PLA BOOK PROJECT DRAFT OPD week-3

Week-3

8th May 2023,Monday

[08/05/23, 8:45:40 AM] Rakesh Biswas Sir: Project : May 6 opd audit toward creating persistent clinical encounters in individual patients to optimize overtesting and overtreatment

[5/6, 9:34 AM] 1.

Op no.20230509700

26/M

Complaints of chest pain since 2 days 

Bloating present 

Complaints of burning sensation in the epigastrium on consumption of spicy food

No h/o SOB and palpitations 

No history of fever, cold,cough, abdominal pain,belching 

No h/o regurgitation of food 

Patient was advised for admission but not willing

[5/6, 10:04 AM]: 2.

Op no: 20210518263

53/F

Complaints of B/L pedal edema since 1 week 

Facial puffiness since 1 week

C/o SOB since 1 month (grade-2)

H/o polyuria and nocturia present 

K/c/o HTN ,Dm since 2 years (on regular medication)

Patient was advised for admission but not willing

[5/6, 10:06 AM]: 3.op no 20210205942

H/o pedal edema  2months back

Was diagnosed with liver infection

K/c/ o CAD -PTCA DONE 2 YRS BACK

Now no fresh complaints came for follow up for getting investigation 

Pt is not willing for addmission

[5/6, 10:09 AM]: 4.

Op no: 20210518264

36/F

C/O B/L knee pain since 3 months 

H/o difficulty in getting up from sitting position 

Not a k/c/o HTN,DM,Thyroid,CVA

Patient was advised for admission but not willing

[5/6, 10:11 AM]: 5.Op no 2023500720

Pt came for general check up 

Not a k/c/o dm,htn,cvs,cad,tb, asthma, epilepsy

Pt is not willing for addmission

[5/6, 10:14 AM] Rakesh Biswas: No testing. 

Please explain to patients that it's not that we are not testing because they are not getting admitted. 

We are not testing them because without a good history taking and clinical examination it's largely unnecessary. 

We are asking them to get admitted 'so that we can give them more time to do a better focused history taking and clinical examination and then order tests if necessary

[5/6, 10:44 AM]: 6.op no 20230509802

26 M

C/o involuntary movements of both upper lateral since 1 year intially started with left u/l and started in rgt since 5-6 months 

Involuntary movements of neck since 4 yr

Pt is admitting

[5/6, 10:53 AM]: 7.op no 20230508531

24F

C/o sob since 4days on exertion,fever (on and off), headache since 4days

Pt is admitting

[5/6, 11:24 AM]: 8.

op no :20230510250

59/M

C/o abdominal discomfort since 2 months (on and off)

C/o generalised weakness since 1 year 

C/o fever associated with body pains since 3 days 

No c/o belching ,constipation 

K/c/o HTN since 30 years (on regular medication-Tab.Telma-40)

Patient is not willing for admission

[5/6, 11:45 AM]: 9.

Op no: 20210425171

56/F

Complaints of fever since yesterday night associated with chills and rigors and body pains 

C/o cold ,cough (non productive)

C/o nausea since yesterday 

K/c/o HTN since 19 (on tab.ramipril2.5mg)

and DM since 16 years (on regular medication tab.Glimi -m1 )

Patient was advised for admission but not willing

[5/6, 11:54 AM]: 10.

Op no:20230510267

40/F

C/o lower back pain since 10days(dragging type )

C/o tingling sensation of B/L lower limbs since 1 month

K/c/o type 2 DM since 6 months (on regular medication Glimi -m1)

Not a k/c/o HTN,TB ,asthma ,cva

Patient is not willing for admission

[5/6, 12:07 PM]: 11.

Op no: 20230510307

38/F

C/o headache (frontal region)since 1 year 

Associated with neck pain and radiating to both upper limbs 

C/o facial puffiness since yesterday night 

C/o low backache since 1 year 

And Tingling and numbness of both lower limbs 

Not a k/c/o HTN,DM,thyroid,epilepsy,CAD

[5/6, 12:45 PM] +91 96183 36209: 12.

Op no:20230510345

67/M

C/o generalised body pains since 10days

Reduced urine output since 10days

Pedal edema since 3 days

Not a k/c/o Htn,DM ,TB ,Epilepsy 

Patient is getting admitted sir

[5/6, 12:49 PM] +91 96183 36209: 13.

Op no:20210312142

24/M

C/o chest pain since 1 week

Insidious in onset ,lasting for 20mins ,radiating to left hand scapula ,relieving spontaneously 

No h/o cough ,fever and cold 

Not a k/c/o HTN,DM,epilepsy,asthma ,TB

[5/6, 12:58 PM]: 14.

Op no:20230510341

33/M

C/o pain in lower back region since 1 week

C/o burning micturition since 1 week associated with increased frequency of micturition 

No h/o Fever 

Not a k/c/o Htn,DM,TB ,epilepsy,cva 

Patient is advised for admission but not willing

[5/6, 1:06 PM]: 15.

Op no :20230510343

16/M

C/o eating of raw rice and mud since 3 years 

C/o lethargic behaviour since 2-3 years (on and off)

No h/o decreased appetite 

No h/o palpitations ,generalised weakness 

Not a k/c/o HTN,DM,thyroid ,TB,epilepsy

patient is advised for admission but not willing

[5/6, 1:12 PM]: 16.

Op no:20230510344

55/M

C/o cold since 4 days associated with sneezing 

c/o cough since 4 days (non productive)

No h/o Fever ,headache 

Not a k/c/o Htn, dm,TB,asthma 

Patient is not willing for admission

[5/6, 2:29 PM]: 17.op no  20210125203

87 m

C/o difficultly in breathing for walking 100 mts since 10 days 

C/o chest pain in left side non radiating since 4-5days

H/o pedal edema 10days back relieved on medication h/o fever 

Not a k/c/o dm,htn,tb,asthma

Pt is advised for admission but not willing

[5/6, 2:36 PM]: 1 causality case admission

90 yr old male with altered behaviour

[5/6, 2:47 PM]: 18.op no 20230510353

27F

C/o tingling sensation in both palms and feet since 3months 

H/o chest pain left side intermittent in nature 1month back ,sob present on climbing stairs since 5months 

Pt is advised for admission but not willing

[5/6, 2:53 PM]: 19.op no 20230510847

26F

Pt came with c/o blunt head trauma since 3 months (3times in the last 6months)

No h/o nausea, vomiting

No ent bleed

No h/o loss of consciousness

Pt is advised for admission but not willing

[5/7, 7:07 AM] Lohith Varma PG Kims 2022: Only 19 patients were seen in the OP yesterday sir, 

maybe because it was Saturday, there were less patients 

Out of them two were admitted 

And one admission from casualty 

@⁨Prachetan Kims 2022 PG⁩ @⁨Pavan 2021 PG Kims Med⁩  sir were there in the OP yesterday

[08/05/23, 9:07:55 AM] ~ Vaishnavi: 1.op no 20230511516

55M

k/c/o diabetic since 4 months on metformin+ glimepiride 2 mg

H/0 burning micturation intermittent 

No h/o polyuria,polydypsia,easy fatigability,fever 

Not a K/c/o htn,asthma,tb, epilepsy

Pt was advised for admission but not willing

[08/05/23, 9:17:45 AM] Rakesh Biswas Sir: Please mention what was done for the patient

[08/05/23, 9:18:13 AM] Rakesh Biswas Sir: 2mg once a day?

[08/05/23, 9:19:40 AM] ~ Vaishnavi: Once  a day in the morning sir

[08/05/23, 9:20:53 AM] ~ Vaishnavi: Pt was not willing for admission so we didn't adviced any investigation..he returned back

[08/05/23, 9:24:49 AM] Rakesh Biswas Sir: But how are we going to ensure follow up and help him? 

Shouldn't we have another intern to prepare his PaJR group and case report and also advice Fbs,  ppbs once weekly along with hba1c once in three months? 

Most of the tests that he needs can be done near his home but what he needs is you to follow him up and guide him? Where is he from?

[08/05/23, 9:29:51 AM] ~ PAVANI: 2.

Op no.20210417921

C/o abdominal pain since 3 days  intermittent type.umblical region and in right iliac fossa ,stools passed yesterday.

Patient came for follow up 

Cheif complaint of burning micturition  1 month back 

No c/o pain during  micturition, fever .

On examination:BP:110/60

PR:84BPM

P/A:SOFT,TENDERNESS PRESENT 

CVS:S1,S2 HEARD NO MURMURS 

CNS:NFND.

RS:BAE PRESENT.NVBS HEARD.

PATIENT ADVISED FOR ADMISSION BUT NOT WILLING.

[08/05/23, 9:32:48 AM] ~ Vaishnavi: Advised fbs,ppbs,HBA1c

[08/05/23, 9:34:54 AM] Rakesh Biswas Sir: No that won't do. He'll just take the test report and go elsewhere. 

First prepare the doctor patient relationship with him and ensure follow up. If necessary he can get the test near his home not here today. 

Where is he from?

[08/05/23, 9:35:16 AM] ~ Dr.ramyareddypebbeti: 3.

Op no:20210524184

39/M

K/C/o  type 2 DM since 4 yrs came for general checkup (on tab.GLIMI-M2)

C/o tingling sensation of both feet since 1 week

C/o blurring vision (to near vision)since 1 month

C/o generalised body pains since 1 week 

No h/o burning micturition,polyuria,polydypsia,polyphagia,nocturia

Not a k/c/o HTN,Tb,epilepsy,CAD

K/c/o alcoholic since 15 yrs 

Patient is advised for admission 

But not willing

[08/05/23, 9:36:13 AM] ~ Dr.Sai Pavan: 4.Op no.20210318049

C/o tightness of abdomen ,bloating + aggravated on intake of spicy food 

C/o low backache since 2 years , aggravated on bending down ,relieved on rest 

C/o nocturia since 2 months ,burning micturition+

No polyphagia and polydypsia

N/k/c/o HTN;DM;CVA;CAD,TB,Asthma

Patient is a known case of hypothyroidism since 5 yrs on medication since 1 yr 50 mcg ----->75 mcg po/od

K/c/o  Renal calculi since 6 months ,used medications 2.

On examination:BP:130/90 mm hg 

PR:84BPM

P/A:SOFT,NON TENDER 

CVS:S1,S2 HEARD NO MURMURS 

CNS:NFND.

RS:BAE PRESENT.NVBS HEARD.

PATIENT ADVISED FOR ADMISSION 

BUT NOT WILLING .

[08/05/23, 9:39:20 AM] Rakesh Biswas Sir: Tell us what you did to help the patient!

[08/05/23, 9:39:31 AM] Rakesh Biswas Sir: Tell us what you did to help the patient!

[08/05/23, 9:51:02 AM] ~ PAVANI: 5.

Op no.20230511536

C/o diffuse chest pain (burning sensation) intermittent type since 15 days bleching present ,no history of bloating,no history of regurgitation,history of sweating during pain episode ,history of chestpain  aggravated on heavy food 

History of sob(G 1) since 2 months. 

History of Bilateral pedal edema present for 4to5 days ,1 month ago ,history of diuretic usage for 1 day.

No c/o decreased urine output. 

Not a known case of ,Hypertension,epilepsy,asthma,tuberculosis. 

Polydipsia present no polyuria,polyphagia,no burning micturition.

K/c/o diabetes since 3 days.

We advised patient for admission  but not willing for admission.

[08/05/23, 9:56:22 AM] ~ Dr.Sai Pavan👨‍⚕️: 6.Op no:20230511959

C/o left sided headache  in temporal and occipital region since 3 months 

Nausea+

No photophobia 

No phonophobia 

Loss of appetite+

No blurring of vision 

No watering from eyes 

No ear pain and tinnitus

N/K/C/O DM2;HTN;TB, epilepsy ,CVA,CAD

Patient advised for admission,but not willing

[08/05/23, 10:05:05 AM] Rakesh Biswas Sir: Tell us what you did to help the patient!

[08/05/23, 10:05:08 AM] Rakesh Biswas Sir: Tell us what you did to help the patient!

[08/05/23, 10:07:27 AM] ~ PAVANI: 7.

 Op.no20230511929

C/o chest pain and neck pain since 2 months which is of intermittent type.non radiating,

Generalised body pains since 6 months ,lower back ache present  which is releived on rest.

CHEST PAIN AGGRAVATED AFTER HAVING SPICY FOOD ,NO BLOATING,BLECHING,

History of Sob on ordinary activity since 6 months.(mmrc grade 2) 

Pitting type of pedal edema present ,profuse sweating present ,no decreased urine output,no orthopnea,no PND.

not a known case of hypertension,CAD,Asthma,epilepsy,tuberculosis,cva.

On examination:pallor PRESENT  ,pitting type pedal  edema present.

Cvs:S1,S2 HEARD no murmurs. No rise in jvp.

RS: BAE PRESENT.NVBS HEARD 

P/A :SOFT AND NON TENDER. 

CNS:NO FOCAL NEUROLOGICAL DEFICITS. 

HB:8 GM/DL IN PREVIOUS REPORTS.

HISTORY OF CATARACT surgery 2 months ago.

We advised patient for admission but patient is not willing for admission.

[08/05/23, 10:09:29 AM] Rakesh Biswas Sir: At least tell us what is your clinical diagnosis of her requirements and your plan to manage those requirements!

[08/05/23, 10:12:37 AM] ~ Rajkumar Adepu: 8.Op no:20230511963

C/o of SOB (Grade : 3) since 10 days 

C/o abdominal pain in left hypochondriac region since 10 days 

Burning micturition +

No decreased urine output

No loin pain 

No chest pain 

Passed stools today morning 

Surgical h/o: B/L DJ stenting under LA on 24/01/23

N/K/C/0 HTN,DM2,TB, epilepsy,CAD,CVA 

PATIENT ADVISED ADMISSION,BUT NOT WILLING

[08/05/23, 10:13:28 AM] Rakesh Biswas Sir: What did you do for his shortness of breath? 

What is your plan for his abdominal pain?

[08/05/23, 10:14:00 AM] Lohith Pg Gm : H/o neck pain and chestpain started after lifting heavy weights - thinking of it as muscular pain… advised ultracet 1/2tab QID for 3days 

As she is having Low Hb,SOB grade 2 to 3 and pitting edema 

Shall we advice for hemogram and ecg sir

[08/05/23, 10:14:01 AM] ~ Dr.Sai Pavan👨‍⚕️: Adviced 

Tab.NAPROXEN 250mg po/bd for 2 days

Adviced Ophthalmology review i/v/o refractory error

[08/05/23, 10:15:08 AM] Lohith Pg Gm : O/E pallor was present sir

[08/05/23, 10:15:11 AM] Rakesh Biswas Sir: No ask her to come back after her preliminary relief

[08/05/23, 10:15:41 AM] Rakesh Biswas Sir: Don't send them to other OPDs as it will distract

[08/05/23, 10:37:36 AM] ~ Dr.Sai Pavan👨‍⚕️: 9.Op no .20230511978

Patient came for follow up

Referred from UHTC as RBS-520 mg/dl

K/c/o DM2 since 5 years

Using GLIMI M1 since 10 days po/od

Used metformin 500 mg po/od for 5 years

N/k/c/o HTN,TB, epilepsy,CVA,CAD

Advised FBS,PLBS,HBA1C

[08/05/23, 10:44:35 AM] ~ Dr.ramyareddypebbeti: 10.

Op no:20210525372

59/M

C/o pain in RIF since 2 months 

H/o loin to groin pain +

H/o burning micturition +

H/o renal calculi for which he underwent surgery 

Not a k/c/o HTN,DM, TB,asthma 

Usg findings: 

E/o multiple calculi noted in right kidney largest measuring 16mm in interpolar region 

B/L renal cortical cysts 

Referring to urology opd (follow up case of urology)

[08/05/23, 10:51:00 AM] ~ Dr.Sai Pavan:11.Op no: 20230512073

Patient came for follow up 

K/c/o DM2 since 2 years using unknown medication 

K/C/O HTN since 6 years using unknown medication 

No acute complaints 

Adviced FBS,PLBS

[08/05/23, 10:53:57 AM] ~ PAVANI: Op:11 20230512032 48/F

K/C/O Hypothyroidism since 8 years. 

And is on tab:thyroxine50 mcgpo/od since 8 years.

History of generalized weakness amd easy fatiguability on doing ordinary work.

History of difficulty in swallowing since 2 to 3 months to solids but not to liquids.

No history of recent hair fall weight gain or weight loss,no hoarseness of voice.

No history of fever ,cold,sob ;chest pain.

Not a k/c/o DM,htn,tb,asthma,Epilepsy CAD.

O/E

No pallor and lymphadenopathy. 

Thyroid gland Palpable.

SO SIR CAN WE ADVICE USG NECK AND TFT.

WE ADVISED PATIENT FOR ADMISSION BUT SHE IS NOT WILLING SIR.

[08/05/23, 10:57:37 AM] ~ PAVANI: Op:12

[08/05/23, 11:02:38 AM] ~ PAVANI: Op:13

70/M

C/O OF GENERALISED WEAKNESS SINCE 3TO 4MONTHS,EASY FATIGABILITY

NO C/O SOB,CHEST PAIN,PALPITATIONS,NO WEIGHT LOSS .

PALLOR PRESENT. 

NOT A KNOWN CASE OF HYPERTENSION,EPILEPSY , ASTHMA, TB, DM.

SIR SHALL WE ADVICE FOR HEMOGRAM SIR

WE ADVISED PATIENT FOR ADMISSION BUT HE IS NOT WILLING FOR ADMISSION

[08/05/23, 11:07:17 AM] ~ PAVANI: Op no.20230441407

[08/05/23, 11:13:55 AM] ~ Rajkumar Adepu: 14.

Op no.202315012462

C/o pain in neck region from 3 years 

Pain radiating to left shoulder along with neck pain 

No h/o parasthesia tingling sensation 

C/o occasional dysphagia 2 months back

C/o swelling in anterior aspect of neck

Pt is advised to admit but not willing

[08/05/23, 11:23:07 AM] ~ Vaishnavi: 15.Op no 20230512061

40F

Patient came for follow up

H/o anemia Hb:6.8

No H/o palpitations, fatigability,shortness of breath,hematura,hairloss, melena

Patient is advised for admission but not willing

[08/05/23, 11:24:50 AM] ~ Rajkumar Adepu: 16.

Op no 20230512064

C/o bilateral pedal edema since 4 days pitting type till knees

B/l knee pains rt>lt since 1 yr

Neck pain since 7 months associated with giddiness 

No h/o tingling sensation and parasthesia

Abdominal bloating present since 15 days not associated with belching

No c/o fever loose stools vomiting

No c/o decrease urine output, hematuria frothy urine

K/c/o hypertension since 2 months on T. Telmisartan 40 mg + amlodepine  5mg

Pt advised for admission but not willing

[08/05/23, 11:27:04 AM] Rakesh Biswas Sir: What about admission and case report and PaJR link for follow up

[08/05/23, 11:27:41 AM] ~ Rajkumar Adepu: 17.

Op no. 202310510413

K/c/o DM 1 since 6 months came with complaints of generalized weakness and tingling sensation

Advised HbA1c PLBS and FBS

Pt advised for admission but not willing

[08/05/23, 11:28:34 AM] Rakesh Biswas Sir: No testing!! 😨

[08/05/23, 11:29:39 AM] ~ PAVANI: 18

Op no. 20230512467

C/o 

History of silp and fall at home 2 months ago .

Swelling in the head was present in the left side for 2 to 3 days ,subsided spontaneously 

No history of loss of consciousness,vomiting,ent bleed,no c/o blurring of vision.dragging type of intermittent pain (headache)once in 3to 4 days present in left temporal and Frontal headache .

No photo phobia,but phonophobia present,no excess lacrimation,no h/o nausea,noh/o giddiness. 

Not a known case of Diabetes mellitus,Hypertension,epilepsy,asthma,Epilepsy,CAD,TB. 

Cvs:S1 s2 heard and no murmurs 

CNS:NFND

P/A soft and NT

RS:BAE PRESENT.NVBS HEARD 

ADVICED TAB:NAPROXEN 500 MG PO/OD 3DAYS

WE ADVICED PATIENT FOR ADMISSION BUT SHE IS NOT WILLING SIR

[08/05/23, 11:31:12 AM] Rakesh Biswas Sir: No testing! The idea is to help these patients. 

Blanket testing doesn't help them. Knowing more about their sequence of external and internal events does  

Let's prepare their case reports and PaJR links 

Don't worry about opd time. Take them to wards after 4 PM 

Don't rush

[08/05/23, 11:32:07 AM] Rakesh Biswas Sir: Send her to neurosurgeon

[08/05/23, 11:32:11 AM] ~ Rajkumar Adepu: 19.

Op no 20230512075

C/o sweating , Headache, giddiness since 3 days

Generalized weakness pain in upper and lower limbs

No history of fever sob abdominal pain burning micturition pedal edema

N/k/c/o HTN DM.

Pt was advised for admission but not willing

[08/05/23, 11:32:25 AM] Rakesh Biswas Sir: No testing!! 😳😨

[08/05/23, 11:33:01 AM] Rakesh Biswas Sir: Prepare her PaJR and case report asap

[08/05/23, 11:41:07 AM] ~ Rajkumar Adepu: 20.

Op no 20230512472

C/o tingling sensation in bilateral palms and soles since 15 days

Headache (diffuse) since 15 days

Neck pain since 15 days non radiating

Not k/c/o DM HTN TB asthma

Pt advised for admission but not willing

[08/05/23, 11:43:07 AM] ~ PAVANI: 21

Op no.20230512060

37/M

C/O epigastric pain radiating to chest since 1 month 

No history of Sob,orthopnea,PND,NO PROFUSE SWEATING,COMPLAINTS AGGRAVATED AFTER TAKING SPICY OR TANGY FOODS

BLOATING PRESENT,BELCHING  +

REGURGITATION OF FOOD PRESENT 

HISTORY OF SIMILAR COMPLAINTS SINCE 1YEAR 

WORSENED SINCE 1 MONTH.

NOT A KNOWN CASE OF HYPERTENSIVE,HTN,EPILEPSY,ASTHMA,DM,CAD. 

WE ADVICED PATIENT FOR ADMISSION BUT HE IS NOT WILLING TO ADMIT

[08/05/23, 11:45:08 AM] ~ Rajkumar Adepu: 22

Op no 20210114280

C/o headache since morning 

H/o trauma to head during bike accident 

No episode of loss of consciousness

No episode of vomiting 

K/c/o hypothyroidism since 6 months on thyronorm 12.5mcg

Pt was advised for admission but not willing

[08/05/23, 11:55:37 AM] ~ Rajkumar Adepu: 23

Op no 20210516301

C/o weight gain since 2 years (almost 20 to 25 kgs)

No complaints of hair loss , constipation, Palpitations, polyphagia

Pt advised for admission but not willing

[08/05/23, 11:56:58 AM] ~ PAVANI: 24

Op no:20230512591

C/o severe headache in B/L temporal and occipital region 

 since 1 month

No photo phobia and no phonophobia

Ear pain +

No tinnitus 

Blurring of vision+

Watering from eyes+

N/k/c/o HTN DM TB epilepsy CVA CAD

[08/05/23, 11:59:47 AM] ~ Rajkumar Adepu: 25.

Op no 202103818049

C/o generalized weakness and headache since 2 weeks

K/c/o DM and HTN since 5 years on medication 

No history of giddiness , fever , trauma, hairloss, wt loss , 

Pt advised for admission but not willing

[08/05/23, 12:08:40 PM] ~ Rajkumar Adepu: 26.

Op no. 20210522567

C/o b/l back pain from 1 month sharp type, intermittent in nature associated with aggrevated on physical exertion, deep seated pain 

C/o hematuria 2 episodes in last 1 month

No h/o pedal edema facial puffiness

Pt advised for admission but not willing

[08/05/23, 12:09:04 PM] ~ PAVANI: 27.

Op no :

C/O TINGLING SENSATION OF RIGHT UPPER LIMB SINCE 1 MONTH 

NO NUMBNESS 

HISTORY OF NECK PAIN 

PRESENT WHICH US RADIATING TO HEAD AND TOTHE ROGHT ARM N/K/C/O

HTN,CVA,CAD,TB,ASTHMA,,DM.

WE ADVICED PATIENT FOR ADMISSION BUT HE IS NOT WILLING TO ADMIT

[08/05/23, 12:11:28 PM] Rakesh Biswas Sir: Why is he having headache and tingling for 15 days? 

Use your history taking and examination skills to tell us that or else surrender your internship and mbbs degree

[08/05/23, 12:12:16 PM] Rakesh Biswas Sir: What is your hypothesis for his abdominal pain?

[08/05/23, 12:12:37 PM] Rakesh Biswas Sir: Trauma when?

[08/05/23, 12:13:14 PM] Rakesh Biswas Sir: Share the images of visceral fat and muscle mass! Age? Gender?

[08/05/23, 12:14:10 PM] Rakesh Biswas Sir: What is your hypothesis for the headache? 

Age?  Gender?

[08/05/23, 12:14:45 PM] Rakesh Biswas Sir: What is the reason for his loin pain and hematuria?

[08/05/23, 12:14:53 PM] ~ Rajkumar Adepu: Today morning

[08/05/23, 12:15:05 PM] ~ Rajkumar Adepu: Male 14 years

[08/05/23, 12:15:18 PM] ~ Vaishnavi: 28.

Op no:20210313208

52 yr/FEMALE 

C/o weakness since 1 week

Bloating sensation present

Generalised body pains present

Belchings absent

 No SOB 

No Pedal edema

No Palpitations

C/0 multiple joint pains since 3 days 

No morning stiffness

No h/o fever

[08/05/23, 12:16:04 PM] Rakesh Biswas Sir: Why is she having tingling and neck pain since one month?

[08/05/23, 12:16:45 PM] Rakesh Biswas Sir: On examination? 

Share everyone's visceral fat and muscle mass images asap

[08/05/23, 12:26:03 PM] ~ PAVANI: 29

Opno.20230512592  

41F

C/O diffuse headache.

Since 1 month.

Photophobia,Phonophobia present. Nausea present,neckpain present and no rigidity. 

History of similar complaints since 4years.

PATEINT was on domperidone 10mg+NAPROXEN 500mg

C/o bloating sensation since6 months 

Belching present .

Aggravated after having food

Adviced Ultracet 1/2qud for 3 days.

We advised patient for admission but she is not willing sir.

[08/05/23, 12:31:41 PM] ~ Dr.Sai Pavan👨‍⚕️: 30.

Op no :20230512632

33 yrs/female 

C/o of diffuse abdominal pain in hypogastric region since 5 days 

Burning micturition present 

C/o low grade  fever since 2 days 

Not associated with chills and rigors 

No cold and cough 

No evening raise of temperature  

N/K/C/O HTN,DM,TB ,epilepsy ,CVA,CAD

Patient advised for admission but not willing

[08/05/23, 12:32:04 PM] ~ Rajkumar Adepu: 31

Op no 20230512604

C/o headache with neck pain associated with left upper limb pain and tingling sensation since 15 days

Low backache since 1 week non radiating

No C/o photophobia phonophobia vomiting lacrimation

N/k/c/o DM HTN TB asthma

[08/05/23, 12:32:27 PM] ~ Rajkumar Adepu: Pt advised for admission but not willing

[08/05/23, 12:37:15 PM] ~ Rajkumar Adepu: 32

Op no 20210419028

C/o bilateral pedal edema since yesterday morning pitting type till shin of tibia

Burning micturition since morning non foul smelling

No c/o decreased urine output, frothy urine, hematuria

No c/o fever, loose stools, vomiting, cough

K/c/o HTN since 6 months on Telmisartan 20 mg of

Pt advised for admission but not willing

[08/05/23, 12:41:15 PM] ~ Rajkumar Adepu: 33.

Op no 20230512580

C/o pain abdomen in hypogastric region followed by diffuse in nature since 7 days 

Indigestion present

Abdominal bloating with belching

H/o fever since 1 month not associated with chills resolved now

Generalized body pains present 

N/k/c/o DM HTN TB CVA CAD

Pt advised for admission but not willing

[08/05/23, 12:43:36 PM] ~ PAVANI: 34

Opno:20230512520

30/F

Patient came for regular follow up k/c/o hypothyroidism since 15 years. 

Tab.thyroxine 80mcg  from 15 years and 2yrs ago 100mcg and since 1year 125 po/od

C/o swelling of entire body and weight gain since 3 years.

History of hairfall present generalised weakness present

History of difficulty in swallowing. Since 2to3 years.

No cold intolerance,no hoarseness of voice.

Not a k/c/o Dm,htn,asthma,tb,epilepsy. 

We advised patient for admission but she is not willing for admission

[08/05/23, 12:50:12 PM] ~ PAVANI: 35

28/M

C/O generalised body pains of upper and lower limbs since 10 days.

No h/o fever ,cold ,cough.

Noc/o sob,chest pain.

Nocomplaints of polyuria,polyphagia,polydipsia,

Noc/o weight loss /gain , nohistory of cold intolerance

No history of hairfall ,

Not a known case of htn,dm,CVA,CAD,tb,asthma. 

No c/o joint pains.

We advised tab:Ultracet 1/2 po/qid×3days.

We advised patient for admission but he is not willing for admission

[08/05/23, 2:30:50 PM] ~ Prathyusha Singam: 52

55/F 

Decayed tooth, planned for extraction, referred i/v/o high BP. 

K/c/o DM since 2years. On medication. 

N/k/c/o HTN, TB, asthma.

[08/05/23, 2:39:17 PM] Rakesh Biswas Sir: One similar patients got admitted recently after she lost her vision!

[08/05/23, 2:39:46 PM] Rakesh Biswas Sir: Why acute headache?

[08/05/23, 2:40:03 PM] Rakesh Biswas Sir: Why acute edema?

[08/05/23, 2:41:00 PM] Rakesh Biswas Sir: Why fever since one month?

What is the best approach to help these patients even if they don't admitted?

[08/05/23, 2:41:51 PM] Rakesh Biswas Sir: What would be the likely cause for her dysphagia?

[08/05/23, 2:42:22 PM] Rakesh Biswas Sir: Dengue?

[08/05/23, 2:42:43 PM] Rakesh Biswas Sir: Admitting for BP control?

[08/05/23, 2:45:10 PM] ~ Prathyusha Singam: 55

C/o bloating sensation of abdomen after having food since 1year. 

Belching+

Regurgitation+

No h/o sob, chest pain, palpitations.

N/k/c/o HTN, DM,TB, CVA, asthma. 

O/E:

Pallor+

CVS:S1,S2+. No murmurs

RS: BLAE+. No added sounds. 

Diagnosis: GERD

Rx: T. RAZO 40mg PO/OD before breakfast for 14days. 

Avoid spicy and tangy food.

[08/05/23, 2:45:25 PM] ~ Prathyusha Singam: 60/F

[08/05/23, 2:50:15 PM] Rakesh Biswas Sir: You think no one gave him razo for 1 year! 👺

[08/05/23, 2:54:07 PM] ~ Prathyusha Singam: 56

30/M

C/o abdominal bloating since 2 days after having food. 

Belching -

Regurgitation -

Aggravated on having spicy, tangy food. 

N/k/c/o HTN, DM, TB, CVA. 

Diagnosis: Acid peptic disease 

Rx: T. Pan 40mg PO/OD before breakfast

Avoid spicy food.

[08/05/23, 2:54:58 PM] ~ Bhuvana phanindra Sharma: 57

28/M

C/O neck pain since 4days.insidious in onset, dragging type,no aggregating and reliving factors

associcated with headache and nausea.

No h/o fever ,cold ,cough.

Noc/o sob,chest pain.

Nocomplaints of polyuria,polyphagia,polydipsia,

Noc/o weight loss /gain , nohistory of cold intolerance

No history of hairfall ,

Not a known case of htn,dm,CVA,CAD,tb,asthma. 

No c/o joint pains.

We advised tab:Ultracet 1/2 po/qid×3days.

We advised patient for admission but he is not willing for admission

[08/05/23, 2:56:41 PM] ~ Afeefa Farzana: 51

30/F

C/O chest pain since 3 months on and off,non radiating 

H/0  lifting weight, burning sensation in epigastric region after intake of spicy foods

Belchings present

No palpitations, sweating,pedal edema,SOB,PND,orthopnea

N/k/c/o HTN, DM,TB,epilepsy, CAD 

Treatment given

Ultracet half tab qid

Avoid spicy foods

We advised patient for admission but she is not willing for admission

53

35/F

C/O pain in left loin region since 2 days which is insidious in onset,continuous dragging type of pain aggravated on daily activities no relieving factors ,radiating to thigh and lower leg

No H/O fever,burning micturition, Lower abdominal pain 

No H/O pedal edema 

No H/O decreased urine output 

Not k/c/o DM, HTN, epilepsy, thyroid, TB,asthma 

O/E

Pallor present

No renal angle tenderness 

Treatment 

T.ultracet half tablet po /qid

We advised patient for admission but she is not willing for admission

55

37/M

C/O right side chest pain since 2 days only after lifting heavy weights,non radiating 

Belchings absent,no chest tightness

No palpitations, sweating,pedal edema,SOB,PND,orthopnea

N/k/c/o HTN, DM,TB,epilepsy, CAD 

Treatment given

Ultracet half tab qid

We advised patient for admission but he is not willing for admission

[08/05/23, 3:02:03 PM] ~ Prathyusha Singam: 58

25/M

C/o belching present since 6months. 

C/o burning sensation in chest 

C/o abdominal tightness + which aggravated on having tangy food 

Regurgitation+

No c/o sob, chest pain

N/k/c/o HTN, DM, TB, CVA, CAD

 Diagnosis: Acid peptic disease

Rx: T. RAZO - D 40mg PO/OD before breakfast. 

Syp. SUCRAFYL - O PO/TID. 

Avoid spicy food.

[08/05/23, 3:02:36 PM] ~ Prathyusha Singam: Advised for admission but patient is not willing for admission

[08/05/23, 3:03:57 PM] ~ Prathyusha Singam: We advised for admission but she is not willing to admit sir.

[08/05/23, 3:18:45 PM] ~ Prathyusha Singam: 60

28/F

C/o B/L headache(temporal region) aggravated since 6months- present since 2years. It is present everyday since 6months, intermittent,   throbbing headache in nature.

Photophobia and  photophobia + 

No neck pain, nausea, giddiness. 

No excessive lacrimation. 

No earache, buzzing sensation in ear. 

N/k/c/o HTN, DM, TB, CVA, CAD.

Rx: T. Naproxen 250mg PO/BD (@8am & 8pm) for 5days.

[08/05/23, 3:18:53 PM] ~ Afeefa Farzana: 58

60/M

C/O giddiness 3 days back

First episode 

Headche present,No loss of consciousness, no ear pain,no tinnitus,no nystagmus, rombergs negative,no postural hypotension, no postural variation,no ear discharge, no neck pain

C/O knee pain since 4 months

Restriction of movements present

Crepitus present

k/c/o HTN since 3 years using tab.cinod 10 mg OD

DM since 3 years using glucroyl M2 OD 

not K/c/o TB,epilepsy, CAD 

Treatment given

Ultracet half tab qid

We advised patient for admission but he is not willing for admission

[08/05/23, 3:38:12 PM] ~ Prathyusha Singam: 61

75/M

C/o epigastric pain since 2years(dragging type).  Aggravated since 1 month and on having tangy & spicy food. 

Relieved after having food, taking antacids. 

Bloating+

Belching+

Regurgitation - 

No c/o sob, chest pain, PND, orthopnea. 

Diagnosis: Acid peptic disease

Rx: T. RAZO 40mg PO/OD before breakfast

[08/05/23, 4:19:48 PM] Rakesh Biswas Sir: Wouldn't they have been better off visiting a pharmacy and getting pantoprazole?

[08/05/23, 4:24:24 PM] Rakesh Biswas Sir: Why are you all wasting valuable typing time typing negative histories? 

Tell us a proper sequence of events in detail! 

Start with what were the patients daily activities when he was absolutely alright 

Then tell us what happened to those activities once the problem started and what are his current day to day activities. 

Every patient must have been very troubled by their problems to have taken a day off to come and visit you all and waste an entire day. What have be done to understand their requirements and solutions?

[08/05/23, 4:25:18 PM] Rakesh Biswas Sir: 5 days is a lot  

2 days should have been enough

[08/05/23, 4:26:23 PM] Rakesh Biswas Sir: Ultracet should never be given more than two days. 

In USA they put doctors in jail for over prescribing opiods

[08/05/23, 4:28:01 PM] Rakesh Biswas Sir: Razo can be taken from pharmacy 

What can justify this person's wasting his entire day here ?

[08/05/23, 4:28:02 PM] Rakesh Biswas Sir: How many admissions out of 61? 

[08/05/23, 4:29:22 PM] ~ Keerthi Madireddi: 3 admissions sir

[08/05/23, 4:32:27 PM] ~ Afeefa Farzana: Yes sir we gave only for 2 days

9th May 2023,Tuesday

[09/05/23, 9:32:21 AM] ~ Rachana Gangula: 9/5/23

Sno 1 

Op no 20230513374

55/F

C/O neck pain on the right side since 1 month. Non-radiating type of pain,

Aggregated on sleeping on bed. 

No h/o trauma. Not associated with headache. 

Farmer by occupation and has significant history of bearing heavy weights overhead. 

Advised admission for further evaluation but patient not prepared and not willing for admission

[09/05/23, 9:33:32 AM] Rakesh Biswas Sir: Weight bearing since? 

What factor precipitated the pain since one month?

[09/05/23, 9:35:45 AM] ~ Rachana Gangula: Weight bearing since almost 20 years until 6 months ago sir.

[09/05/23, 9:37:42 AM] Rakesh Biswas Sir: Why did he stop?

[09/05/23, 9:52:51 AM] ~ Rachana Gangula: 9/5/23

Sno 5

Op no 2023051337

51/F

Patient is a k/c/o type 2 DM since 4 years ( on medication Tab. metformin 500mg po/od) 

K/c/o HTN since 1 year, on unknown medication

K/c/o hypothyroidism since 10 years  on TAB Thyronorm 100mcg 

Patient came for regular investigations, Advised admission for the same, but patient not willing for admission

[09/05/23, 9:56:49 AM] Rakesh Biswas Sir: Weekly glucometer readings? 

PaJR link for follow up with diet and activities for life style modification?

[09/05/23, 10:02:28 AM] ~ Rachana Gangula: 9/5/23

Sno 3

Op no 20230513758

65/F

C/O burning sensation of bilateral feet since 3 days, insidious in onset. No aggregating or relieving factors. 

N/K/C/O DM, HTN, TB, Asthma, , Epilepsy, CAD. 

H/O cataract surgery to left eye 3 years back. 

H/o cataract surgery to right eye 3 months back 

Patient advised admission for further evaluation but patient not willing for admission

[09/05/23, 10:14:11 AM] ~ Rachana Gangula: Sno 2

Op no 20230500668

77/M

C/O Right sided chest pain since 3 days

C/o SOB since 10 days

SOB grade-Ill relieved by taking rest,

No orthopnea , NO PND

Palpitations+ Intermittent 

C/0 Nocturia since 2 months 

Burning micturition since 2 months 

C/O constipation since 6 years

K/C/O haemorrhoids since 6 years

Blood in stools+ intermittent 

K/c/o  HTN  since 6 years on regular medication 

N/K/C/O  Dm, CVA, CAD, TB, Epilepsy 

Patient advised admission for further evaluation but patient not willing for admission.

[09/05/23, 10:19:05 AM] ~ Dr. Meesum Abbas: 6. 

Op no. 20210119480

64/M

Came for blood investigations. 

K/c/o DM since 2 yrs, using T. Metformin 500 mg po/od before lunch 

K/c/o HTN since 1.5 years using T telma 40 mg po/od after breakfast

[09/05/23, 10:24:21 AM] ~ Dr. Meesum Abbas: 8. 

Op no. 20210119480

60/M

C/O headache since 1 year in b/l temple region

No nausea, vomiting, photophobia, phonophobia

Relieved on medication 

C/o nocturia and hesitancy since 1 year

Patient advised admission for further evaluation but not willing

[09/05/23, 10:27:16 AM] ~ Rachana Gangula: 9/5/23

Sno 7

Op no 20210422941

37/F

C/O generalised weakness since 1 year. 

C/O intermittent tingling sensation of bilateral limbs upper limbs and lower limbs. 

No h/o polyuria, polydipsia, polyphagia, fever, loose stools. 

N/K/C/O  Dm, CVA, CAD, TB, Epilepsy

On examination- Pallor + 

Patient advised admission for further evaluation but patient not willing for admission.

[09/05/23, 10:38:25 AM] ~ Rachana Gangula: Sno 9

Op no 20230513807

46/F 

C/O Headache - 5 days

clo Neck pain - 5 days

Body pains - 5 days

Fever 3 days back 

low grade, relieved on taking medication

c/o cough  - 5 days

dry cough , relieved on taking medication 

C/O Nocturia since 4 months 

No Polydipsia, No tingling sensations 

K/clo DM-II  since 4 months  on GLIMI -M1 po/od

N/K/C/O  HTN, CVA, CAD, TB, Epilepsy, Asthma 

Patient advised admission for further evaluation but patient not willing for admission.

[09/05/23, 10:40:56 AM] ~ Dr. Meesum Abbas: 11. 

Op no. 20230613784

50/M

C/o burning micturition since 10 days

K/c/o Hypothyroidism since 3 years (on thyronorm 50 mcg)

C/o weight gain since last 2 months, fatigue since 2 months

Patient advised admission for further evaluation but not willing to get admitted

[09/05/23, 10:51:39 AM] ~ Dr. Meesum Abbas: 12. 

Op no. 20230513837

C/o c/o heaviness in chest since 10 days, no pain, non radiating 

SOB since 10 days, grade 2, orthopnea +, PND+ 

No pedal edema or palpitations 

C/o vomitings since 10 days, 5-6 episodes in 10 days, non projectile, non bilious, content- food

C/o menorrhagia but last cycle 2days/28 days, white discharge p/v

Patient advised admission for further evaluation but not willing

[09/05/23, 10:59:44 AM] ~ Dr. Meesum Abbas: 10. 

Op no. 20230513832

64/M

C/o b/l lower limb swelling from knee to ankle since 10 days, insidious in onset aggravated on sitting for a long time

C/o burning sensation in b/l feet since 7 days

H/o fever 4 months back relieved after taking medication 

H/o similar complaints 2 years back

K/c/o HTN since 6 years. On telma 40 mg metoprolol 50 mg po/od

Patient advised admission for further evaluation but not willing

[09/05/23, 11:13:19 AM] ~ Rachana Gangula: Sno 16 

Op no 20230513902

60/F 

C/O constipation since 2 months. 

No h/o pain abdomen, vomitings, nausea. 

H/0 Burning micturition since 10 days. 

H/O burning sensation and tingling sensation of both feet since 10 days 

N/K/C/O DM, HTN,TB, Asthma,CAD,CVA. 

O/E- mild tenderness in left lilac fossa 

Patient advised admission for further evaluation but patient not willing for admission.

[09/05/23, 11:17:58 AM] ~ Dr. Meesum Abbas: 17. 

Op no. 20230513927

60/F

C/o generalised body pains since 2 years

C/o burning sensation of b/l UL and LL since 1 year

C/o itching of whole body since 1 year

C/o constipation since 1 year once for 6-7 days, no blood in stools, hard stools+

K/c/o DM2 since 1 year. On tab glimi m2 po/bd

K/c/o HTN since 3 years on tab Amlokind-at

Patient advised admission for further evaluation but not willing

[09/05/23, 11:28:15 AM] ~ Dr. Meesum Abbas: 18. 

Op no. 20230513935

36/F

K/c/o hypothyroidism since 6 years

C/o loss of hair, excessive sweating and weight gain

No c/o palpitations, fatigue, irregular cycles 

No goitre or hoarseness of voice 

Patient advised admission for further evaluation but not willing

[09/05/23, 11:36:37 AM] ~ Rachana Gangula: Sno 24

Op no 20230514400

55/F 

C/O weakness of both lower limbs since 1 month associated with difficulty in walking since 1 month. 

K/C/O type 2 DM since 15 years and one regular medication. 

N/K/C/O HTN,TB, Asthma,CAD,CVA

Patient advised admission for further evaluation but patient not willing for admission.

[09/05/23, 11:43:31 AM] ~ Dr. Meesum Abbas: 19. 

Op. no. 20230513954

77/M

C/o generalised body weakness since 1 month

C/o SOB grade 3 since 1 month, decreased after medication 

Orthopnea+, PND+, pedal edema+

C/o decreased appetite since 1 month

K/c/o AF, Tachy Cardiomyopathy

Patient on T Digoxin 0.25

T Met-xl 50 mg

T. Xapilis 2.5 mg 

T. dytor plus 10/50 

H/o trauma to head 1 month back, bleeding+

Patient advised admission for further evaluation but not willing

[09/05/23, 11:46:25 AM] ~ Rachana Gangula: Sno 14 

Op no 20230428629

30/M

C/O pain abdomen since 10 days

Burning type, diffuse, more before eating and relives after eating.

C/O decreased appetite since 10 days. 

N/K/C/O DM, HTN,TB, Asthma,CAD,CVA

Patient advised admission but not willing for admission.

[09/05/23, 12:20:36 PM] ~ Rachana Gangula: Sno 22

Op no 20210110835

45/M 

C/o Fever- 3days

Low grade , Intermittent, a/w chills and rigors 

relieved on medication.

clo cough -2 day.

Dry cough

C/o burning micturition Since 1 week

No deceased urine output 

K/C/o HTN since 5 years using unknown medication 

N/K/C/O DM, TB, Asthma,CAD,CVA

Patient advised for admission for further evaluation but patient not willing.

[09/05/23, 12:21:28 PM] ~ Dr. Meesum Abbas: 25. 

Op no. 20230514421

30/F

C/o burning sensation in epigastric region since 15 days, more on food intake, relieved after 30 mins

Advised admission for further evaluation but not willing

[09/05/23, 12:35:15 PM] ~ Dr. Meesum Abbas: 26. 

Op no. 20230514438

58/M

C/o tingling sensations of b/l UL and LL since 10 days

C/o burning sensation of b/l feet since 10 days

SOB on exertion and relieved on rest

K/c/o DM since 5 years on Glimi 1 mg Metformin 500 mg po od 

K/c/o HTN since 5 years on Tab Amlong 5 mg atenolol 15 mg

Patient advised admission for further evaluation but not willing

[09/05/23, 12:39:39 PM] ~ Rachana Gangula: Sno 15 

Op no 20230513844

27/F 

C/o chest pain left side on and off since 20 days radiating to left hand and left side of neck. Associated with palpitations, sweating, insidious in onset. Aggravated on food intake and exertion. 

No C/o SOB, pedal Edema, fever, decreased renal output. 

N/K/C/O DM, HTN,TB, Asthma,CAD,CVA

Patient advised admission but not willing for admission.

[09/05/23, 12:44:22 PM] ~ Dr. Meesum Abbas: 27. 

Op no 20230514370

55/F

C/o headache since 7 months 

H/o nausea, photophobia, phonophobia

C/o blurring of vision of both eyes since 3 months

H/o foreign body sensation of left eye and watering of eye occasionally since 3 months 

H/o cataract surgery 10 months ago

C/o tingling sensation of whole body since 5 months 

Patient advised admission for further evaluation but not willing

[09/05/23, 12:48:15 PM] ~ Rachana Gangula: Sno 24

Op no 20230544169

45/F

c/o Burning Sensation and tingling sensation  of left-side of head, left UL and LL since 5 months  (Intermittent)

Also complains of Numbness of left UL and LL since 5 months

C/O chest pain, Non radiating, Needle pick type of pain with SOB grade I. No orthopnea, NO PND. 

N/K/C/O DM, HTN,TB, Asthma,CAD,CVA

Patient advised admission but not willing for admission.

[09/05/23, 1:30:03 PM] ~ Dr. Meesum Abbas: 30. 

Op no. 20230514471

C/o yellowish discolouration of eyes since four years (on and off) 

C/O pain in epigastric, and in umbilical region since 4 years, pain of squeezing type

No fever, cold, cough

C/O oligomenorrhoea since 4 year, 1 day/28 days 

Patient advised admission for further evaluation but not willing

[09/05/23, 2:41:46 PM] ~ Rachana Gangula: Sno 31

Op no 20230514473

24/F

C/o SOB and cold since 2 years (on and off) 

Associated with dry cough 

SOB grade 2, sudden in onset

Not associated with chest pain, palpitations, orthopnea, PND

No C/o pedal Edema facial puffiness or decreased urine output 

H/O Covid in 2021 

N/K/C/O DM, HTN,TB, Asthma,CAD,CVA

Patient advised admission for further evaluation but not willing for admission.

[09/05/23, 2:45:26 PM] ~ Rachana Gangula: Sno 32

Op no 20210219581

34/M 

C/O pain abdomen since 7 days 

C/o fever since 7 days 

Pain abdomen- Umbilical and right hypochondriac region squeezing type, non radiating, 

No h/o vomitings constipation or loose stools 

Fever since 7 days, high grade, intermittent, associated with chills and rigor, relieved on medication. 

Generalised weakness since 7 days present 

N/K/C/O DM, HTN,TB, Asthma,CAD,CVA

Patient advised admission for further evaluation but not willing for admission.

[09/05/23, 3:05:02 PM] ~ Dr. Meesum Abbas: 33. 

Op no. 20230514818

H/o CVA 14 years back, deviation of mouth to left side

No slurring of speech, no involuntary movements

Patient came with c/o watering eyes since 4 years on and off

Advised admission for further evaluation but not willing to admit

[09/05/23, 3:46:53 PM] ~ Rachana Gangula: Sno 40

Op no 20250514857

35/M 

C/O pain Abomen the Epigastric Region

Since 1 month.

H/o Alcoholism since 17 years of age

40-180ml /day

K/C/o HTN since 1 month and on -Tab TELMA 40mg 

N/K/C/O DM, TB, Asthma,CAD,CVA

Patient advised admission for further evaluation but not willing for admission.

[09/05/23, 3:50:05 PM] ~ Rachana Gangula: Sno 46

Op no 20250514852

52/F 

C/O Epigastric pain since 2 months

C/O burning sensation in epigastric region 

Burning sensation Relieved on taking food.

K/C/o HTN since 6 years and on regular medication 

N/K/C/O DM, TB, Asthma,CAD,CVA

Patient advised admission for further evaluation but not willing for admission.

[09/05/23, 3:55:42 PM] ~ Dr. Meesum Abbas: 43. 

Op no. 20230514824

C/o abdomen pain in epigastric region since 1 month on and off. Burning type of pain

H/o alcoholism since 15 years (90-180 ml per day)

?alcoholic gastritis 

Patient advised admission for further evaluation but not willing to get admitted

[09/05/23, 4:07:41 PM] ~ Dr. Meesum Abbas: 44. 

Op no. 20230514910

C/o cough and cold since 2 days

Headache since today morning 

No h/o fever, ear pain, vomitings, loose stools

?URTI

Patient advised admission for further evaluation but not willing to get admitted

[09/05/23, 4:27:08 PM] ~ Dr. Meesum Abbas: 47. 

Op no. 20230514914

49/F

C/o Generalised Body pains

since 2 days

C/o Left shoulder pain since 6 months

H/o trauma to the left shoulder 6 months back

Patient advised admission for further evaluation, but not willing to get admitted

[09/05/23, 4:37:33 PM] ~ Rachana Gangula: Sno 38

Op no 20230514837

75/M 

C/o weakness of right UL and LL since 4 days 

C/o involuntary micturition since 5 days 

H/O fever 5 days back 

K/C/O HTN since 3 years 

Patient is getting admitted in AMC

10th May 2023,Wednesday 

[10/05/23, 9:59:45 AM] ~ A.R.T.TEJASRI: s no 1

OP no 20230515225

57/F  came for follow up 

k/c/o diabetic for 5 years on gluconorm m2 and istamet.

 patient advised for admission ,but not willing to admit.

[10/05/23, 10:03:03 AM] Rakesh Biswas Sir: Tell us what you are doing to help the patient without testing

[10/05/23, 10:11:00 AM] ~ A.R.T.TEJASRI: s no 2.

60f ,diabetic since 1 year and hypertensive since 3 years ,follow up case 

OP no.20230513927, 

pallor (+) with itching all over body 

generalised myalgia since 1 year with tingling sensation advised to 

continue t.glimi+met and pregabalin 

advised admission for anemia but refused.

[10/05/23, 10:12:05 AM] ~ A.R.T.TEJASRI: following up with a pajr. continuing his anti diabetic medication

[10/05/23, 10:20:20 AM] ~ A.R.T.TEJASRI: s no 3.

op no: 20230515704

52/M

diabetic since 7 years on tab voglibose+glimi+metformin

c/o chest pain on left side since 1 week ,feeling of food stuck in the chest since 1 week. ? GERD

advised Pantop(40mg) + domperidone(30mg) po/of for 4 days 

, not to sleep immediately after eating food ,, avoid spicy food 

patient advised for admission not willing to admit.

[10/05/23, 10:31:16 AM] ~ A.R.T.TEJASRI: s no 4

op no : 20230515754

54/M

chest pain since 4 months, pain relieved on eating food .

neck pains since 4 days radiating to bilateral shoulder and upper limbs.

bilateral knee pains

advised admission , not willing to admit

ultracet for 2 days

pantop for 5 days

[10/05/23, 10:37:07 AM] ~ A.R.T.TEJASRI: s no 5.

op no : 2021021049

61/M

c/olowerlimb pain since 4 days, more in  thigh, aggravated on walking, neck pain radiating to back decreased on rest

o/e slrt +ve on right 

abpi >0.9

Physiotherapy for right sciatic pain

advised for admission not willing to admit .

[10/05/23, 11:25:53 AM] ~ A.R.T.TEJASRI: s no 6

op no 20210208630

34 M

c/o fever since 1 week, intermittent in nature

myalgia since 1 week ,more low back pain  and burning micturition since 1 week , No increased and decreased frequency of micturition 

patient advised to admit , not willing for admission.

[10/05/23, 11:40:09 AM] Rakesh Biswas Sir: For 3, 4, 5, 6?

[10/05/23, 11:42:50 AM] ~ A.R.T.TEJASRI: s no 7

op no: 20230516246

55 F, came for regular check up

type 2 diabetes since 4 years on glimi m1 po/of.

hypertensive since 5 years on tab Thelma-H po/od.

advised admission not willing for admit.

[10/05/23, 11:45:23 AM] ~ A.R.T.TEJASRI: treatment given , patient advised for admission  according to their convenience

[10/05/23, 11:45:31 AM] Rakesh Biswas Sir: 👆

[10/05/23, 11:47:53 AM] Rakesh Biswas Sir: Not just medication 

PaJR is about learning from the patient's hourly activities (energy expenditure) and daily food plates (enery intake) 

Life style modification, the key to beating diabetes is all about the delicate balancing of energy!

[10/05/23, 12:12:40 PM] ~ Parvez Ansari: 8.

Op no. 20230516259

53/F

C/O fever high grade associated with chills for 3 days

C/O severe pain in right  hypochondrium region non radiating for 3 days

Advised admission for further evaluation 

Patient is not willing for admission

[10/05/23, 12:14:09 PM] ~ Parvez Ansari: 09

Op no:20230516263

22/M

C/o- headache for 2 weeks(over temporal region) 

C/O vomitings 2 episodes(non projectile) 

 

Patient was advised admission but they are not willing to get admitted.

[10/05/23, 12:27:11 PM] ~ A.R.T.TEJASRI: 10

op no :20230516298

35 F

c/o pain more in lowerlimbs

radiating from lumbar to ankle,more in calf

aggravated on walking for short distances

pip tenderness +

low grade fever since 1 month

abpi is 0.9

slrt negative 

patient was advised for admission , patient willing to get admitted tomorrow.

[10/05/23, 12:36:14 PM] ~ Parvez Ansari: 11

Op no:20230516303

42/F

C/O knee pain raditing to ankle

C/O shoulder pain radiating to hand for 5 months

K/c/o DM II for 10 years  and on medication glimi M1 

Patient was advised admission

She will come tomorrow for admission

[10/05/23, 12:37:28 PM] ~ A.R.T.TEJASRI: 11 

op no:2023051630

60M

c/o seizure like episode 6 days ago

tongue bite with fronthing,regained consciousness after 2 weeks

first episode 3 years 

second episode 2 years ago

advised for admission not willing to admit.

[10/05/23, 12:43:29 PM] ~ A.R.T.TEJASRI: 12

op no : 20230516293

45/F

ENT referral 

advised admission for evaluation of bronchial asthma, ? metabolic syndrome,chronic uncontrolled hypertension. patient will come tomorrow for admission.

[10/05/23, 12:46:46 PM] ~ A.R.T.TEJASRI: 13

[10/05/23, 12:53:50 PM] ~ A.R.T.TEJASRI: 14.

op no: 20230516682

60/M

C/o fever since 1 week associated with chills and rigors high grade , flank pain since 3 days

advised admission getting admitted.

[10/05/23, 12:57:14 PM] ~ A.R.T.TEJASRI: 15.2023516680

55/M

c/o difficulty in breathing since 10days aggravated since 3 days

c/o headache in frontal area since 10 days 

supraorbital tenderness present 

? frontal sinusitis 

patient advised for admission  not willing to admit

[10/05/23, 1:04:20 PM] ~ A.R.T.TEJASRI: 16

op no : 20230516705

44/F handloom weaver 

c/o neck pain since 2 months radiating to right upper limb .k/c/o cervical spondylosis since 2 years

h/o trauma 2 years ago 

spurling test  negative .

advised admission not willing to admit .

[10/05/23, 1:04:44 PM] ~ A.R.T.TEJASRI: 17.

[10/05/23, 2:43:07 PM] Rakesh Biswas Sir: What were your differentials and please mention what would have you done for every patient after admission

[10/05/23, 2:44:13 PM] Rakesh Biswas Sir: Admitted or just PaJRed from previous?

[10/05/23, 2:45:03 PM] ~ Navya: Not willing for admission

[10/05/23, 2:45:36 PM] Rakesh Biswas Sir: What are your differentials and please mention what would you do for every patient after admission

[10/05/23, 2:46:27 PM] Rakesh Biswas Sir: Elaborate more about how you analyzed his weakness and sweating

[10/05/23, 2:47:55 PM] Rakesh Biswas Sir: How does one diagnose K/c/o cervical spondylosis since two years?

[10/05/23, 2:49:28 PM] Rakesh Biswas Sir: What is the diagnosis for his difficulty in breathing after history and clinical examination? How did you try to help him once he refused admission?

[10/05/23, 3:10:38 PM] ~ Navya: 18.

Op no. 20230316720

28/F

C/O neck pain radiating to both upperlimbs since 2 days

H/O body pains 3 weeks back

Advised admission for further evaluation but not willing for admission

[10/05/23, 3:15:42 PM] ~ Navya: 19.

Op no. 20230513807

46/F

C/O headache since 5 days

C/O neck pain since 5 days

C/O body pains since 5 days

H/O Fever 3 days back, low grade relieved by taking medication

C/O cough since 5 days relieved after taking medication

K/C/O DM-2 since 4 yrs on GLIMI -M1 PO/OD

C/o nocturia since 4 months 

Advised admission for further evaluation but not willing for admission

[10/05/23, 3:18:51 PM] ~ A.R.T.TEJASRI: ? peripheral arterial disease

? radicular pain

? spondyloarthritis

paracetamol given ..as she wants to join tomorrow .

[10/05/23, 3:22:21 PM] ~ Navya: 20.

OP.No:20230516731

30/M

C/O:Left side chest tightness,palpitations since 2 days

No H/O chest pain,SOB, vomitings,fever, diarrhoea,cough

N/K/C/O CAD,CVD,TB,Asthma,Epilepsy, Thyroid abnormalities

H/O Alcohol intake present (90ml per day daily)

Adviced for admission for further evaluation,but not willing to get admitted

[10/05/23, 3:27:51 PM] ~ A.R.T.TEJASRI: * nasal obstruction since 10days aggravated since 3 days , with running nose since 10 days 

differential Rhinosinusitis sir

[10/05/23, 4:36:10 PM] Rakesh Biswas Sir: Would that cause difficulty in breathing? 

What's the reason for his difficulty in breathing?

[10/05/23, 4:36:35 PM] Rakesh Biswas Sir: Only 20 cases seen in opd today! 😳

[10/05/23, 4:38:37 PM] Rakesh Biswas Sir: Sometimes I find myself wishing I had AI language model avatars of our interns particularly on whatsapp platforms as those would at least answer back! @919000166698

[10/05/23, 5:34:09 PM] ~ A.R.T.TEJASRI: no difficulty in breathing, its just nasal obstruction sir.

[10/05/23, 5:35:06 PM] ~ A.R.T.TEJASRI: yes sir.

[10/05/23, 9:59:52 PM] ~ A.R.T.TEJASRI: I meant ,there is no shortness of breath or awareness of his own breath sir .

11th May 2023,Thursday

[11/05/23, 9:24:35 AM] ~ Rishitha: 1.

Op no:20230517078

58/M

C/O Generalised body pains

Pain in B/L upper and lower limbs since 20 days aggravated on taking non veg,non relieving factors 

No back pain,tingling sensation 

K/c/o HTN since 1 month(T.Telma 40mg OD)

Patient adviced for admission but not willing

[11/05/23, 9:30:45 AM] ~ Vasitha: 2. Op no:20210513482

52/F

C/o hyperthyroidism since 10years

On T.Carbimazole 5mg OD

No fresh complaints 

Patient advised for admission but not willing

[11/05/23, 9:42:30 AM] ~ Vasitha: 3.Op no:20230517092

56/M

C/o headache since 6months

Unilateral-R side

Blurring of vision

Neck pain

Patient advised for admission but not willing

[11/05/23, 9:46:08 AM] ~ Rishitha: 3.Op no:20230517093

42/F

C/O pain abdomen since 1 day

Squeezing type in umbilical and hypogastric areas

C/o giddiness since 20 days on and off

P/A-tenderness in hypogastric region 

Patient advised for admission but not willing

[11/05/23, 10:03:01 AM] ~ Rishitha: 5.op no:20230517494

46/F

C/o shortness of breath on exertion and decreased appetite since 1 month

SOB aggravated on activity and relieved on lying down

C/o right sided chest pain decreased now after taking medication 

F/c/o prerenal AKI secondary to dehydration 

K/c/o pneumonia 4 years back

K/c/o DM since 6 years on tab.Glimi M2 PO BD

RS:BAE+

NVBS

Decreased breath sounds in rt side

Patient advised for admission but not willing

[11/05/23, 10:07:05 AM] ~ Vasitha: 6. op no: 20210526475

23/M

C/o chest pain since 1day (Rt side)

Non radiating

Pain in upper back since 1 day

H/o trauma(fist fight) ,since the he had complaints of chest pain&upper back

Patient advised for admission but not willing

[11/05/23, 10:14:21 AM] ~ Rishitha: 7.op no:20230517521

52/M

F/c/o decompensated chronic liver disease 

C/o distension of abdomen decreased

Shortness of breath decreased

C/o pin abdomen in left hypochondrium since 1 month(pricking type)

Increased on sitting and relieved on lying down

P/A-distended

Patient advised for admission but not willing

[11/05/23, 10:33:17 AM] ~ Vasitha: 8. Op no: 20230517502

57/F

C/o Right knee pain f/b b/l knee pain since 2.5yrs

Right shoulder joint pain since 2yrs

Pain in Left wrist joint since 1year

K/c/o Rheumatoid Arthritis &on medication

Early morning stiffness 

Patient advised for admission but not willing

[11/05/23, 10:39:04 AM] Rakesh Biswas Sir: Clinically is she euthyroid?

[11/05/23, 10:39:37 AM] Rakesh Biswas Sir: What medications is she currently on?

[11/05/23, 10:41:06 AM] Rakesh Biswas Sir: Please mention detailed clinical history and examination findings and create a PaJR and case report for every patient that would be made after admission 

@918317669334 Please ensure this asap!

[11/05/23, 10:42:39 AM] Lohith Pg Gm : Okay sir

[11/05/23, 10:44:53 AM] ~ Vasitha: T.Methotrexate 7.5mg weekly once 

T.Folic acid 5mg OD

T.Deflazacort 6mg OD

[11/05/23, 10:46:49 AM] ~ Vasitha: Yes sir

[11/05/23, 10:49:17 AM] ~ Rishitha: 9.op no:20230518017

65/M

C/o cough with expectoration since 20 days

Whitish,mucoid,non blood tinged,non foul smelling

SOB on exertion since 15 days increased on physical activity and relieved on lying down

Patient advised for admission but not willing

[11/05/23, 10:56:28 AM] ~ Vasitha: 10. Op no: :20230518012

50/F

C/o chest pain(Left side) since 1 month

Intermittent

pricking type

Non radiating

K/c/o HTN since 5 years &on medication - Amlodipine 5mg OD

Patient advised for admission but not willing

[11/05/23, 10:59:59 AM] Rakesh Biswas Sir: Is it Grave's hyperthyroidism? Or toxic adenoma? Did she have only medical management?

[11/05/23, 11:00:47 AM] Rakesh Biswas Sir:Ensure a detailed history for this patient

[11/05/23, 11:01:10 AM] Rakesh Biswas Sir: Also clinical examination findings using standard online available templates

[11/05/23, 11:01:49 AM] Rakesh Biswas Sir: Details!

[11/05/23, 11:02:21 AM] Rakesh Biswas Sir: Since when?

[11/05/23, 11:02:50 AM] Rakesh Biswas Sir: Details!

[11/05/23, 11:18:58 AM] ~ Rishitha: 11.op no:20230518071

65/F

Occupation:Rice mill worker since 40 years

C/o while working in ricemill yesterday afternoon 

Patient hair got struck in treadmill of machine and hair got plucked(parietal region)and had pain over that area and right ear

Injury to right ear:contusion seen

No H/O LOC,seizures,bleed over the injured area,hearing abnormalities,skin changes

On examination:

Pt is C/C/C

RS:BAE+

NVBS+

CVS:S1,S2+

No murmurs

CNS:GCS:15/15

NFND

Higher mental functions intact

Tenderness + in parietal area,right ear pinna

No signs of depressed fracture

[11/05/23, 11:21:25 AM] Rakesh Biswas Sir: Since when? 

Clinical image of the affected area?

[11/05/23, 11:22:38 AM] ~ Rishitha: Yesterday afternoon this incident happened sir

[11/05/23, 11:31:18 AM] Rakesh Biswas Sir: Pointer to the affected area?

[11/05/23, 11:38:42 AM] ~ Rishitha: 12.op no:20210527839

43/F

C/o fever since 5 days

Low grade,intermittent

C/o toothache(right upper molar)on and off since 6 months associated with Jaw pain since 1 day

No c/o cold,cough,burning micturition,pain abdomen,vomitings,loose stools

On examination:

Pallor present

Oral examination:

Poor oral hygiene 

Dental caries present

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs

Patient advised for admission for further evaluation but not willing

[11/05/23, 11:54:17 AM] ~ Vasitha: 13. Op no: 20210225234

42/F

C/o headache since 4 days(parietal region)

C/o bloating sensation since 4days

K/c/o hypothyroidism since 2 years

On thyronorm 50 mcg

No h/o nausea, vomiting,photophobia,giddiness,photophobia  

O/E

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs

Patient advised for admission but not willing

[11/05/23, 12:15:41 PM] ~ Vasitha: 14. op no: 20210125559

70/F

C/o b/l pedal edema since 20 days 

Facial puffiness since 20 days

Burning micturition since 20 days

B/l knee pains since 20years  relieved on ayurvedic medication 

B/l crepitus present 

ROM: Decreased 

No hematuria,frothy urine 

O/E

Pt is c/c/c 

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs 

CNS: NAD

P/A : soft,NT

No raised JVP

Pedal edema- Pitting type till knee

Patient advised for admission but not willing

[11/05/23, 12:31:05 PM] ~ Vasitha: 15.Op no : 20210115619

50/F

C/o Giddiness since 1 month. 

c/o tingling sensations on b/l upper

limbs.

C/o profuse  sweating since 1 month.

C/o Neck  pain since 1 month 

H/o chikungunya 3yrs back

C/o Rt Knee pain associated with swelling 3 yrs back - septic arthritis? For which pus was draining and was managed

C/o left sided neck pain since 1 month

Pain increased on neck movements 

associated with giddiness 

associated with tingling sensation in b/l upper limbs

N/k/c/o HTN ,TB,Asthma,CAD,Epilepsy,CVA

O/E

Pt is c/c/c 

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs 

CNS: NAD

P/A : soft,NT

 Patient advised for admission but not willing

[11/05/23, 12:37:51 PM] ~ Vasitha: 16. op no: 20230518196

55/M

C/o Generalised body pains since 4 months 

increased on physical activity 

on and off

relieved on taking medication 

H/o fall from bike 5  months back

(Bike skid and fall) 

Since  then he had c/o body pains

No h/o fever ,cough,vomitings,loose stools

No c/o pedal edema / decreased urine  output/ hematuria/ frothy urine 

NO c/o involuntary movements/ tingling sensation / parasthesias.

O/E

Pt is c/c/c 

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs 

CNS: NAD

P/A : soft,NT

 Patient advised for admission but not willing

[11/05/23, 12:42:26 PM] ~ Rishitha: 17.Op no:20230518114

26/M

Occupation:Student

C/o pain in palms ans soles since 3-4 years

No tingling sensation/numbness

Pain in hands and calf muscles present

No joint tenderness,redness,itching

No H/o fever during pain

No c/o SOB,palpitations,chestpain

Not an alcoholic/smoker

Hairloss in beard and moustache since 3 months

C/o weight gain

O/E:pt is c/c/c

RS:BAE+

NVBS+

CVS: S1,S2 +

CNS:NAD

Reddish patches(macules)seen on palms and soles:tenderness +

[11/05/23, 12:50:49 PM] ~ Vasitha: 18. Op no: 20230518167

46/F

C/o  pain  abdomen since 2 weeks 

Left hypochondrium (pricking type) 

Aggravated sine 3 days

Non radiating 

pain abdomen not increased/decreased on changing postures

No c/o loose stools/ vomitings 

C/o left sided neck pain 

Radiating to left upper limb

Not a/w tingling sensation 

not a/w gildiness

relieved on taking medication given by local rmp

K/c/o DM 

On medication 

T .Glimestar m2 forte 

No c/o fever,cough,sob

N/k/c/o HTN ,TB,Asthma,CAD,Epilepsy,CVA

O/E

Pt is c/c/c 

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs 

CNS: NAD

P/A : soft,NT

 Patient advised for admission but not willing

[11/05/23, 12:51:43 PM] ~ Rishitha: 19.op no:20230518188

35/F

C/o decreased appetite since 4 days

Abdominal tightness present

Generalised body pains since 4-5 days

H/o weight loss,constipation,Belching present

No c/o SOB, palpitations,chestpain,fever,burning micturition,pain abdomen

On examination:

Pt is c/c/c

Skin turgor decreased 

Dry tongue present

RS:BAE+

NVBS

CVS:s1,s2 +

CNS:NFND

Patient advised for admission but not willing

[11/05/23, 1:01:29 PM] ~ Rishitha: 20.op no:20230518578

35/F

C/o burning micturition since 1 day

Normal urine output

No C/o pain abdomen,fever,sob,chestpain,itching,hematuria

Normal menstrual history

No white discharge 

N/k/c/o HTN,DM,Asthma,TB,epilepsy,thyroid disorders

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

 CNS:NFND

Patient advised for admission but not willing

[11/05/23, 1:12:44 PM] ~ Rishitha: 21.op no:20230518186

59/F

C/o nausea and sob since 15 days

Decreased appetite 

Sob increased after taking food

K/c/o hypertension since 1 year on T.Telma 40 mg OD

N/k/c/o DM,Asthma,TB,epilepsy,thyroid disorders

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

 CNS:NFND

Patient advised for admission but not willing

[11/05/23, 2:18:51 PM] Rakesh Biswas Sir: Not sent him to dental college?

[11/05/23, 2:19:31 PM] ~ Rishitha: Sent sir

[11/05/23, 2:34:47 PM] ~ Rishitha: 22.op no:20230518608

33/F

C/o low back ache since 20 days

Left sided radiating to left lower limb

Tingling sensation present 

No C/o numbness,weakness

N/k/c/o HTN,DM,Asthma,TB,epilepsy,thyroid disorders

No similar complaints in the past

No pain/tingling of right lower limb

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

CNS:NFND

Patient advised for admission but not willing

[11/05/23, 2:46:01 PM] ~ Rishitha: 23.op no:20230518609

50/F

C/O Fever 1 month back not associated with chills,intermittent,no diurnal variation,relieved after taking medication 

C/O fever since 1 week not associated with chills

C/o nausea,vomiting,decreased appetite since 5 days

2-3 episodes of vomiting day before yesterday,2 episodes yesterday,bilious and non projectile 

B/L knee pains (left more than right)aggravated since 4 days

Generalised weakness since 4 days

N/k/c/o HTN,DM,Asthma,TB,epilepsy,thyroid disorders

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

 CNS:NFND

Patient advised for admission and getting admitted

[11/05/23, 3:11:18 PM] ~ Vasitha: 24. Op no: 20230518620

55/M

C/o abdominal bloating,indigestion since 2years

C/o burning sensation since 2 years

Belchings present 

decreased sleep

No c/o chest  pain/ S0B/ palpitations/

syncopal attacks

K/c/o HTN

On medication since 3 years

Amlodipine 5mg OD

N/k/c/o TB,Asthma,CAD,Epilepsy,CVA

O/E

Pt is c/c/c 

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs 

CNS: NAD

P/A : soft,NT

Patient advised for admission but not willing

[11/05/23, 3:14:34 PM] ~ Rishitha: 25.op no:20230518619

75/F

C/o pain abdomen(burning type)with regurgitation of food since 1 year aggravated since 5 days

Pain abdomen inversed after taking food 

C/o tingling sensation in right hand since 5 days

No H/O fever,loose stools,burning micturition,vomitings

No H/o chest pain,palpitations,syncopal attacks

N/k/c/o HTN,DM,Asthma,TB,epilepsy,thyroid disorders

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

 CNS:NFND

Patient advised for admission but not willing

[11/05/23, 3:26:57 PM] ~ Vasitha: 26.Op no: 20230518589

30/M

C/o  Neck pain(left side)since 1 month

Radiating to left shoulder 

No c/o giddiness 

No c/o tingling sensation/ parasthesia

No c/o headache 

No restriction of movements

H/o trauma to Neck 1 year back

N/k/c/o HTN,TB,Asthma,CAD,Epilepsy,CVA

O/E

Pt is c/c/c 

RS:BAE+

NVBS+

CVS:S1,S2 +

No murmurs 

CNS: NAD

P/A : soft,NT

Patient advised for admission but not willing

[11/05/23, 3:27:45 PM] ~ Rishitha: 27.op no:20210212984

37/M

C/o pain in right lumbar region radiating to umbilical area since today morning 

C/o burning micturition since last night 

No c/o nausea,vomiting,loose stools,constipation,fever

C/o abdominal bloating and distension since today morning 

Normal urine output 

N/k/c/o HTN,DM,Asthma,TB,epilepsy,thyroid disorders

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

 CNS:NFND

Patient advised for admission but not willing

12th May 2023,Friday

[12/05/23, 8:28:04 AM] Rakesh Biswas Sir:How many admitted out of 27 seen in OPD?

[12/05/23, 8:29:04 AM] Lohith Pg Gm : 2 admissions sir

[12/05/23, 9:58:35 AM] Deepthi Ma’am : 1. Op no :20230518916

45/F

C/o pain in left  side neck starts in left occipital region  dragging type since 3years associated with headache in left fronto parietal region ,pain not relieved by taking rest

N/k/c/o DM ,HTN,tb epilespsy ,asthma

O/E:

No swelling/tenderness over left occipital region

RS: BAE+

NVBS

CVS:s1 s2+

No murmers 

CNS :NFND 

Patient advised admmision but not willing for admission

[12/05/23, 10:06:07 AM] Rakesh Biswas Sir: Share more about the history 

What are the hourly activities of the patient from early morning till sleeping at night and when does he experience the pain? What is the duration and frequency of the pain 

Create a PaJR group for those who can't be admitted to regularly follow up their pain. Tell them this case report is the most important report they need to get done. 

Ask all interns to do the same

[12/05/23, 10:17:57 AM] ~ Rithika: 2. OP NO: 20210321153

32/F

Complaints of pain while swallowing since 3 to 4 days

Complaints of difficulty in swallowing insidious in onset gradually progressive since 1 month

No history of fever, vomitings, diarrhoea,sob , palpitations, chest pain, increased sweating.

K/c/o hyperthyroidism on tab.carbimazole 10 mg PO/OD

N/K/C/O DM,TB, asthma , cad,cva

O/E : Diffuse Neck swelling present

Swelling moving with deglutition

RS - BAE +

NVBS

CVS - S1S2 HEARD

No murmurs

Cns - nfnd

P/A - soft, NT

Patient is advised admission but not willing for admission

[12/05/23, 10:24:27 AM] Rakesh Biswas Sir: Since when is he on carbimazole? 

Share the details of the hourly activities of the patient from early morning till sleeping at night before his diagnosis and how it changed since incuding what difference was made with carbimazole.

Create a PaJR group for those who can't be admitted to regularly follow up their pain. Get his upper GI endoscopy. Can come empty stomach on Tuesday 

Tell them this case report is the most important report they need to get done. 

Ask all interns to do the same

[12/05/23, 10:25:10 AM] Rakesh Biswas Sir: What about his eyes? No exopthalmos?

[12/05/23, 10:26:02 AM] ~ Rithika: Tab.carbimazole since 1 month

No exophthalmos sir

[12/05/23, 10:29:42 AM] ~ Penchala Manogna: Sir patient left sir untill we could trace her

[12/05/23, 10:31:13 AM] Rakesh Biswas Sir: Her fault I guess

[12/05/23, 10:38:18 AM] Deepthi Ma’am : 2. Op no 20230519345 

75/m  who is a farmer by occupation   Wakes up every morning  6am ,

7am he has   Breakfast, then goes to work after finishing his farming work returns to home by evening. Since 1yr he stopped going to his work because of pain at b/l knee region, pain at neck region whichis dragging type,radiating  to right side of neck since 1yr

 O/E:

tenderness in cervical region

Both knee joint tenderness

Crepitus +

 Cvs: s1 ,s2 heard ,no murmers

RS: BAE+ NVBS+

P/A soft , NT

[12/05/23, 10:43:27 AM] Rakesh Biswas Sir: What does he do the entire Day hourly and at which time does he experience the pain?

[12/05/23, 10:50:01 AM] ~ Rithika: 4.op no.20210208751

27/F

Complaints of headache since 15 days More on Right side than left, more in the morning and again at the evening,

Associated with nausea, associated with giddness ,photophobia present, phonophobia present,

no h/o trauma,loc,tinnitus, hearing loss,sob,chestpain, palpitations,orthopnea,pnd,no c/o cough,fever,cold, burning micturition 

O/E 

Cvs- s1s2 heard

RS - BAE +

CNS- NFND

P/A - soft,nt

Tenderness present b/l over medial canthus of eye 

Dix hallpike manoevre - negative

Patient was advised for admission but not willing.

[12/05/23, 10:50:10 AM] ~ Penchala Manogna: Wake up at 5:30 and she will cook for the children, she is experiencing headache(duration-1hr)at morning which is relieved by taking medications immediately and come to the hospital by 8:30, breakfast(9am) and will do duty(ophthalmic assistant) till 5pm,she will return to home 

And do household chores(cleaning), and will do dinner by 8:30,sleep till 9:30 

And she also has headache during evening

@penchala manogna

[12/05/23, 10:53:59 AM] ~ Rithika: Bp in supine position - 110/70

Standing position- 96/70

[12/05/23, 10:54:26 AM] Rakesh Biswas Sir: Was she absolutely alright before 15 days?

[12/05/23, 10:57:07 AM] ~ Shivang Sharma: She was experiencing headache intermittently sir once a week

[12/05/23, 10:57:09 AM] ~ Manohar Nadella: O.P no:20238518937

36/F

H/o Hypothyroidism since 1yr 

36 year old female who looks after household work ,1 year back she noticed gaining weight; went to local hospital diagnosed with hypothyroidism and started on tab thyronorm 75mcg ( tsh value not available) later she not on follow up, 1 wk back she got thyroid testing done outside TSH - 11 thyronorm dose increased to 100mcg outside 

8/5/23

TSH: 11.15

T3:88.25

T4:6.8

O/E

Pt is c/c/c

CVS:S1 S2 heard ; No murmurs

RS:BAE + , NVBS +

P/A Soft Nontender

Advised for admission but not willing for it.

[12/05/23, 11:04:47 AM] ~ Rithika: 6.op no 20230519319

Complaints of heaviness in chest since 3 to 4 months

Complaints of occasional palpitations since 3 to 4 months

Complaints of nausea throughout the day precipitated by emotional factors,noise

Complaints of sob since 6days grade 3 aggravated with daily routine works and releived with rest

No history of orthopnea, pnd,chest pain

Complaints of fever since 3 days not associated with chills and rigors relieved on medication.

Complaints of burning micturition since 5 to 6 days

No history of decrease the urine output ,cough , cold

Hypertensions since 5 months tab.met xl 50 mg po/od

N/k/c/o dm , thyroid disorder, epilepsy 

1st episode dec 22

Palpitations relieved only on taking medication

Frequency 1/week

Not associated with anxiety fever

No giddiness,sob,chest tightness

O/E 

CVS - s1s2heard,no murmurs

Rs - bae +,nvbs

Patient was advised admission but not willing.

[12/05/23, 11:09:55 AM] ~ Rithika: 7.op no.20230519346

40/F

Complaints of cough since one year, associated with sputum, whitish yellowish in colour , scanty in amount ,blood tinged, non foul smelling,

Complaints of weight loss associated with low grade fever more in the evening

Complaints of pain in the epigastrium aggravated with spicy food intake relieved with medication

N/k/c/o htn.tb,dm, thyroid disorder.

Patient was advise for admission but not willing.

[12/05/23, 11:10:17 AM] Deepthi Ma’am : 3.op no:20230519836

55/M who is a daily labour by occupation wakes up every morning at 7am,then at 8 am he has breakfast ,then he goes to daily labour work but stopped  his  daily labour work due to sudden onset weakness left upper limb and left lowerlimb 3years back ( CVA) and was on ecospirin av but he stopped medication after using for 15days . He was not using medication due to affordability issues . 

H/o low backache radiating to b/l lower limbs associated with tingling sensation of distal extermities 1yr 

And he was given nsaids with pregabalin.

He noticed development of pedal edema after using pain killers he stopped taking them

 Now ,came  with Complaints ofdragging type of pain lf lowerlimb so he was unable to do his daily labourer job

K/c/o HTN  since 3years but not using any medication

0/E

Patient c/c/c

CVS: s1s2 heard 

RS: BAE + NVBS +

P/A soft ,Non tender

CNS: antalgic gait

 Advised admission but not willing for admission

[12/05/23, 11:11:56 AM] Deepthi Ma’am : 8th*

[12/05/23, 11:14:06 AM] ~ Manohar Nadella: O.P no:20230519416

38/M

Bank employee came;C/O:Left side Chest Pain, since 3 days , he noticed pain after lifting heavy weight while doing his farming activity near house which is pricking type and increases on lifting weights.

Pain is non radiating, not associated with sob, palpitations, excessive sweating, giddiness

N/K/C/O Htn Dm Tb Epilepsy Asthma .

O/E: 

Pt is C/c/c

Tenderness present in left side of chest. 

CVS:S1 S2 + No murmurs 

RS:BAE + NVBS +

P/A:Soft Non Tender 

Adv:ECG

Diag: ? Chest pain 2o to Musculoskeletal origin

[12/05/23, 11:18:28 AM] ~ Manohar Nadella: 9th

[12/05/23, 11:20:25 AM] ~ Rithika: 10.op no.20210524434

54/F

Complaints of headache since 3 to 4 days in the frontal region.

Associated with nausea, photophobia ,giddiness.

phonophobia absent 

No h/o loc, tinnitus, hearing loss,

No h/o sob,chestpain , palpitations ,orthopnea, pnd ,pedal edema,fever

N/k/c/o htn,dm,tb, epilepsy, asthma 

O/E 

Cvs- s1s2 heard

RS - BAE +,nvbs

CNS- NFND

P/A - soft,nt

Patient is advised admission but not willing.

[12/05/23, 11:22:47 AM] ~ Shivang Sharma: 11.Op.no- 20230519348 22/F   c/o - generalised weakness since 10 days , c/o sob grade. 3 , aggregated with daily routine nd relived with rest , c/o occasional palpitations , pallor+ nt , no fever ,cough ,cold , burning micturition,diarrhea ,     no h/o low grade fever significant wt loss 5 kg with in 2 months .   Not a k/c/o htn dm , thyroid disorder   cvs - S1 S2 heard ,no murmur , rs - BAE + ,NVBS ,.    Per abdomen - soft ,non tender ,no organomegaly . patient is advised admission but not willing.

[12/05/23, 11:31:29 AM] ~ Manohar Nadella: 10. O.P no : 20230519421

44/M 

Saree Weaver by occupation came with C/O: Fever on and off since 1 month which is Low grade ,a/w Lower Back ache and Pain Abdomen (Burning type) 

Both Knee joint pains.

Headache aggravated on alcohol intake.

C/o: Cough , Cold since 2 days 

Cough: Productive , Scanty sputum with brownish colour  , Non blood stained.

N /k /c/o : Htn Dm Tb Asthma Epilepsy 

O/E: Pt is C/c/c 

CVS :S1 S2 + No murmurs 

RS: BAE + NVBS + 

P/A : Soft Nontender

CNS :NFND

Diag:? Viral Pyrexia 

Pt. Advices for admission but not willing for it.

[12/05/23, 11:31:41 AM] ~ Penchala Manogna: Might not be grade-3 

Wake up at 7:00am, 

breakfast -10:30,

And start doing work(work from home)-duration-4hrs a day

Lunch-2:30 

Since 10days she is experiencing shortness of breath (not able to go upstairs-2floors which she used to do before)-grade -2

Dinner-10pm 

Sleep-11:30pm

[12/05/23, 11:32:17 AM] ~ Rithika: 12.op no.20230519341

50/f

Complaints of neck pains since 3 to 4 days

Associated with headache more over the occipital region

Not associated with nausea vomiting photophobia phonophobia

Occasional lacrimation present from bilateral eyes

No loc,h/o trauma, fever chest pain palpitations increase the sweating sob 

O/E 

Dix hallpike manoevre -negative

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 11:33:16 AM] ~ Manohar Nadella: 13.

[12/05/23, 11:33:22 AM] ~ Manohar Nadella: *

[12/05/23, 11:42:04 AM] ~ Rithika: 14.Op no.20230519884

53 M

Complaints of knee pains since 2 months insidious onset and gradually progressive

Complaints of tingling and numbness of both upper and lower limbs since 2 months

Nocturia present

Polydypsia,polyphagia absent

Complaints of fever since 3 days associated with chills and rigor 

Complaints of constipations since one year

No history of cough cold burning micturition

N/k/c/o dm,htn , epilepsy, thyroid disorder, asthma 

O/E 

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised admission but not willing

[12/05/23, 11:47:44 AM] ~ Rithika: 15.op no.20230519889

35/F

Complaints of tingling and numbness of both upper and lower limbs since 3 months

Complaints of generalised weakness since 3 months

No history of cold fever,cough,  burning micturition ,sob, chest pain ,palpitation ,pnd, orthopnea

N/K/c/o htn,dm, thyroid disorder 

O/E 

Pallor + 

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 12:06:27 PM] ~ Rithika: 16.op no.20230519921

60/M

Complaints of pain over suprapubic area since 10 days not associated with nausea and vomiting

Insidious in onset gradually progressive aggravated on food intake and relieved with medication

Complaints of constipation since 10 days

complaints of pain while defecations since 10 days

No history of fever, burning micturition,pedal edema ,decreased urine output,sob, palpitations, pnd orthopnea 

O/E

P/A

Tenderness present over suprapubic area

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

Patient is advised for admission but not willing

[12/05/23, 12:06:46 PM] Rakesh Biswas Sir: So her only issue was weight gain and no other symptoms of hypothyroidism? 

How did she notice weight gain?

[12/05/23, 12:07:23 PM] Rakesh Biswas Sir: What about her clinical images of visceral fat and muscle in her PaJR group?

[12/05/23, 12:07:58 PM] Rakesh Biswas Sir: Age? Gender?

[12/05/23, 12:08:25 PM] Rakesh Biswas Sir: Respiratory rate?

[12/05/23, 12:08:41 PM] Rakesh Biswas Sir: 6 minute walk test?

[12/05/23, 12:09:36 PM] Rakesh Biswas Sir: @917893782276 The SR's can also guide?

[12/05/23, 12:11:45 PM] ~ Manohar Nadella: 16.O.P: 20230519436

50/F

Daily Labourer by occupation came with C/O: Lower back ache and tingling sensation in  both the feet since 2 months,She stopped going to work since then and complains of pain even while rest

K/c/o: HTN since 1 yr. and on regular medication. 

O/E: 

Pt is C/c/c 

No tenderness in neck 

No tenderness in spine 

No restriction of movements 

CVS : S1   S2 + No murmurs 

RS : BAE + NVBS + 

P /A: Soft NonTender 

CNS : NFND

Diag : ? Lumbar spondylosis

[12/05/23, 12:12:00 PM] Deepthi Ma’am : 17Op no: 20230519425

69/F who is agricultural  labour by occupation came :

C/o neckpain since 4days insidious in onset ,aggravated during movements, not asscoiated with tingling senasation of b/l upperlimbs

  History of right upper limb and lower limb weakness with slurring of speech (CVA)10years back

K/c/o HTN  since 10 years and was on medication (TAB TELMA H 40/12.5mng

Tab telma, chlorthalidone, cilnidipine)40,6.125,10mg

O/E: no neck tenderness

No restriction of movements

Cvs:s1s2 heard ,no murmers

RS: BAE+

P/A: soft ,non tender

CNS: NFND

N/k/c/0  DM,tb ,epilepsy,asthma

 Patient advised admission not willing for admission

[12/05/23, 12:12:07 PM] ~ Rithika: 50/F

Rr-22cpm

6 minutes walk test - negative

[12/05/23, 12:12:23 PM] Rakesh Biswas Sir: What was his daily hourly activity since he stopped work?

[12/05/23, 12:13:46 PM] ~ Manohar Nadella: 18

[12/05/23, 12:15:15 PM] Rakesh Biswas Sir: Negative means not done? 

Tell us how you did it in the OPD? 

Would tachypneoa not be a contraindication?

[12/05/23, 12:18:27 PM] ~ Manohar Nadella: She doesn’t mention regarding cold intolerance 

Constipation

Menstrual abnormalities 

Her clothing was getting tight and cross check her weight .

[12/05/23, 12:20:07 PM] Deepthi Ma’am : Wake up at 6:00am, 

breakfast -8:00am

Sits ideally watches tv ,talks with his neighbours  ,

Lunch-2:30 

Sits outside in the evening   , spends time with his family

Dinner-10pm 

Sleep-11:30pm

[12/05/23, 12:28:49 PM] ~ Rithika: 19. Op no.20210115696

Complaints of fever since 10 days associated with chills and rigor 

Relieved with medication

Complaints of heaviness in chest, complaints of sob ,grade 1 since 10 days

Complaints of burning micturition since 10 days

No decreased urine output ,chest pain, palpitations

N/k/c/o htn,dm, thyroid disorder 

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 12:29:23 PM] ~ Rithika: 32/F

[12/05/23, 12:31:30 PM] ~ Manohar Nadella: 20. O.P no : 20230520023

38/M

Occu:Shopkeeper supplying plumbing material

C/o: Burning Micturition since 5 months 

Heaviness in both Lowerlimbs since 5 months 

Indigestion since 5 months

Generalised body weakness since 5 months 

N/K /c/o : Htn Dm TB Epilepsy   Asthma 

O/E: 

Pt is C/c/c

CVS : s1 s2 + No murmurs 

RS : BAE+ NVBS+ 

P/A : Soft Nontender 

CNS: NFND 

Diag : ?  Acute gastritis 

            ? Dyspepsia 

Advised for admission but not willing for it

[12/05/23, 12:37:52 PM] ~ Rithika: 21.op no.20210116670

44/F

Complaints of heaviness in chest pain since 3 to 4 days

No c/o palpitations, orthopnea, pnd ,sob 

Complaints of generalised weakness of upper Limbs and lower limbs since 10 days

No history of fever, vomitings ,diarrhoea, burning micturition, decreased urine output

N/k/c/o htn,dm, thyroid disorder 

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 12:40:27 PM] Deepthi Ma’am : 22.Op no :20230519977

47/M who is a school teacher by occupation came with

C/o pain in left side of chest since 1week as the

Patient had injury 1week back hit by wall on left side of chest,since then he developed pain in left side of chest wwhich is aggravated on sleeping on that side and relieved by sleeping on other side

 N/k/c/o HTN ,DM,Tb asthma, epilepsy

O/E:

 Tenderness over 2nd and 3rd ribs on left side

 CVS: s1 s2 heard

RS: BAE+

CNS: NFND

P/A  soft ,nontender

Patient advised admission but not willing for admission

[12/05/23, 12:50:03 PM] ~ Rithika: 23. Op no. 20210507159

63/M

C/o sob grade 3 since 2years aggravated more since  2 months relieved with medication, more with daily activities

Associated with sputum whitish ,scanty ,mucoid, non foul smelling

No history of cough cold fever burning micturition

No history of chest pain palpitations orthopnea pnd

K/c/o asthma since 10 years using inhaler

Using dexamethasone 0.5mg tablets and montelukast tablets at time of attack 

N/k/c/o htn,dm, thyroid disorder 

O/E

Cvs- s1s2 heard

RS - BAE + , wheeze + in  right MA ,IAA,SSA,interscapular area 

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 1:07:10 PM] Deepthi Ma’am : 23.op no20230519979

48/F

C/0 pain in right calf region since 4months ,pain aggravates on walking ,so he stops walking due to pain and takes rest

C/0 difficulty in passing urine since 1year

 Frequency ,urgency, hesitancy+

O/E:

Pt c/c /c

CVS: s1 s2heard

RS:BAE+

PA :soft ,non tender

CNS:NFND 

Patient advised admission not willing for admission

[12/05/23, 1:08:44 PM] Deepthi Ma’am : 24

[12/05/23, 1:11:34 PM] ~ Rithika: 25.op no.20230519431

30/F

Complaints of unilateral headache on left side since 3 months associated with neck pain

No complaints of nausea vomiting photophobia ponophobia

No complaints of giddiness, loc, trauma

No history of cough, cold, fever ,burning micturition, vomiting, diarrhoea 

No history of chest pain, palpitations, orthopnea ,pnd.

K/c/o hypothyroidism since 5 years on tab.carbimazole 10 mg po/od

N/k/c/o htn,dm, thyroid disorder 

O/E 

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 2:12:56 PM] Rakesh Biswas Sir: When in these hourly slots does he experience the low backache? For how long?

[12/05/23, 2:13:38 PM] Rakesh Biswas Sir: Any tenderness over the chest or on movement of his upper limbs?

[12/05/23, 2:14:38 PM] Rakesh Biswas Sir: Respiratory rate?

[12/05/23, 2:17:27 PM] Rakesh Biswas Sir: Carbimazole for hypo?

[12/05/23, 2:18:24 PM] ~ Rithika: Hyperthyroidism* sorry sir typing mistake

[12/05/23, 2:30:28 PM] ~ Shivang Sharma: 16 cpm

[12/05/23, 2:49:41 PM] Deepthi Ma’am : 26. Op no 20230520425

50/M

Farmer by occupation came with complaints of

Tingling of right side of body since 3days

N/k/c/o DM,Tb,asthma epilepsy

O/E 

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 2:55:48 PM] Deepthi Ma’am : Backache is present all time sir   but aggaravates on bending or walking for long distance

[12/05/23, 3:10:39 PM] Deepthi Ma’am : 27.op no: 20230520431

66/M who is a farmer by occupation came with hyperpigmented lesion on left foot which is 7 *5 cm associated with itching 6months back. 

Patient had thorn prick and had lesion that healed by taking some medication .after 3months he had itching over same area and patient started scratching over same area,then developed hyperpigmented lesion

K/c/o DM since 2years but not using any medication

N/c/k/o HTN,tb ,asthma epilepsy

 O/E 

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[12/05/23, 4:20:48 PM] ~ Manohar Nadella: Tenderness is present over chest.Also positive for abducting in acute angle.pt can raise arms comfortably

[12/05/23, 4:23:51 PM] Rakesh Biswas Sir: Only 27 seen in opd today? How many admitted @918317669334 ?

[12/05/23, 4:31:31 PM] Lohith Pg Gm : One admission sir

13th May 2023,Saturday 

[13/05/23, 10:12:41 AM] ~ Vaishnavi: 1.Op no 20230521217

18M

C/0 headache which is Unilateral on left side,sometimes on right side since 3-4 yrs associated with neck pain,trigerring factor are eating non veg food/cold water weekly thrice since 3-4yrs

  H/o sensitivity to light and sound present

Relieved on medication(dolo) within 1hr

No H/o nausea , vomiting fever,giddiness 

Cvs s1s2 heard no murmur

Cns nfnd

Rs BAE present

P/a soft non tender 

Diagnosis -? migraine 

Pt was advised for admission but not willing

[13/05/23, 10:14:26 AM] Rakesh Biswas Sir: Tell us in detail his hourly 24x7 routine before the headache 4 years back and how his routine was disrupted after the headache started

[13/05/23, 10:20:55 AM] ~ Rajkumar Adepu: 2.

Op no 20230521244

45 M farmer by occupation came with complaints of bloating since 2 years

Abdominal discomfort since 2 years

Increased After consumption of alcohol and spicy food

C/o early satiety 

H/o belching +

No h/o regurgitation of food

No h/o nausea, vomiting

No h/o chest tightness

N/k/c/o HTN, DM, CVA, CAD, TB, THYROID DISORDERS

O/E :

Pt is c/c/c

Bp 130/80 mmHg

Pr 80 bpm

P/A-soft ,non tender

Cvs S1 S2+

CNS: NFD

RS BAE+

Provisional diagnosis:

Dyspepsia under Evaluation 

Pt advised for admission but not willing

[13/05/23, 10:22:16 AM] Rakesh Biswas Sir: Tell us in detail his hourly 24x7 routine before the abdominal discomfort 2 years back and how his routine was disrupted after the abdominal discomfort started

[13/05/23, 10:32:58 AM] Rakesh Biswas Sir: What kind of differential diagnosis are they making, None of you are checking! 

[13/05/23, 10:33:25 AM] ~ Vaishnavi: 4.Op no 20210411219

32 M

A supermarket worker came with c/o  pain in lower rgt sacral dimples radiating to rt lumbar region since 15days

No h/o increased frequency of urine, burning micturation,fever

Pain is increased on bending forward and relieved on its own without taking medication

Routine 

Regular travel on bike from home to shop

Mild pain experience on traveling after bending forward which is dragging type of pain experience atleast 4times per day

Not a k/c/o DM,htn,tb,cva,cad, epilepsy, asthma

Diagnosis -?lower backache

Pt was advised for admission but not willing

[13/05/23, 10:34:06 AM] ~ Vaishnavi: Pt is c/c/c 

Cvs s1s2 heard no murmur

Cns nfnd

Rs BAE present

P/a soft nontender

[13/05/23, 10:34:40 AM] Rakesh Biswas Sir: Tell us in detail his hourly 24x7 routine before the abdominal discomfort months back before his stroke and how his routine was disrupted after the stroke happened and focus on motor and sensory

[13/05/23, 10:38:07 AM] Rakesh Biswas Sir: Don't write a blanket statement like "patient adviced admission but unwilling"!! 

Tell us the patient requirements and what is our plan after admission. 

 I have been coming daily to opd and crying hoarse about this! Do you want me to come with a stick now and beat up everyone in the opd?

[13/05/23, 10:39:53 AM] Rakesh Biswas Sir: What about examination of musculoskeletal system with spine?

[13/05/23, 11:07:20 AM] Rakesh Biswas Sir: Check out the case history written by here👇 and restart asap 

[13/05/23, 11:07:35 AM] ~ Rajkumar Adepu: 5.Op no 20210514853

22F clerk by occupation

Her daily routine 

She wakes up at 6am in the morning and completes her household chores by 8 am skips her breakfast and lunch intermittently in hurry to work and continues her work comes back by 6pm to home and completes her dinner by 10pm and goes back to sleep immediately after food

came with complaints of Abdominal pain since 3 months burning type, non radiating, epigastric region  increased on taking food not associated with belching, bloating

H/o decrease in appetite 

No H/o regurgitation of food

No H/o nausea, vomiting

No h/o fever

O/E 

Pt is c/c/c

Temp afebrile

PR 84 bpm

Bp 100/60mmHg

P/A soft and non tender

Cvs S1 S2+

RS BAE+

CNS NFD

Provisional diagnosis

Acid peptic disease

[13/05/23, 11:10:23 AM] Rakesh Biswas Sir: Don't share negative history 

Share images of visceral fat and muscle mass as shown in the link above by 

[13/05/23, 11:12:32 AM] Rakesh Biswas Sir: Is it the routine three months before her symptoms? Did it change in the last three months after the symptoms started? At what point of time in her hourly routine were the symptoms noticed the most?

[13/05/23, 11:14:05 AM] Rakesh Biswas Sir: What about your cases from opd?

[13/05/23, 11:17:28 AM] ~ Vaishnavi: 6.Op no 20230521293

60F

Pt was homemaker do farming activities during free time but stopped working from past 20yrs due to increase in age from that she wakes around7am and do normal small household activities and takes rest but from past 2month she has difficultly in standing, walking,passing urine

Pt came with c/o pain in low back, dragging type of pain radiating to left lower limb upto knee since 2-3 months

Able squat and stand byherselfand pain on standing 

K/c/o htn since 10yrs on medication (atenolol 50mg+amlodipine 6mg) po od

Pt is c/c/c

Musculoskeletal system examination 

On right side

Straight leg test  -60degree positive

Pain on abduction,adduction, external rotation of hip joint

Sacroiliac joint tenderness

Cvs s1s2 heard no murmur

Cns nfnd

Rs BAE present

P/a soft non tender

Diagnosis -?sciatica 

Patient was adviced xray of spine  and adviced for  admission but not willing

[13/05/23, 11:19:20 AM] ~ Vaishnavi: Xray of LS spine

[13/05/23, 11:23:23 AM] ~ Rajkumar Adepu: 7.

Op no 20210114449

32F 

Teacher by occupation

Her daily routine

Wakes up at 530am in the morning and completes her household chores by 7am and have her breakfast by 8 am and goes to school at 1230pm she will have her lunch and continues the work comes back home by 5pm and do the house work and eats dinner by 8pm and goes back to sleep by 10pm 

came with complaints of low backache since 1 month non radiating not associated with tingling sensation of lower limb 

No h/o trauma

H/o increase in pain on prolonged sitting or bending forwards decreased on lying down on bed

No h/o renal calculi

O/E

SLRT -Ve

Paraspinal muscle tenderness

Cvs S1 S2+

RS BAE+

P/A soft and non tender

Provisional diagnosis

Myofacial pain due to overuse

[13/05/23, 11:26:04 AM] Rakesh Biswas Sir: No testing! Ask her to plan her next visit for admission and necessary testing 

It's SI joint with LS spine not LS Spine alone

[13/05/23, 11:27:30 AM] Rakesh Biswas Sir: 20 years back she was 40! What do you mean increasing Age? 

Share visceral fat and muscle mass images as illustrated in the PaJR link above

[13/05/23, 11:30:14 AM] Rakesh Biswas Sir: Is it the routine one month before her symptoms? 

Did it change in the last one month after the symptoms started? 

At what point of time in her hourly routine were the symptoms noticed the most?

[13/05/23, 11:34:44 AM] ~ Ajay Kumar Reddy: No change in her daily routines prior sir 

She doesn't recollect any change in routines 

She is experiencing pain while traveling in the bus and on prolonged sitting

[13/05/23, 11:38:52 AM] ~ Rajkumar Adepu: 8.Op no 20230521356

36F housewife 

Daily routine 

Wakes up at 6am and does household chores by 8am and eats her breakfast by 10 am and cooks lunch for family and will have lunch around 1pm

And takes rest and prepares dinner by 8pm and have dinner and goes back to sleep by 10pm

Came with complaints of fever since 1 day

No H/o cold cough

No h/o burning micturition

Low backache since 2 months increased on bending forwards

C/o abdominal discomfort associated with bloating and nausea early satiety

H/o decreased appetite

H/o hypokalemic periodic paralysis

H/o myalgias and generalized weakness

No previous documentation available

Using syp POTCHLOR ON AND OFF since 5 years 

O/E 

paraspinal tenderness

Cvs S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender

Advised admission for further evaluation of hypokalemia I/v/o channelopathy

But pt wants to get admitted later

[13/05/23, 11:48:35 AM] ~ Rajkumar Adepu: 9.

Op no 20230521350

70F 

Was prior farmer continued farming until 5 years ago

Daily routine 

Ragi Java with butter milk daily at 8am 

1 cup of rice with curry and curd at 2pm 

1 cup of rice with curd at 8pm

Presented with complaints of burning sensation of left foot since 2 months 

K/c/o DM since 2 months not on medication 

HTN since 20 years on unknown medication 

Vitals

Bp 110/60mmhg

PR 84bpm

O/E

CVS S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender 

Pt advised for admission for DM evaluation and wants to get admitted on Monday

[13/05/23, 11:50:40 AM] Rakesh Biswas Sir: So the pain is mild and not having any significant effect on slowing her daily routine?

[13/05/23, 11:52:52 AM] Rakesh Biswas Sir: Since when does she have history of hypokalemic paralysis? 

Has her two months of low back ache changed her daily routine or is it insignificant?

[13/05/23, 11:55:37 AM] Rakesh Biswas Sir: In this daily routine you have mentioned only her meals? 

Has the burning sensation in her left foot affected her life significantly?

[13/05/23, 11:57:03 AM] ~ Rajkumar Adepu: 5 years back two episodes ? Respiratory paralysis

No change in routine

[13/05/23, 11:58:53 AM] ~ Ajay Kumar Reddy: Yes sir pain is mild 

She is able to carry out routine activities

[13/05/23, 12:01:21 PM] Rakesh Biswas Sir: All interns please mention their full names in their dp as all the conversational transcripts will be analysed for their learning outcome contributions to the department to assess their internship completion competence. The interns who's names don't feature here and in the other group "ward audit" are at risk for extension

[13/05/23, 12:02:23 PM] ~ Rajkumar Adepu: She takes injections at RMP for pain since 5 years

[13/05/23, 12:06:04 PM] Rakesh Biswas Sir: So her pain since 5 years hasn't changed her routine inspite of her having to take injections? How frequently does she need to take them?

[13/05/23, 12:07:36 PM] ~ Vaishnavi: 10.Op no 20230521352

48M

Patient was apparently asymptomatic 17yrs ago then he had appearance of lesion plaque(non scaly)type over dorsal aspect of palm later all over the body which was diagnosed as psoriasis and on topical medication (steroid).

From 2013

He had c/o multiple joint pain i.e pain in tarso metatarsal joint with joint pain and restrictions of movement,mrng stiffnessand ,for he got investegated in 2013 for Ana -negative,

RA -negative

CCP negative

Esr-15mm/hr

CRP 1.1

diagnosed with psoriasitic arthritis and on medication 

Now came with c/o deformity in both hand and finger

K/c/o DM 2 on glipizide 5mg since 10yrs

Htn since 3month on medication lisinopril

Examination

Left hand

Tenderness present in left first carpal

Second and third metacarpophalangeal joint

Joint deformity present in  PIP  

Unable to clasp his fist completely

Right hand

Tenderness present in second and third MCP joints

Joint deformity present in interphalangeal joints

Unable to close his fist left>>right

Plaque (non scaly)all over body more over dorsal aspect of hands

Cvs s1s2 heard no murmur

Cns nfnd 

Rs BAE present

P/a soft non tender

Diagnosis psoriasitic arthritis

Pt was advised for addmission for further clinical examination and follow up but he came from california to meet his brother who is suffering with cancer so not willing for admission

[13/05/23, 12:09:26 PM] Rakesh Biswas Sir: Good also open his PaJR group and shift this data there

[13/05/23, 12:25:01 PM] ~ Rajkumar Adepu: 11.

Op no 20210120917

67M

Shepherd by occupation goes to work at 8am in the morning and comes back at 5pm 

came with complaints of neck pain since 1 week dragging type Associated with headache giddiness for 1 day in the past 1 week

Giddiness for 30 min relieved after taking unknown medication

No h/o Pedal edema , decreased urine output

Diagnosed as HTN 1 week ago not on any medications had high BP recordings 160/90 150/90mmhg for 2-3 days and took medication

N/k/c/o CVA, DM 

O/E 

pt is c/c/c

Cvs S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender

Pt attender is security gaurd here so advised ECG sr.creatinine

CUE

[13/05/23, 12:51:38 PM] ~ Rajkumar Adepu: 12.Op no 20230521769

65M

Came with complaints indigestion and low grade fever since 1 week

3 to 4 times per day, immediately after food

Associated with pain abdomen squeezing type in epigastric to umbilical region

N/k/c/o HTN DM CVA CAD TB

O/E 

Pt is c/c/c

CVS S1 S2+

CNS NFD

RS BAE+

P/A soft and non tender 

Provisional diagnosis

?APD gastritis

Pt is getting admitted

[13/05/23, 2:38:58 PM] Rakesh Biswas Sir: Any causal association between his symptoms and mild hypertension? 

Were you investigating to screen for target organ damage? 

What are the target organs of hypertension you left out in your examination?

[13/05/23, 2:42:45 PM] Rakesh Biswas Sir: Both arthritis and Diabetes were diagnosed at the same time 10 years back?

[13/05/23, 2:43:09 PM] ~ Vaishnavi: Yes sir

[13/05/23, 2:44:11 PM] Rakesh Biswas Sir: He went to the doctor for arthritis and Diabetes was detected on incidental screening?

[13/05/23, 2:55:15 PM] ~ Ajay Kumar Reddy: Yes sir patient may have hypertension with the symptoms he  presented.  

Yes sir to look for any proteinuria, or nephropathy he has developed

We have left  fundoscopy for any retinal Changes

[13/05/23, 2:59:54 PM] ~ Vaishnavi: Op no 20230522158

30M

Pt came with c/o chest pain left side non radiating since 3days relieved on its own and drinking water

Chest pain more during night

H/o giddiness during chest pain since 3days 

H/o regurgitation of food content during night time since 3days

No h/o loss of consciousness 

Not a k/c/o dm,htn, asthma,cad,cva

Local examination

Tenderness over 3rd rib on left side 

Systemic examination 

Cvs s1s2 heard no murmur

RA BAE present,

Cns nfnd

P/A soft non tender

Diagnosis- GERD

Patient was adviced for further examination and follow up but she was not willing as she have small kids at home

[13/05/23, 3:00:04 PM] ~ Vaishnavi: 13.

[13/05/23, 3:11:47 PM] ~ Shivang Sharma: 14 Op no  - 20230522126    40 yr F . Daily routine         wake up at 7am,breakfast - 8 am , and complete her house work by 10 am , and goes to farm ,she will have lunch at 2 pm , again goes to work and comes back by 6 pm , dinner at 8 pm and she goes to sleep by 9 pm    .c/o difficulty in breathing since 5/6 days associated with pain in abdomen ( epigatric region) since 5/6 days , c/o bloating since 5)6 days after eating .not k/c/o dm ,htn , cad ,tb ,asthma , epilepsy  . Fever -nt , loose stools - nt , vomiting - nt .                      Echo done on May 9 /23 ,    EF 62 % , trivial AR / MR + ve , normal LV function , no RWMA , no Ar / TR , no PE / PAH                                            O/E  PT IS C/C/C                                           cvs S1 S2 heard                    cns nfd.                                      p/a soft and non tender.      RS BAE+

[13/05/23, 3:30:35 PM] ~ Penchala Manogna: 15. op.no-20230522136

36F 

Daily routine- housemaker 

Wakes up at 6:00 am

Breakfast- 9:00am 

Their is a history of intake of spicy foods

She takes her lunch-2:00pm 

And do her daily chores(like cleaning) and sleeps at 9:00pm 

Patient came with the complaint of chest tightness since 2months 

She is experiencing early satiety and bloating 

Associated with belching 

Their is no history of regurgitation of food.

Nausea+

No H/o Vomiting

She is experiencing similar complaints which were intermittent,relieved on taking medications 

Not a k/c/o-asthma, tb, epilepsy, hypertension 

O/E

Pt is C/C/C

Abdomen-soft and non tender 

CVS S1 S2+

CNS NFD

RS BAE+

Provisional diagnosis

Dyspepsia under evaluation 

Patient is advised for admission but not willing to get admitted

[13/05/23, 3:33:27 PM] ~ Vaishnavi: 30F

[13/05/23, 4:03:06 PM] ~ Vaishnavi: 16.Op no 20230521776

39M

Pt came with c/o difficulty in passing stool daily once since 6months

C/o drowsiness only while driving long distance @100kms happened last Sunday 

H/o loss of consciousness for 3-5sec only happened after tired days

H/o disturbed sleep since 2yrs only during more thoughts regarding family, office work

H/o hearing loss in both ears since 6yrs , hearing aid +in left ear

H/o both lower limb swelling after sitting for long hrs i.e 3-4hrssince  3yrs

No h/o giddiness

K/c/o htn since 7yrs on telmisartan +amolodipine po od

Pt is c/c/c

Bp 160/100

Cvs s1s2 heard no murmur

Cns nfnd

RA BAE present

P/a soft nontender

Pt was advised for further follow up but not willing

[13/05/23, 4:25:47 PM] Rakesh Biswas Sir: Overtesting! 

That may have been white coat hypertension due to your non busy opd?

[13/05/23, 4:27:04 PM] Rakesh Biswas Sir: Gerd with chest tenderness!! 

Regurgitation of food?

[13/05/23, 4:28:11 PM] Rakesh Biswas Sir: Respiratory rate? In a patient of shortness of breath that's the least we can mention?

[13/05/23, 4:28:36 PM] Rakesh Biswas Sir: Disease duration?

[13/05/23, 4:29:41 PM] Rakesh Biswas Sir: Past reports of renal function?

[13/05/23, 4:30:14 PM] Rakesh Biswas Sir: 16 patients total in opd today! 😳

[13/05/23, 5:48:20 PM] ~ Rajkumar Adepu: Op no 20230521769

65M

Came with complaints of  indigestion and low grade fever since 1 week

3 to 4 times per day, immediately after food

Associated with pain abdomen squeezing type in epigastric and umbilical region

N/k/c/o HTN DM CVA CAD TB

O/E 

Pt is c/c/c

CVS S1 S2+

CNS NFD

RS BAE+

P/A soft and non tender 

Provisional diagnosis

?APD 

Pt got admitted and absconded