he devoleped grade II shortness of breath 1 week ago DAILY ROUTINE: Patient used to be a farmer by occupation but he stopped 2 montgs back due to increased knee pain and was mostly confined to his home ad surroundings. He wakes up at around 5:30 AM and freshens up. He will be having breakfast at around 10

62M pedal edema with HTN and DM TYPE 2

62 year male pt presented with chief complaints of -POLYURIA since 2 months -BURNING MICTURITION since 2 months -TINGLING AND BURNING SENSATION OF BOTH LIMBS since 2 months -ITCHING all over the body since 2 months -SWELLING OF B/L LOWER LIMBS since 1month -LOWER BACK ACHE since 10-15 days HISTORY OF PRESENTING ILLNESS- Pt was apparently asymptomatic 2 months back, then he developed POLYURIA which was insidious in onset and gradually progressive, associated with burning micturition and frothy type of urine, Pt also complained of increased urine frequency at nights. He developed B/L SWELLING OF LOWER LIMBS, pitting type and extending upto the knee, aggravated on walking and relieved in lying down position He developed LOWER BACK ACHE 10-15 days back, which was non radiating type ,without any tingling sensations and relieved on lying down. PAST HISTORY: Known case of DM type 2 since 2 years. Known case of HTN since 2 years. Not a known case of EPILEPSY, TB, ASTHMA, CVA, CAD and

79Y/M with recurrent CVA with aspiration pneumonia and seizures.

79 y/o male with Recurrent CVA and left hemiplegia with Aspiration pneumonia and seizures disorder COMPLAINTS AND DURATION: A 79 y/o male was brought to casuality with c/o cough since 20 days , fever since 10 days difficulty in swallowing and h/o Aspiration pneumonia since one month C/o altered sensorium since 3 days HOPI: Patient was apparently asymptomatic 20days back then he developed cough insidious in onset and gradually progressive. PRODUCTIVE but patient is not able to spit it out. Difficulty in swallowing. H/o cough on intake of liquids. H/o change of voice since 20 days, insidious, hoarse in character and SLURRING OF SPEECH +present No h/o difficulty in breathing, breathlessness, hemoptysis Fever since 10 days -high grade. O/e Chills and rigors + (38 spikes). N/h/o vomiting, chest pain, loose stools. 7 YEARS BACK:(2016) He developed head ache at around afternon 2pm and followed by vomtings and left hand itching and weakness. PATIENT is awake on that night due to

SRIVATSA GONWAR ROLL NO 48

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