SRIVATSA GONWAR ROLL NO 48

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

This is a case of a 60year old female with the c hief complaints of -  Neck pain and headache since 5 years  HISTORY OF PRESENTING ILLNESS The patient was apparently asymptomatic 10 years ago. She then complained of back pain which is insidious in onset and gradually progressive. There are no aggravating or relieving factors. She then developed a head injury due to a heavy object (bottle gourd) falling on her head. 5 years ago she developed fever which was associated with pain in multiple joints and was diagnosed with Chikungunya. Following the episode the joint pains persisted and the  patient complained of pain in multiple joints which started in the fingers and wrist and progressed to all the joints. The pain in the joints is greater when she wakes up and is associated with stiffness. The stiffness is relieved on activity.  Her neck pain also started around 5 years ago and is associated with pain in the right nuchal and  occipital region and the right shoulder. The pain is temporari