PLA BOOK PROJECT DRAFT OPD week-4

Week-4

15th May 2023,Monday

[15/05/23, 10:05:59 AM] ~ Prathyusha Singam: 2

Op. No. 20230523051

35/F who is labourer by occupation, has a daily routine of waking up at 6am, finishing up all the household chores by 8am, has breakfast and goes to work. She has her lunch at around 1pm at work. She comes back home by 6pm and has dinner @8pm and goes to sleep by 9pm.

C/o fever since 1 week, low grade fever,continuous.

No evening rise of temperature, not associated with chills & rigors, cold and cough.

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

Vitals:

Pt is c/c/c

BP: 110/70 mm Hg

PR: 92bpm

RR: 19cpm

Temp: 99.7 F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Oral examination: no oral congestion.

Provisional diagnosis: pyrexia under evaluation.

Rx:

T. Dolo 650mg PO/TID

[15/05/23, 10:11:49 AM] ~ Prathyusha Singam: Advised fever charting 4th hrly

[15/05/23, 10:18:47 AM] ~ Dr.Sai Pavan👨‍⚕️: 3.Op no : 20230523496

A 30 year old female farmer by occupation(goes to farm daily at 8 am after breakfast at home,lunch at 1 pm at work and reaches home by 5 pm and continue her house hold activities,dinner at 8 pm and goes to sleep by 10 pm ), came to opd with c/o right sided neck pain since 1 month ,spasm like pain ,non radiating,no restriction of neck movements

No medication used ,used zandu balm (pain decreased but not swelling )

No h/o increased work

H/o right serous otitis media 1 month back

On examination:

No pallor

Neck :swelling midly palpable ,non tender ,at insertion of sterno cleido mastoid to clavicle

Thyroid : normal

Bp:100/60 mm hg

PR:64 bpm

RR:18 cpm

[15/05/23, 10:38:28 AM] ~ PAVANI: 4.

Op no.20230523500

C/o of neck pain since 4 days

Radiating towards right upper limb associated with tingling sensation,no history of weakness ,no history of trauma.

History of headache on and off since 10 years.

No history of unilateral headache.

Headache is associated with nausea and vomitings.

Photophobia present and phonophobia present.

Cheif complaints of lowerbackache radiating to right lower limb.associated with tingling since 2 days.

No history of tingling or numbness over the trunk or face.

General examination:Patient is conscious coherent and cooperative.

Moderately built and moderately nourished.

No palloricterus,cyanosis,clubbing,lymphadenopathy,edema.

Vitals:

Bp:110/80 mmhg

Pr:80 bpm

Rr:18cpm

Temp :afebrile.

Systemic examination:

Cvs:s1,s2 heard No murmurs

Rs:BAE+and no murmurs.

PA:SOFT AND non tender

CNS:

Power:ul : 5/5.

Ll: 5/5.

TONE:NORMAL

Reflexes:B:1+

T:1+

S:1+

K:1+

A:--

Treatment ×1week

Tab: Ultracet BD

1/2--0---1/2

Tab:multivitamin OD

0--1--0.

Patient not willing for admission.

[15/05/23, 10:39:46 AM] ~ Dr.Sai Pavan👨‍⚕️: 8.op no :20230523525

A 30 year old female computer operator by occupation ( goes to work at 8 am ,lunch at 1 pm at work and reaches home by 5 pm and continues her house hold works,dinner at 8 pm and goes to bed by 10 pm)came with c/o low grade fever with chills and rigors since yesterday night , intermittent in nature .

C/o giddiness was present today morning, sore throat,headache( yesterday night ), difficulty in swallowing

H/o travelling outside yesterday ( in sun )

No c/o burning micturition ,cold and cough

Patient had a h/o consuming 70 thyronorm tablets one week back and was admitted in EMD and was given activated charcoal

On examination:

Bp:100/60 mm hg

PR:80 bpm

RR:18 cpm

[15/05/23, 10:46:06 AM] ~ Dr.Sai Pavan👨‍⚕️: Advised pcm 650 mg 8th hrly for 2 days

Salt water gargling tid

Review after 2 days

[15/05/23, 11:01:53 AM] ~ Prathyusha Singam: 6

Op. No. 20230523470

60/F who stays home, wakes up at 6am, does all the household chores, has lunch at 1pm and dinner at 7pm and goes to sleep at 8pm.

C/o generalized weakness since 2months.

C/o generalized body aches since 2 months.

B/L knee joint pains, low backache since 3 months.

No radiation of pain

No H/o trauma.

No H/o tingling/numbness.

No H/o fever

K/c/o CVA (right hemiparesis) 20yrs back.

K/c/o HTN since 9years. On T. Telma 40mg OD.

On T. Cilnidipine 50mg OD.

Vitals:

Pt is c/c/c

BP - 120/80mm Hg

PR - 80bpm

CVS - S1, S2 heard. No murmurs

RS - BAE+, NVBS heard.

P/A - soft, NT

CNS:

Tone - R L

UL- N N

LL- N N

Power:

UL- N. N

LL- N. N

Reflexes :

Biceps. 2+ 2+

Triceps. 2+ 2+

Supinator 2+ 2+

Knee. 2+ 2+

Ankle 1+ 2+

Plantar - -

Patient is getting admitted to evaluate generalized weakness.

[15/05/23, 11:02:26 AM] ~ PAVANI: 5.

Op:20230523504

PATEINT came for follow up

Cheif complaints of right sided dragging type ofchest pain radiating to back side since 20 days .

Pain is of intermittent type on and off for 30 minutes and releived on medication.

C/o sob only when pain is present.

No c/o orthopnea,PND,decreased urinary output.

Known case of hypertensive since 6 years.on tab telma 40mg po/od.

Not a known case of dm,epilepsy,tb,CAD,Asthma.

Diagnosis :chestpain under evaluation.

ECG:

ST elevation in leads ll,lll,avF less than 1 mm.

Patients wife Is getting admitted and we are evaluating him along with her.

[15/05/23, 11:07:27 AM] ~ Dr.Sai Pavan👨‍⚕️: 7.op no :20230523514

A 45 year old male govt.employee by occupation ( goes to work at 9 am ,lunch at 1 pm at work and reaches home by 4 pm and continues his works at home ,dinner at 8 pm and goes to bed by 9 pm)

Patient came for follow up ( patient is a k/c/o B/L csom with DNS since 1 year

Patient is a k/c/o DM II since 4 years ; on tab ZORYL M1( GLIMI 1 MG),metformin 500 mg po/od

K/c/o hypothyroidism since 7 years; on tab thyronorm 100 mcg

Not a k/c/o HTN; asthma; tb;CVA,cad

On examination:

Bp:100/60 mm hg

PR:80 bpm

RR:18 cpm

Cvs:s1 s2 + ,no murmurs

Rs: BAE+ ,no added sounds

P/A:soft; non tender

CNS: NFND

Local examination:goiter not palpable

[15/05/23, 11:23:04 AM] ~ Prathyusha Singam: 10

Op no. 20230523535

65/F who stays home and does household chores.

C/o vomiting since 10days, containing food particles, non bile stained. 1 episode/day.

C/o low grade fever one day.

Bloating sensation+

Belching+

Burning sensation of tongue +

Used 3rd generation cephalosporins for 1week.

K/c/o HTN since 7years. On T. Telma H 40/12.5mg PO/OD

K/c/o DM since 7years. On T. Vidagliptin(50mg) + metformin (500mg) PO/OD

Vitals:

Pt is c/c/c

BP - 90/70mm Hg

PR - 80bpm

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Patient is getting admitted to evaluate?GERD.

[15/05/23, 11:25:12 AM] ~ PAVANI: 9.

Op:20230523520.

12/05/2023

c/o heaviness in the chest since

clo occasional palpitation 3-4 month's

C/o nausea through out the day

Precipitated by emotional factors, Noise

clo SOB since 6 days, Grade-III. No to Orthopnea, PND, chest pain Aggrevated with daily routine works, and relieved with rest.

clo Fever since 3 days, not associated with chills and Rigors, relieved on medication

c/o Burning mictuntion Since 5to6 days. No decreased urine output, Cough, cold.

Htn since5 months on

T-MET-XL 50mg PolOD. DMO, epilepsy, thyroid disorders.

Not a known case of Diabetes mellitus,Tuberculosis,Epilepsy,asthma,CAD.

Cvs:s1,s2 heard No murmurs

Rs:BAE+,NVBS.

1st episode of palpitations Dec 2022

Palpitations releived only on taking medication.

Sudden loud noises.

Frequency 1/week

Not a/w anxiety and fever.

No giddiness,sob,chest tightness.

15/05/2023

Follow up case of AF which reverted to sinus rhythm in December.

Patient is willing for admission .

[15/05/23, 12:00:50 PM] ~ Prathyusha Singam: 13

Op no. 20230524054

45/F who stays home(stopped going to work 3years back)

C/o giddiness followed by fall yesterday evening.

H/o injury to left elbow

H/o giddiness (for around 5-10mins) occassionally from past 5years not associated with nausea, vomiting.

H/o neck pain, dragging type, not associated with tingling sensation.

No H/o ear ache, discharge from ear.

No H/o tinnitus, headache.

K/c/o HTN since 1year. On T. Metoprolol 50mg.

O/E :

Vitals:

Pt is c/c/c

BP - 130/70mm Hg

PR - 78bpm

Left elbow - pain & difficulty in extension beyond 90°

Romberg's - negative.

Cerebellum:

Nystagmus - absent

Finger nose test - Normal

Dysdiadokinesia - absent.

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly

Provisional Diagnosis : Giddiness under evaluation.

[15/05/23, 12:02:09 PM] ~ PAVANI: 12.

Op:20230524094.

C/o of bloating and bleching.since 2to 3 years.

Abdominal discomfort present and increased on intake of alcohol and spicy foods.

No History of nausea and vomitings .

History of regurgitation of food.

History of similar complaints on and off. Form past 3 years,no history of loss of appetite

Diagnosis:Dyspepsia under evaluation.

Patient is not willing for admission.

[15/05/23, 12:39:37 PM] Rakesh Biswas Sir: Clinical images?

[15/05/23, 12:40:37 PM] Rakesh Biswas Sir: Ultracet is half qid and shouldn't be given for more than two days!

[15/05/23, 12:41:09 PM] Rakesh Biswas Sir: Why multivitamin? One placebo is not enough?

[15/05/23, 12:42:34 PM] Rakesh Biswas Sir: What about fever charting?

[15/05/23, 12:45:28 PM] Rakesh Biswas Sir: Clinical images?

[15/05/23, 2:55:41 PM] ~ Prathyusha Singam: 17

Op no. 20230524511

50/F who stays home came with

c/o SOB grade -III since 6months, insidious in onset, gradually progressive, aggravated while walking short distance, relieved on taking rest.

Palpitations+

No chest pain, heaviness of chest, pedal edema, decreased urine output.

K/c/o DM since 7years. On T. Glimi M2 PO/OD

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

Vitals:

Pt is c/c/c

BP - 130/80mm Hg

PR - 88bpm

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

[15/05/23, 3:01:43 PM] ~ Dr.Sai Pavan👨‍⚕️: 21.Op no : 20230524547

A 42 year old male farmer came to opd with c/o diffuse headache with giddiness after performing physical activity since 1 year Each episode of headache lasts for about 2 to 3 hrs, relieved after taking medication and taking rest .

Headache associated with photophobia

Not associated with phonophobia,lacrimation and vomiting .

Indigestion+ and abdominal bloating after taking food .

Chest pain ( burning type );non radiating , intermittent since 6 months

not associated with sweating; palpitations and SOB.

On examination:

Bp:110/60 mm hg

PR:64 bpm

RR:18 cpm

Cvs:s1 s2 + ,no murmurs

CNS :HMF INTACT

Rs: NVBS ,BAE+

Pupils:B/L NSRL

Cranial nerves : normal

Motor system :bulk- normal

Tone - normal

Reflexes: RT. LT.

B. 2+. 2+

T. 2+. 2+

S. 2+. 2+

K. 2+. 2+

A. 2+. 2+

Cerebellar signs

No nystagmus

Rhombergs sign : negative

[15/05/23, 3:10:37 PM] ~ PAVANI: No.23

Op:20230524590

c/o Rt sided chest pain since I month after participating in running competition.

Pain present only while running (walking fast relieved on rest dragging type pain, intermittent rest.

No clo Shortness of breath, palpitations orthopnea, PND.

Bloating & belching present since year.

No complaints of Regurgitation.Bloating & belching Aggravated after spicy food.

No clo HTM, DM, CvA,CAD, TB, Asthma.

O/e:

Bp:120/80mmhg

Pr:64bpm.

Rr:15cpm.

Tenderness present over 2nd 3rd 4th costochondral joints and in the 4th rib

Cvs:s1,s2 heard ,no murmurs

Rs:BAE+,NVBS.

Treatment:

DOLO 650MG ×5DAYS.

[15/05/23, 3:14:31 PM] ~ Prathyusha Singam: 28

Op no. 20230524593

35/F who is a daily wage labourer by occupation with daily routine of waking up at 6am, does household chores and goes to work by 9am. She comes home for lunch at 1pm and goes to work, returns home by 7pm. And sleeps at 9pm. She came with

c/o fever since 4days associated with chills and rigors, insidious in onset, episodic, with no diurnal variation, relieved on taking medication. C/o loss of appetite+

No H/o cold, cough, body pains, abdominal pain, burning micturition.

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

Vitals:

Pt is c/c/c

BP: 130/70 mm Hg

PR: 86bpm

RR: 19cpm

Temp: 99.2° F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Oral examination: no oral congestion.

Provisional diagnosis: pyrexia under evaluation.

Advised fever charting 6th hrly.

[15/05/23, 3:28:24 PM] ~ PAVANI: S.no.22

Opno.20230524564

clo shortness of breath since 15 days on less than ordinary activity (grade 3 MMRC).

With pitting type of oedema present up to knees since 15 days.

NO H/O OF Orthopnea PND

decreased urine output since today morning

Patient has a history of drinking toddy regularly since 1 month.

k/c/o Alcoholic Regularly since 25 years.

Patient is c/c/c

Pallor present

Cvs: s1,s2 heard , no murmurs,jvp Raised.

RS- BAE+ NVBS

Decreased air entry on Rt side (Basalregion)

PIA-soft nontender

Patient advised for admission but not willing as paralyzed parents present at home.

[15/05/23, 3:50:54 PM] ~ Afeefa Farzana: Opno.20230524566

clo generalised weaknesss since 2 weeks,loss of Appetite,C/O burning micturition

H/O walking with support since 3 months (H/O slip and fall)

Since 1 week Patient is unable to walk Even with support

Symmetrical weakness of proximal muscles of lower limbs

On examination

Spinal tenderness present T12 to L1

Examination of lower limbs

Gluteal muscle weakness present,hamstring muscle weakness present,quadriceps muscle weakness present

Rt Lt

B + +

T + +

S. + +

K. +++ +++

A. + +

P. Extension. Flexion

K/c/o HTN and DM since 15 years

Patient is getting admitted sir

[15/05/23, 4:41:31 PM] Rakesh Biswas Sir: Summary?

16th May 2023,Tuesday

[16/05/23, 7:50:34 AM] Rakesh Biswas Sir: [5/16, 7:12 AM] Navya KIMs Pg 2022: attend the camp today

[5/16, 7:42 AM] Rakesh Biswas: Tell all camp people to not propagate the myth of unnecessary testing and treatment but tell them that the purpose of getting admitted is to get evaluated in detail by the physicians who will make their detailed case report which will be handed to them as a discharge summary and that is the best possible test they could ever hope to get done anywhere.

Let's be honest with them and check if honesty is truly the best policy as we have been given to hypothesize since our school days?

[5/16, 7:48 AM] Rakesh Biswas: Same goes for our OPD workflow!

Yesterday brought a patient who at first glance appeared to be in urgent need of testing although 'she wasn't agreeable to get admitted and had a KAP card.

On deeper probing we realized she already had most of the tests done and history taking and clinical examination was more than sufficient!

Lohith please update us as to what happened to her later

Remember to probe and examine every patient in detail and not write any test without asking me and let's hope we can change the impression of medicine department opd from a testing counter to a human counter where patients can actually have their requirements assessed and addressed rather than get bypassed by the healthcare abcd protocol

[16/05/23, 9:20:43 AM] ~ Nikithchandra: No :1

Op:20230524897

60 year old female farmer ,(wakes up at 5am ,does all the household chores, breakfast at 9am and goes to field ,has lunch at 1pm and she comes home at 5pm, has dinner at 8pm ,goes to sleep at9pm)

C/o. Burning sensation at throat since 1year

C/o burning sensation in abdomen since 1year

Cc generalized weakness since 1year

Cc of indigestion associated with bloating sensation and Abdominal discomfort since 1year

N/k/o HTN, DM,epilepsy, thyroid,CVA

Vitals:

Bp:140/80mmhg

Pr:76bpm

Rr:60cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is not willing for admission

This patient may visit our opd today with complaints of vomiting after eating food since 2-3 days.

She is coming alone as her parents work on daily basis, loss of pay would effect on their monthly revenue. Please evaluate her.

She is on wysolone 2.5 mg, Azathioprine 50mg.

If she needs admission let me know, let us try to convience there patients. If not please send necessary basic investigations for RBS, CBP- agranulocytopenia and renal failure ( side effects of above drugs )

[16/05/23, 9:25:37 AM] ~ Nikithchandra: No :2

Op:20230524903

38 year old female farmer ,(wakes up at 6am ,does all the household chores, breakfast at 8am and goes to field ,has lunch at 1pm and she comes home at 6pm, has dinner at 8pm ,goes to sleep at 9pm)

C/o:left side neck pain radiating to left hand since 3years

No restriction of neck movements

H/o weight bearing on the shoulder in the past

N/k/o HTN, DM,epilepsy, thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:74bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is not willing for admission

[16/05/23, 9:26:52 AM] Rakesh Biswas Sir: What happened to her daily routine after the illness ?

Did it change?

Please focus on that

[16/05/23, 9:28:13 AM] Rakesh Biswas Sir: Agranulocytopenia as in lymphopenia?

[16/05/23, 9:32:42 AM] ~ Basani Sravanthi: No :3

Op:20230524904

38 year old female tailor by occupation,wakes up at 6am ,does all the household chores, breakfast at 10am ,has lunch at 2pm and has dinner at 9pm ,goes to sleep at 10pm came to OPD with c/o monkey scratch over the left side of lower back.

N/k/o HTN, DM,epilepsy, thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:68bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is not willing for admission

[16/05/23, 9:45:42 AM] ~ Rachana Gangula: Sno 4

Op no 20210205620

30/F

C/O Neck Pain since 2 months and headache since 2 months

Headache- 2-3 episodes /week

B/L, Frontal, Associated with nausea, Photophobia & Phonophobia

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

Patient advised admission for further evaluation but not willing for admission because she has kids and came from a long distance

[16/05/23, 9:47:01 AM] ~ Nikithchandra: No :5

Op:20230524894

50year old female who stays home,wakes up at 6am ,does all the household chores, breakfast at 8am and goes to field ,has lunch at 1pm and she comes home at 6pm, has dinner at 8pm ,goes to sleep at 9pm, sometimes once in every 3-4days she use to feel weak while doing work

C/o: burning type of pain in left side of chest since 1year, associated with palpitations

Burning sensation in throat since 1year

Cc of tingling sensation

K/c/o DM since 6years(on regular medication unknown)

N/k/o HTN, epilepsy,asthma thyroid,CVA

Vitals:

Bp:150/80mmhg

Pr:76bpm

Rr:18cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is willing to admit later

[16/05/23, 9:50:46 AM] ~ saicharankulkarni: Yes sir even pancytopenia 2to bone marrow supression.

[16/05/23, 10:34:57 AM] ~ Basani Sravanthi: N0-6

Ip- 20230524907

50 yrs old female came to OPD with

c/o all joints pain and stiffness since 3 yrs.

Also associated with morning stiffness.

For which she to the other hospitals . She is on medications (corticosteroids,sulfasalazine, hydroxychloroquine),she stopped using medication since 15 days back as her pains were not reducing even after using medication.

Daily routine-

She was a daily wage labourer and active person before 3 yrs ,used to do all her household works.since 3 yrs she is unable to do her house hold works and stopped working.

Past history -k/c/o HTN since 2 yrs , hypothyroidism since 3 mns

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

Menstrual history - attained menopause 8 yrs back

Local examination-

Tenderness in all joints .(shoulder,elbow,wrist,MCP,IP,hip, knee,ankle,spine)

Ristricted joint movements .

Vitals:

Bp:130/80mmhg

Pr:66 bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

[16/05/23, 10:35:05 AM] ~ Nikithchandra: No:7

Op:20230525330

50year old female farmer,wakes up at 6am ,does all the household chores and , breakfast at 8am and goes to field ,has lunch at 1pm and she comes home at 6pm, has dinner at 8pm ,goes to sleep at 9pm, due to pain she decreased working hours

C/o: diffuse chest pain since 5years, insidious,continous pain,non radiating,aggrevated during menstrual cycle and decreased after the cycle and on medication

Local examination:

Tenderness over the bilateral breast in upper outer quadrant,no swelling,no local rise of temperature

Menstrual history:p3L3

Regular cycle 3/30,not associated with pain and clots

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/70mmhg

Pr:74bpm

Rr:18cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Provisional diagnosis:?cyclical mastlagia

Patient is not willing for admission

[16/05/23, 10:47:15 AM] ~ Nikithchandra: No:8

Op:20230525389

27year old female who stays home ,wakes up at 5am ,does all the household chores and , breakfast at 8am ,has lunch at 1pm and , has dinner at 8pm ,goes to sleep at 9pm, due to pain she decreased working hours

C/o: chestpain since 1year on and off,non radiating,diffuse,more over the left region

C/o generalized weakness and fatigue since 1year

C/o sob, insidious in onset, gradually progressive,grade2

C/o fever,on and off,low grade, associated with chills and rigors since 1year

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/70mmhg

Pr:86bpm

Rr:18cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is willing for admission

[16/05/23, 10:57:14 AM] ~ Basani Sravanthi: No :9

Op:20210509635

54 year old female came to OPD with C/o epigastric pain since today mrng (5am),sudden in onset,dragging type of pain,no aggrevating and relieving factors. Associated with the loose stools (4 episodes) belching + . Not associated with vomitings.

C/o burning micturition since 1 mn.

No H/o heart burning,sweating , palpitations

Daily routine:

(3yrs back)-She wakes up at 6am ,does all the household chores goes to work (daily wage labourer), breakfast at 10am ,has lunch at 2pm and has dinner at 9pm ,goes to sleep at 10pm.

But now she is not working,stopped working at 3 yrs back due to knee and neck pains.

Past history-

K/c/o hypothyroidism since 16 yrs(on thyronorm 50 mcg)

N/k/o HTN, DM,epilepsy, thyroid,CVA

Vitals:

Bp:130/80mmhg

Pr:67bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is not willing for admission

[16/05/23, 10:57:36 AM] ~ Nikithchandra: No:10

Op:20230525365

50year old female she was a daily wage labourer,wakes up at 7am ,does all the household chores and , breakfast at 9am ,has lunch at 2pm and , has dinner at 8pm ,goes to sleep at 9pm, due to pain reduction of her daily work hours

C/o: pain over the right hypochondrium,since 10days, insidious in onset, non progressive and radiating to back,no aggrevating and reliving factors

C/o generalized weakness and fatigue since 1year

C/o occasionally burning sensation in the epigastrium,after spicy food intake

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:92bpm

Rr:18cpm

Pallor: present

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing

[16/05/23, 11:04:57 AM] ~ Basani Sravanthi: No :11

Op:20230525363

70 year old female came to OPD with C/o burning sensation in the abdomen associated with palpitations since 3 days.pain is aggrevating with sour and spicy foods.

No H/o sob, sweatings,chest pain.

No h/o nausea and vomitings.

Past history-

K/c/o HTN since 5 yrs.

N/k/o DM,epilepsy, thyroid,CVA

Vitals:

Bp:110/80mmhg

Pr:100bpm

Rr:18cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

[16/05/23, 11:09:11 AM] ~ Nikithchandra: No:12

Op:20230525406

60year old female 1month nack she was farmer,wakes up at 7am ,does all the household chores and , has lunch at 12am and , has dinner at 7pm ,goes to sleep at 9pm, but now she is not working,stopped working 1month back due to pain

C/o:left knee pain since 1month, history of fall(trauma), insidious and gradually progressive

S/p :ptca 7years back on medication

K/c/o DM since 9years,and is on medication (unknown)

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:110/80mmhg

Pr:86bpm

Rr:18cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing

[16/05/23, 11:27:57 AM] ~ Rachana Gangula: Sno 10

Op no 20230525338

23/M

Clo dry cough since 6 months

Chest pain during cough

No fever or nasal stuffiness, no diurnal variation of cough.

H/O intentional weight loss of 14kgs in 3 months

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

Vitals:

Bp:120/80mmhg

Pr:86bpm

Rr:80cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R/S- BAE,NVBS heard

Patient advised admission for further evaluation but not willing for admission

[16/05/23, 11:30:28 AM] ~ Ashiness Kashyap: What is the description of the scratch? How deep was it?

No other information regarding what was advised for the patient other than admission?

[16/05/23, 11:31:35 AM] ~ Basani Sravanthi: No :17

Op:20230525784

40 year old female came to OPD with C/o giddiness on and off since 2 yrs. Not a/w nausea and vomitings.

Since 2 months onwards giddiness is worsened.

No aggrevating factors,relieved after taking rest.

Daily routine-

Before illness- She was a daily wage labourer and active person before 2 yrs ,used to do all her household works.

After illness- she stopped working since 2 mns due worsening of giddiness.

Past history-

H/o Meningitis at the age of 5 yrs

N/k/o htn, DM,epilepsy, thyroid,CVA

Vitals:

Bp:110/80mmhg

Pr:78bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Pt advised admission,but wanted to admit later

[16/05/23, 11:52:42 AM] ~ Basani Sravanthi: No :15

Op:20230525412

60 yr old female daily wage labourer by occupation came to OPD with C/o B/l swelling of lower limbs from knees to feet since 10 days.

No H/o Sob , chest pain, sweating, palpitations.

No h/o burning micturition, decreased urine output.

Past history-

H/o similar complaints 1 yr back, due to vesicel calculus and cystolithotripsy was done.

After cystolithotripsy the lower limb sweelings was relieved.

K/c/o htn since 2 yrs

N/k/o, DM,epilepsy, thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:78bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Pt advised admission,but not willing for admission

[16/05/23, 12:07:09 PM] ~ Nikithchandra: 16

Op no : 20230525415

A 60 year old male c/o fall on 14/5)23,at night and previous on 12/5/23,morning after

Giddiness,continuous since 15 days

Right side deviation of mouth,no wrinkling,no loss of nasolabial fold, slurring of speech

No opthalmoplegia

Premature beats present

K/c/o DM2 since 3years

On examination:

Bp:150/70 mm hg

PR:86 bpm

Cvs:s1 s2 + ,no murmurs

Rs: NVBS ,BAE+

CNS:E4V5M6

Cranial nerves : normal

Motor system :

bulk- normal

Tone - RT. LT

UL N. N

LL N. N

Power:

RT. LT

UL:4/5. 4/5

LL:4/5. 4/5

Reflexes: RT. LT.

B. -. -

T. -. -

S. -. -

K. -. -

A. -. -

P. -. -

Cerebellar signs

Finger nose test:normal

No nystagmus

Rhombergs sign: positive ( SWAYING PRESENT MORE TOWARDS LEFT)

Finger nose in cordination: absent

Sensory:. RT. Lt

Fine touch: decreased decreased

Crude.touch. +Ve. +Ve

Pain. +Ve. +Ve

Propioception. 3/10. 2/10

Patient is willing for admission on Thursday

[16/05/23, 12:15:50 PM] ~ Nikithchandra: No:20

Op:20230525406

60year old female she was farmer,wakes up at 7am ,does all the household chores and breakfast at 10am goes to field , has lunch at 1pm and , has dinner at 7pm ,goes to sleep at 9pm

C/o:

Sob since 1month, grade 2 insidious In onset,non progressive, bloating present

Menstrual cycle:

Irregular cycle no cycle since 2months , previous cycle is regular 3/30,

Increased weight gain significant

No history of constipation,no pedal edema

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:110/80mmhg

Pr:76bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing

[16/05/23, 12:30:25 PM] ~ Rachana Gangula: Sno 23

Op no 20230525861

46/M

C/o diarrhea since 1 week around 20 episodes

C/O vomitings since 1 week around 6-7 episodes

Food as content, Non-projectile, Non-Bilious

Fever since 3-4 days

associated with chills and rigor

H/O trauma (fall) one week back No LOC, No giddiness no ENT bleed

C/o Lethargy since 1 week

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

Vitals:

Bp:100/50mmhg

Pr:90bpm

Rr:80cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R/S- BAE,NVBS heard

Patient advised admission for further evaluation but not willing for admission because he came alone and patient attenders are not present

[16/05/23, 12:40:02 PM] ~ Basani Sravanthi: No :18

Op:20210514446

36 yr old male, came to OPD with C/o fever a/w chills and rigor since 5 days.

C/O burning micturition , decreased urine output with hesitancy of urination since 4 days.

C/o headache since yesterday a/w nausea.

C/o loose stools (4 episodes ) since mrng.

No h/o cough and cold.

Past history-

N/k/o htn, DM,epilepsy, thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:80 bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmurs

CNS: NFND

R.s:BAE,NVBS heard

Admitted

[16/05/23, 12:49:01 PM] ~ Rachana Gangula: Sno 30

Op no 20230525827

44/M

C/O low Back ache since 1 Year

Pricking type of pain in both feet since 6 months

B/L knee Pains Since 5 months

H/O pain in left loin radiating to the front of abdomen for which he visited hospital and was found to have renal calculus and has started medication for the same since then but pain did not subside.

Daily Routine - wakes up at 6 am & he climbs tree for toddy.

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

Vitals:

Bp:80/60 mmhg

Pr:86bpm

RR- 18 cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R/S- BAE,NVBS heard

L/E- no spine deformity/ tenderness

Crepitus + in both knee joints

Patient advised admission for further evaluation but not willing for admission right now. He wants to get admitted after one week as he has some work at home.

[16/05/23, 12:55:45 PM] ~ Basani Sravanthi: No :19

Op:20230525804

50 yr old male, came to OPD with C/o giddiness since 1 week not a/w nausea and vomitings, relieved after taking rest.

C/o generalised body pains and weakness since 1 week.

C/o headache on and off since 1 week.

No h/o fever, vomitings,loose stools.

Past history-

N/k/c/o htn, DM,epilepsy, thyroid,CVA

Vitals:

Bp:140/100mmhg

Pr:84 bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmurs

CNS: NFND

R.s:BAE,NVBS heard

[16/05/23, 12:57:12 PM] ~ Nikithchandra: No:29

Op:20230525917

60year old male he was farmer,wakes up at 7am and breakfast at 10am goes to field , had lunch at 1pm and , had dinner at 7pm ,goes to sleep at 9pm

C/o:

Pain in the left illiac fossa since 4days, insidious in onset,non gradually progressive, radiating to left flank aggreavated with food intake and relieved but not completely

C/o decresed appetite since 10days

C/o burning micturition since 4days

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:90/50mmhg

Pr:76bpm

P/a: left illiac fossa tenderness

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[16/05/23, 2:07:54 PM] ~ Dr. Meesum Abbas: No. 31

Op no. 20230526265

47/M

C/O SOB on exertion since 15 days while riding a cycle or brisk walking

K/c/o DM since 4 years. On OHAs

Daily routine :

Wakes up at 6 am. Goes walking or cycling for 30 mins.

Patient advised admission for further evaluation but not willing as he didn’t come prepared

[16/05/23, 2:12:22 PM] ~ Basani Sravanthi: No :22

Op:20230525834

60 yr old female, came to OPD with C/o tingling sensation in left hand since 10 days.

C/o neck pain ,Paraspinal tenderness +.

No restriction of neck movements.

Past history-

K/c/o htn since 3 yrs

N/k/c/o DM,epilepsy, thyroid,CVA

Vitals:

Bp:110/70mmhg

Pr:78 bpm

Rr:16cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmurs

CNS: NFND

R.s:BAE,NVBS heard

[16/05/23, 2:39:37 PM] ~ Dr. Meesum Abbas: 32.

Op no. 20230526283

60/M

C/O giddiness since 6 months. H/O pus discharge from Right ear 6 months back, relieved on using ear drops.

H/O similar problem in left ear 1 months back then developed giddiness, 2-3 times/week, aggravated on bending down.

Not K/C/O DM, HTN, TB, Asthma, Epilepsy

?BPPV

Patient advised admission for further evaluation and wants to get admitted after 3 days

[16/05/23, 2:59:06 PM] ~ Rachana Gangula: Sno 36

Op no 20230526307

40/F

Patient came for Normal check up as she had high BP (140/90 mmhg) when she got checked by an RMP 20 days ago.

She is not a previously known case of HTN, DM, TB, Asthma,CAD,CVA, Epilepsy, Thyroid Disease

Vitals:

Bp:140/90 mmhg

Pr:78 bpm

RR- 18 cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R/S- BAE,NVBS heard

Patient advised admission for further evaluation but not willing for admission as she came alone and patient attender is not present.

[16/05/23, 3:12:43 PM] ~ Dr. Meesum Abbas: 37

Op no. 20230526313

28/F

C/O headache since 1 month, B/L, with ringing of ears (right>left), nausea, photophobia, phonophobia +

Neck pain since 1 month

H/o domestic violence 12 years back, got hit by a wall, developed headache, right sided. Has refractive error for which she used spectacles.

H/o headache 2 years ago, right sided, associated with numbness of tongue, LOC for 1-2 mins.

?Migraine

Patient advised admission for further evaluation but not willing

[16/05/23, 3:33:12 PM] ~ Nikithchandra: No:37

Op:20230526307

40year old female who stays home ,wakes up at 6am ,does all the household chores and breakfast at 10am , has lunch at 1pm and , has dinner at 7pm ,goes to sleep at 9pm,due to weakness she decreased working hours

C/o:

Generalized weakness and easy fatiguability since 1day

Menstrual cycle:

Regular,4/30,not associated with clots and pain

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/80mmhg

Pr:73bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[16/05/23, 3:42:45 PM] ~ Nikithchandra: No:40

Op:20230526320

30year old female she was farmer ,wakes up at 7am ,does all the household chores and breakfast at 10am and goes to field , has lunch at 1pm and , has dinner at 7pm ,goes to sleep at 9pm, she has decreased working hours

K/c/o: rhemotoid arthritis 2weeks back,

Joint pain and swelling decresed

She came for follow up

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:130/80mmhg

Pr:78bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[16/05/23, 4:18:17 PM] ~ Nikithchandra: Op:20230526312

30year old female

C/o: feeling palpitations in epigastrium since 1year,1-2times per day,5-10minutes duration,increases in eating food, spontaneous resolved

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:88bpm

Pallor:present

P/a: soft,non tender

Cvs:pulsations felt in epigastrium ,non radiating,S1S2 heard ,heavy grade 1 in left parasternal area near tricuspid

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[16/05/23, 4:35:11 PM] Rakesh Biswas Sir: How many admissions out of 41?

17th May 2023,Wednesday

[17/05/23, 7:52:28 AM] Rakesh Biswas Sir: 👆?

[17/05/23, 7:52:37 AM] Rakesh Biswas Sir: and others taking the extended university summative assessment this year :

We need to see you presenting your cases daily offline after having shared them online in the proper case report format (after obtaining signed informed consent archived safely in your email sent items the day before.

Our offline rounds start from 9:00 AM in opd and end at 4:00 PM in ICU with 1-2 PM break in between

[17/05/23, 8:01:03 AM] Kshitij Sharma:

My email-id!

Also CC : Dr. Dinesh dutta sir

[17/05/23, 8:18:13 AM] Lohith Pg Gm : 1 admission sir

[17/05/23, 8:18:23 AM] Lohith Pg Gm : From OP

[17/05/23, 10:06:03 AM] ~ Pavithra: No:1

Op no:20230526745

54/f c/o neck pain and head ache(occipital region)since 6 mon

H/o vomitings on bend neck for more 30 min which is watery,non bilious, non projectile, occasional giddiness present

No h/o fever,neck stiffiness,restriction of movement.

K/c/o hypothyroidism on thyronorm 180mcg po/od

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Temp:afebrile

Bp:130/80

Pr:82bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission.she will review after 2days

[17/05/23, 10:13:19 AM] Rakesh Biswas Sir: Clinical images of lateral view showing muscle mass and visceral fat for all patients along with PaJR links to follow up

[17/05/23, 10:15:09 AM] ~ Pavithra: No:2

Op:20230526746

60/f c/o giddiness and fall,bleeding from nose while carrying water on her back 1 yr back

No loc and c/o involuntary movements, micturation and defecation.

C/o slurring of speech since 6 mon

C/o giddiness on walking, deviation of angle of mouth to right ?h/o cv

Romberg test :normal,no nystagmus

Cns:gcs:e4v5m6

Power:

Rt lf

Ul:5/5 5/5

Ll: 4/5 4/5

Tone:

Ul: n n

Ll: n n

Reflexes:

B 3+ 3+

T 2+ 2+

S 2+ 2+

K 3+ 3+

A 2+ 2+

P f f

Vitals:

Temp:afebrile

Bp:130/80(standing)

Supine:130/80

Pr:92bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission.

[17/05/23, 10:15:44 AM] Rakesh Biswas Sir: Clinical images of lateral view showing muscle mass and visceral fat for all patients along with PaJR links to follow up

[17/05/23, 10:32:15 AM] ~ Pavithra: No:3

Op: 20230526761

45/F c/o pain dragging type through out the spine from lumbar region ( vertebrae )

To ascending to the cervical region associated with headache in occipital region since 2 mon

No c/o giddiness ,nausea,vomiting, involuntary movements

No c/o weakness in both ul and ll

C/o tingling,numbness on same side on sleeping for long hrs since 2 mon relieved on waking up

Pain present everyday during work hours(farming work),since 2 days increased on bending forwards,relived on taking medication

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/70mmhg

Pr:80bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS:

Power:

Rt lf

Ul:5/5 5/5

Ll: 4/5 4/5

Tone:

Ul: n n

Ll: n n

Reflexes:

B 2+ 2+

T 2+ 2+

S -- --

K 2+ 2+

A -- --

P f f

R.s:BAE,NVBS heard

Strict diet, exercise, walking daily for 30 min

[17/05/23, 10:37:52 AM] ~ Pavithra: No:4

Op no:20210207008

50/f c/o neck pain since 1

week radiating to the right shoulder and upper limb

Occasional right lower limb pain h/o trauma to the hip

No h/o fever,restriction of neck movements, giddiness and headache.

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/70mmhg

Pr:72bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 10:54:35 AM] ~ Navya: No 5.

Op no. 20210218356

62/F

C/O pain in bilateral lower limbs from 5 days

Knee pain radiating to both calf regions

C/O neck pain radiating to upper back region, dull aching, continuous.

C/O intermittent SOB grade 2

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:76bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission for further evaluation and patient is getting admitted

[17/05/23, 11:08:49 AM] ~ Navya: No 6.

Op no. 20230527231

48/F

Follow up case of

? OHA induced Hypoglycemia with k/c/o DM-2

[17/05/23, 11:12:46 AM] ~ Pavithra: No:7

Op:2023052701

30/m yellowish discolouration of eyes since 4 days

N/h/o discolouration of urineand stools.

N/h/o fever,cough,cold and sob.

N/h/o pain abdomen, vomitings, loose stools and giddiness.

N/h/o jaundice in the past.

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:130/100mmhg

Pr:84bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission.

[17/05/23, 11:31:26 AM] ~ Pavithra: No:9

Op:20230527176

67/m c/o pain in the left UL and LL sudden in onset,gradually progressive, dragging type, no h/o tingling and numbness

No h/o weakness,difficulty in walking and loss of sensation.

No h/o trauma/fall

K/c/o CAD s/p CABG 6 yrs ago

K/c/o htn since 2yrs on metroprolol,telmisartan and chlorothiazide.

N/k/o DM,epilepsy,asthma thyroid,TB.

Vitals:

Bp:130/80mmhg

Pr:78bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 11:55:32 AM] ~ Pavithra: No:10

Op:20230527237

50/F c/o neck pain since 2 yrs

C/o difficulty in walking with lBA ,non radiating since 2 years ,increased on bending, unable to extend the limb completely(more since 6 months)

C/o neck pain right more than left,radiating to shoulder with mild restriction of movements to right

Used NSAIDS on and off

O/E:-

SLR-negative

Right Hip:- restriction with pain of felxion,extension,adduction,abduction

Tenderness along joint line

Left Hip:- mild tenderness with restriction

Reflexes(2+)

Neck: paraspinal tenderness with restriction of right sd neck

Gait:- Antalgic with right waddle

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/80mmhg

Pr:82bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 12:08:55 PM] ~ Navya: No.11

Op no:20210427529

30/M

C/O Fever since 10days,high grade,not a/w chills and rigors ,intermittent during evenings ,decreased apetite

C/O ployuria,polydypsia

H/O weightloss 5-6kgs since 20 days

H/O multiple joint pains present,b/l elbows and wrist joint pain

No h/o cough,cold,sob,vomitings, loose stools,pain abdomen,migratory polyarthralgia present

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/60mmhg

Pr:82bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Tenderness and restriction of movements in left ankle joint

Tenderness in left 1st metacarpo phalyngeal joint

Left shoulder overhead anduction and internal rotation not able to perform

[17/05/23, 12:23:45 PM] ~ Pavithra: No:12

Op:20230527776

45/F c/o neck pain since 5 ys radiating to rt shoulder and right Rt UL

H/O occasional headache (b/l) blurring of vision present,

N/h/o trauma or fall

H/O occasional giddiness

N/h/o vomiting, loss of sensation, tingling/ numbness

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:120/80mmhg

Pr:82bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 12:35:38 PM] ~ Pavithra: No:13

Op:20230527249

56/M c/o swelling in the bilateral foot since 2 days

No h/o trauma

H/o RTA 12yrs ago for which he was operated to right hip(rt hip replacement 12 yrs ago) referred i/v/o b/l pedal edema since 3 days

H/o left dorsam of foot post skin grafting

Wound is healing ruptured due to scratching blebs with discharge and pruritis

H/O Itching at right ankle

No decreased urine output and sob

O/E

Local rise of temp

Pitting edema upto skin

Discolouration upto ankle

Peripheral pulses:- couldn't feel due to swelling

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:140/90mmhg

Pr:76bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission.

[17/05/23, 12:49:55 PM] ~ Navya: no.14

Op no.20230527865

41/F

C/O b/l pedal edema since 2 months progressed to anasarca ,used diuretics for 4-5 days and stopped

Lower backache since 3 months,non radiating increases on working and bending

on and off nsaids use

Stream of urine not continuous, no burning, no suprapubic pain,

irregular menses since 3 months 4/30 days- 4/40-50 days

O/E :-

Mild pallor present

Goitre present

Lower back ache:-

SLRT-negative

No loss of lumbar lordosis

No spinal tenderness and paraspinal spasm

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:110/70mmhg

Pr:80bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmurs

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 12:50:43 PM] ~ Navya: No.15

Op no.20230527880

28/F

C/O pain in the legs since 3 days,more during nights ,pricking type of pain,relived on massaging

N/H/O fever,cough cold,sob

N/h/o vomiting, loose stools.

Myalgia present

N/k/o HTN, DM,epilepsy,asthma thyroid,CVA

Vitals:

Bp:100/70mmhg

Pr:84bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 1:23:44 PM] ~ Pavithra: No:16

Op:20230526412

20/F c/o lower backache,dragging type radiating to the cervical spine region with headache in occipital region since 1 week

No fever,vomoting.

C/o giddiness since 7 to 8 yrs only when temperature present

H/o angioplasty done 18 yrs back not on any medication

N/k/o HTN, DM,epilepsy,asthma thyroid,TB.

Vitals:

Bp:90/60mmhg

Pr:80bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission.

[17/05/23, 2:54:40 PM] Rakesh Biswas Sir: Don't share the patient identifiers IN the form of their advocate numbers in this group. That can be done only inside their PaJR group but even that is best kept in pm to the opd PG for the day

[17/05/23, 2:56:51 PM] ~ A.R.T.TEJASRI: 17.

55F

OPNO:20230527906

c/o burning sensation in epigastric region since 1 year , pain aggravates on eating food. no h/o regurgitation of food , no h/o vomiting ,nausea

N/k/o HTN, DM,epilepsy,asthma thyroid,TB.

Vitals:

Bp:120/70mmhg

Pr:80bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 2:58:10 PM] ~ A.R.T.TEJASRI: 18.

25F

OPNO:20230528480

c/o headache unilateral in origin later progressed to diffuse headache associated with photo phobia, phonophobia aggravated on stress relieves on sitting in dark room, no aura .

clinical case of pcod since 5 years

N/k/o HTN, DM,epilepsy,asthma thyroid,TB.

Vitals:

Bp:110/80mmhg

Pr:84bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[17/05/23, 3:16:15 PM] ~ A.R.T.TEJASRI: 19.

36M

c/o fever since sunday associated with chills and rigors , intermittent, relieved on medication

c/o cold since sunday cough associated with sputum , copious , non blood stained since sunday

c/o headache , bursting type of headache, diffuse,( holocranial type since subday)

c/o loose stools ( 20 episodes), large volume,watery in consistency relieved by medication .

N/k/o HTN, DM,epilepsy,asthma thyroid,TB.

Vitals:

Bp:100/6pmmhg

Pr:99bpm

Patient is advised for admission ,willing to admit

[17/05/23, 3:37:57 PM] ~ Navya: 20.

Op no. 20230426632

46/M

C/O tingling, numbness in right hand little finger since 10 days

C/O low backache since 10 days (stiffness present) ,no h/o trauma, aggravating factors-on bending forward pain increases, relieving factors-pain decreases on walking for some distance

K/C/O HTN since 3 months on medication (metoprolol 25 mg and clinidipine 10mg)

Vitals:-

BP:-130/80 mm hg

PR:-86bpm

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

[17/05/23, 7:49:49 PM] Lohith Pg Gm : Today

[17/05/23, 7:51:39 PM] Lohith Pg Gm : 3 Admissions from OP sir

18th May 2023,Thursday

[18/05/23, 9:46:13 AM] ~ haqansari7863: No.1

20210413089

18/5/2023

C/O neck pain since 4 months

No restriction of movements

No tenderness

Pain during bending movements

Pain started after lifting heavy weights

N/K/O HTN ,DM, EPILEPSY,ASTHMA,THYROID,CVA

VITALS

Bp:90/60

Pr:86bpm

P/A :soft nontender

Cvs:NFND

RS:BAR,NVBS heard

Advice given:

Avoid heavy weight lifting

Ultracet 1/2 qid for 2 days

Patient was advised admission but not willing to get admitted because patient told he will come again and get admitted it pain did not subside

[18/05/23, 9:49:34 AM] ~ Rishika.: 2.

46F

OP NO:20230528807

C/o headache since 2 days

H/o trauma on the occipital region 2 days back (fell from the bike)

Complaints of phonophobia,tinnitus and ear pain during loud sounds

No complaints of giddiness,blurring of vision,photophobia and nausea

Complaints of groin to loin pain since 3 months

Burning micturation present

No pain present during micturation

No hematuria

Vitals:

BP:110/70mmHG

PR:98bpm

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a known case of DM,HTN,asthma,epilepsy and CAD

Treatment:

Ultracet 1/2 tab PO/QID for 2 days

Patient is not willing to get admitted

[18/05/23, 9:50:49 AM] Rakesh Biswas Sir: Don't use opiods for such pain

Better just give paracetamol 650mg 6 hourly for one day

[18/05/23, 9:52:58 AM] ~ Dr.Dinesh Datta: Yep,aceclofenac does the job as well.

Anyways,opioid isn't indicated

[18/05/23, 9:53:21 AM] ~ Dr.Dinesh Datta: Any history suggesting towards renal calculi.

[18/05/23, 9:53:24 AM] ~ Dr.Dinesh Datta: ?*

[18/05/23, 10:02:31 AM] ~ haqansari7863: 3.

20230529236

30/f

Referral from dental opd i/v/o hemithyroidectomy and fitness for thooth extraction

No complaints of weight gain/loss ,cold or heat intolerance

No complaints of palpitations

,Pedal edema tingling sensation

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

VITALS

Bp:120/80mmhg

Pr:76bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Advice: follow up with thyroid profile every 3monthly

[18/05/23, 10:04:38 AM] ~ Rishika.: 4.

60M

OP NO:20210309006

C/o burning sensation of feet since 1 week

Polyphagia and polydipsia present

K/c/o HTN since 8 years and is on medication (telma 40mg OD)

DM type 2 since 8 years (Glimi M2 in the morning and Glimi M1 at night)

H/o alcohol consumption everyday (90ml) since 25 years

Vitals:

BP:150/80mmHg

PR:118bpm

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Vibration: Right. Left

MTP: 4 sec. 4sec

Tibial. 10sec. 10sec

Medial malleolus. 10 sec. 10 sec

Sensation. Right. Left

Fine touch. Normal. Normal

Crude touch Normal. Normal

Patient was adviced to get PLBS and HBA1C test done

[18/05/23, 10:05:07 AM] ~ Dr.Dinesh Datta: They started performing Hba1c in KIMS?

[18/05/23, 10:05:23 AM] ~ Dr.Dinesh Datta: What's fbs or rbs?

[18/05/23, 10:13:16 AM] ~ haqansari7863: 5.

22/m

C/o fever and body pains since 3 days,lowgrade and intermittent

Not associated with chills and rigor

No c/o cold , cough,pain abdomen ,loose stools, vomiting , burning micturation

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

VITALS

Bp:110/70mmhg

Pr:74bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Adviced

1)T. Dolo 650mg /tid x 3days

2)T.Montex cc bd x3days

Patient was advised admission but not willing to get admitted

[18/05/23, 11:16:06 AM] ~ Rishika.: 8.

72F

OP NO:20230529290

C/o

-neck pain since 6months

-shortness of breath (grade 4) since 2 days

-loss of apetite since 2 days

No h/o pedal edema,palpitations,orthopnea,PND,heaviness and tightness of chest

No restriction of movements and not increased while bending downwards

H/o PTCA in 2018

K/c/o CKD since 5 years

Vitals:

BP:90/60mmHG

PR:78bpm

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a known case of DM,HTN,asthma,epilepsy,TB

Adviced admission but not willing to admit as she has no attender to stay with her

[18/05/23, 11:35:54 AM] ~ Rishika.: 9.

27F

OP NO:20210417906

C/o

-bilateral lower limb and feet pain since one week which is increased during walking

-bilateral palm pain since one week

No burning sensation

-S/P hysterectomy one year back

Vitals:

BP:100/60mmHG

PR:68bpm

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a known case of DM,HTN,asthma,epilepsy,TB

Treatment:

Tab.Ultracet 1/2tab PO/QID for 2 days

[18/05/23, 11:42:16 AM] ~ haqansari7863: 9.

20230529760

28/m

C/o pain abdomen since 3 days ,belching and abd tightness present ,wt loss present

Sob grade 2,burning micturation since 10days

Not associated with chills and rigor

Fever lowgrade , intermittent,on and off ,not associated with chills and rigor

Itching and rash overback

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

VITALS

Bp:120/70mmhg

Pr:76bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Patient was advised admission and is not willing to get admitted

Advise

1)T.pan 50mg po/od x10days

2)syp.sucralfate 10ml po/tid

[18/05/23, 11:46:15 AM] ~ Rishika.: 10.

40F

OP NO:20230529824

C/o

-lower backache since 2 months which is increased on bending downwards

-neck pain since 2 months and no restriction of movements

Vitals:

BP:120/80mmHG

Weight:109kg

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a known case of DM,HTN,asthma,epilepsy,TB and thyroid abnormalities

Advice:

-Diet modification

-Avoid junk food

-Regular exercise

[18/05/23, 11:56:18 AM] ~ haqansari7863: 11.

50/m

C/o loss of speech since 10days

Pt.was admitted and discharged

Symptoms improved now

Speech improved as compared before

/k/c/o

HTN since 5 years

Dm since 1 year on HAI

VITALS

Bp:120/80mmhg

Pr:78bpm

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Dx Recurrent CVA came for follow up

Adviced

1)T. Clinidipine 20mg

2)T. Clopidogril 75/75mg

3)T.Atorvas 20mg

Patient was advised admission but not willing to get admitted

[18/05/23, 12:10:23 PM] ~ Rishika.: 12.

45M

OP NO:20230529738

C/o

-slurring of speech since 3 days and deviation of mouth to the left

-speech improved today

-tingling sensation of feet and palms since 1 year

-burning sensation of feet

No weakness of upper and lower limbs

-known case of TB 5 years back and was on medication for 3 months

Vitals:

BP:140/90mmHG

Weight:84kg

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a known case of DM,HTN,asthma,epilepsy and thyroid abnormalities

Right. Left

Tone. UL. Decreased. Decreased

LL. Decreased. Decreased

Power UL. 5/5. 5/5

LL. 5/5. 5/5

Reflexes

Biceps. ++. ++

Triceps. ++ ++

Supinator ++ ++

Knee. ++ ++

Ankle. ++ ++

Plantar. ++ ++

Patient was adviced for a neurophysician opinion.

[18/05/23, 12:30:22 PM] ~ haqansari7863: 15)

48/m

C/o pain left upperlimd since 1month

No Chest pain

H/o ptca 8years back

NoPalpitations ,orthopnea,pnd, chest tighteness

K/c/o htn since 8 years (tab arkanmine 0.1mg po/tid

K/c/o dm2 since 8 years

K/c/o Cad in 2016

N/k/c/o

epilepsy,thyroid,tb,asthm

VITALS

Bp:110/70mmhg

Pr:74bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

S/p

Pci done to RRA

B/l RAS

Patient was advised admission but not willing to get admitted

[18/05/23, 12:45:59 PM] ~ haqansari7863: 16)

44/m

K/C/o

Dm/htn since 6 months and on medications (t.metformin 500mg and t.telma 40mg) came for routine checkup

VITALS

Bp:130/80mmhg

Pr:74bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Patient was advised admission but not willing to get admitted

[18/05/23, 1:07:37 PM] ~ Rishika.: 18.

50F

OP NO:20230529920

C/o

-neck pain since 2 months and increased pain while bending down

-loin pain since 6 months

-burning sensation all over the body

-tingling sensation bilateral palms since 1 year

Vitals:

BP:110/70mmHG

PR:98bpm

UL and LL Right. Left

Sensation. Normal. Normal

Fine touch. Normal. Normal

Crude touch. Normal. Normal

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a k/c/o HTN,DM,TH,epilepsy and CAD

Treatment:

Tab. ultracet 1/2 tab PO/QID for 2 days

[18/05/23, 1:11:11 PM] ~ Rishika.: 14.

45M

OP NO:20230529738

C/o

-giddiness 1 episode (last night) in supine position

-neck pain increased during movements and while bending downwards

No complaints of ear pain,tinnitus,no positional variation,blurring of vision.

Rhomberg’s test negative

Known case of DM type 2 since 2 years

(Glimi 2mg+voglibose 0.2mg +metformin 500mg)

Known case of HTN since 2 years

(Amlodipine 5mg + atenolol 50mg)

Diagnosis: ?cervical spondylosis

Vitals:

BP:120/80mmHG

PR:68bpm

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Treatment:

Tab. ultracet 1/2 tab PO/QID FOR 2 days

[18/05/23, 1:17:33 PM] ~ haqansari7863: 17)

52/m

C/o giddiness since 4 days

No h/o loc and seizures

No h/o chest pain,sob , palpitations

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

VITALS

Bp:130/80mmhg

Pr:74bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

pt was advised admission but patient is not willing to get admitted

[18/05/23, 1:32:18 PM] ~ haqansari7863: 13)

52/m

C/o pain right upperlimd since 1year

Tingling sensation and neck ache present

No nausea , vomiting,pain and

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

VITALS

Bp:110/70mmhg

Pr:74bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Advice

1)T.ULTRACET x5 dys

Patient was advised admission but not willing to get admitted

[18/05/23, 1:33:31 PM] ~ haqansari7863: 12)

52/m

C/o pain abd since 15 days on and off

Squeezing type of pain in right lumbar and hypochondrial region

Loose stools since 2days watery ,non blood tinged

No c/o nausea, vomiting

Belching present

C/o pain in rt lower limg since 15 days

C/o burning micturation since 15 days

K/c/o dm since 2 years

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

?UTI

VITALS

Bp:110/70mmhg

Pr:74bpm

CNS :NFND

CVS:S1S2 Heard ,no mumurs

RS: BAENVBS heard

P/A : soft nontender

Advice

1)T.Buscopanx 2days

Patient was advised admission but not willing to get admitted

[18/05/23, 2:57:56 PM] ~ haqansari7863: 18)

34/m

C/o pain in both the calves since 6months increased on lying down and standing for long time

No tingling/numbness/fever

No h/o trauma /injury

No h/o swelling of lowerlimbs

N/k/c/o dm ,htn, epilepsy,tb ,thyroid,

CNS:NFND

CVS:S1S2 heard

RS BAE NVBS heard

P/A:soft nontender

Patient was advised admission but patient is not willing to get admitted as patient for general check up, his wife is admitted in obgy dept. , He is getting his blood group testing done for blood donation

[18/05/23, 3:01:35 PM] ~ Rishika.: 19.

28M

OP NO:20230530293

C/o

-blood in vomitings,large volume, 1 episode/day associated with abdominal pain since 3 days immediately after waking up.

-fever associated with chills and rigor since 3 days

-burning micturation which is relieved on medication, no diurnal variation

-dry cough since 3 days which is more during the nights

-headache in the occipital region since 3 days associated with nausea and phonophobia

-weight loss: 3kg since a week

Vitals:

BP:110/80mmHG

PR:94bpm

CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender

Not a known case of DM,HTN,asthma,epilepsy,TB and CAD

Consumption of ghutka all day:10 packets/day

Treatment:

-Tab. Dolo 650mg PO/TID

-Tab.zofer 4mg PO/BD

-Tab. Naproxen 250mg PO/BD

Patient was advised for admission but not willing to as he is not prepared.

[18/05/23, 3:15:57 PM] ~ haqansari7863: 20)

70/m

Pt came for ct angiogram

C/o chest pain since 10days

Sob since 10days grade 2 progressed to grade 3

Swelling of b/l lower limg since 20days

No orthopnea , palpitations,giddiness or sweating

K/c/o htn on medications since 3 years

N/kc/o dm htn epilepsy,tb, thyroid

CNS:NFND

CVS:S1S2 heard

RS BAE NVBS heard

P/A:soft nontender

Patient was advised admission but bot willing to get admitted because patient didn't bring attender

[18/05/23, 3:35:59 PM] ~ Rishika.: Patient was adviced to come back tomorrow and he said he would.

No admissions today from op sir

19th May 2023,Friday

[19/05/23, 9:49:45 AM] ~ Tharunkumar: 1.Op no: 20230530673

57/M

C/o decreased urine output and increased frequency of urination since 1 month

C/o tingling sensation and numbness of both upper and lower limbs since 1 week

C/o hematuria 4 days back

No h/o burning micturition

No c/o hesitancy/ dribbling of urine

No H/o fever,cough,cold,chest pain, palpitations,pain abdomen, orthopnea,PND.

B/l Pedal edema present upto knee

Not a k/c/o HTN,DM, epilepsy, thyroid disorders.

H/o renal calculi 3yrs back

H/o dialysis 3yrs back- fistula intact

Patient was advised admission for further evaluation and is getting admitted.

[19/05/23, 10:07:57 AM] Deepthi Ma’am : 2. Op no20230530673

80/m

C/o tingling sensation and numbness of both upper limb (distal palms )and lower limb (feet)since 10days

C/o cough since 2days ,sudden in onset ,non productive with no aggravating and relieving factors

No c/o fever,pain abdmonen,vomitings,diarrhea

No h/o chest pain ,palpitations,orthopnea,pnd, no pedal edema

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

Patient advised admission but attenders are not willing for admission

[19/05/23, 10:10:28 AM] Rakesh Biswas Sir: How many days of dialysis 3 years back?

[19/05/23, 10:11:49 AM] ~ Tharunkumar: 2 sessions of dialysis sir

[19/05/23, 10:27:20 AM] Deepthi Ma’am : 3.op no: 20230531084

48/m

C/0 chest pain on left side of chest since 7days on and off, non radiating,stabbing type of pain

C/o occasional palpitaions

No c/o orthopnea,sob,pnd,pedal edema

No c/o fever,burning micturition,vomitings, diarrhea

N/k/c/o HTN,DM,thyroid,epilepsy

O/E: tenderness over the left 3rd intercostal space

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[19/05/23, 10:33:47 AM] ~ Tharunkumar: 4.Op no:20230531091

46/M

C/o fever since 1 week

C/o cough since 4 days

Fever-High grade, intermittent,not associated with chills and rigors, associated with headache(b/l), relieved after taking medication

Cough-productive,scanty, yellowish colour, aggravates on eating food and drinking tea.

K/c/o DM2 since 1 year and not on medication but on diet control

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

O/E

RS-BAE +, NVBS

CVS- S1 S2 heard,no murmurs

P/A-soft non tender

CNS- NFND

Daily routine - Wakes up at 6am and does some farming work,returns back to home, eats breakfast at 8am and goes for work(car driver) and eats lunch at 1am (ragi jawa) returns home in the evening and does household work & takes rest.Dinner at 8pm(mixed flour roti) and sleeps at 9:30 pm.His daily routine was disturbed past 4 days and sleep was disturbed.

Patient was advised admission but not willing as he hasn't applied for leave will come after 3 days.

[19/05/23, 10:54:09 AM] ~ Tharunkumar: Op no:20230531109

60/M

C/o pain abdomen since 2 months

Lower back ache since 15 days

Pain abdomen -epigastric region, rt. hypochodrium and rt.lumbar region associated with abdominal discomfort after eating.

Lower back ache radiates to left lower limb.

N/k/c/o HTN, DM,TB, epilepsy, asthma

H/o Right loin pain 12 yrs back for which he went to yashoda hospital and relieved after medication.

O/E

CVS-S1 S2 heard,no murmurs

RS-BAE + NVBS

P/A- soft,mild tenderness present in epigastrium,right lumbar and right hypochodrium

CNS-NFND

Diagnosis -? Dyspepsia?APD

Patient was advised admission but not willing as he came only for usg abdomen

[19/05/23, 11:17:15 AM] Deepthi Ma’am : 6.op no20230531125

55/F

Who is a homemaker by occupation

Wakes up at 5:ooam , cooks food ,has breakfast at8:00am,watches tv ,has lunch at 12:00 pm , sleeps for sometime , then again talks to her neighbours, goes for walk for sometime ,dinner at 9pm

Sleeps at 11pm .

Sleep disturbed since few days

No change in her daily routine

C/o pedal edema since 20days,pitting type extending upto knee not relieved on rest

C/o sob grade3 since 20days

C/o snoring since1 year (grade4)

No orthopnea,pnd,chestpain,palpitaions

No decreased urine output,no h/o burning micrurition

No c/o fever,cough,vomiting,diarrhea

C/oheadache ,right side unilateral, lacrimation from both eyes.

K/c/o hypothyroidism since 4years using TAB THYRONORM 25mcg

N/k/c/o DM,HTN ,thyroid,epilepsy

O/E

Pallor+

Right side DNS ,turbinate hypertrophy

Tenderness over right maxillary sinus

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[19/05/23, 11:54:49 AM] Deepthi Ma’am : 7. Op no:20230531582

65/M who is a a construction worker by occupation wakes up at 6am,then he has breakfast at9 am then he goes to work but stopped his work due to sudden onset of weakness in right upper limb and right lower limb 2years back (cva), he now came with

c/o tingling and numbness in upper limb and lower limb since 2months

C/o restriction of movements of right hip joint and right knee since 2months

C/p neckpain radiating down the lumbar spine,aggravated on bending forward and relieved but not completely after medication

K/c/o HTN since 2years ,on medication using TAB (TELMA40mg)

K/c/o right hemiparesis 2years back

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[19/05/23, 11:55:32 AM] ~ Tharunkumar: 8.Op no: 20230531112

36/F

C/o pain in left side of chest(axilla) since 5 yrs

SOB(Grade 2) since 5 yrs

Chest pain- continuous,non radiating,no postural variation,no aggravating and relieving factors

No h/o palpitations, orthopnea,PND

No h/o fever,cough

N/k/c/o DM HTN TB Asthma thyroid

1st pregnancy-2015 2nd pregnancy -2018

Patient started having SOB on exertion since 2nd pregnancy. After delivery she went to hospital and diagnosed as CRHD with moderate MR and started T.ATENOLOL 25mg po/OD since 1 year.

O/E-

CVS-S1 S2 heard, no murmurs

RS-BAE+ NVBS

P/A-soft NT

CNS -NFND

Advised admission but not willing as she has children at home.

[19/05/23, 12:16:47 PM] Deepthi Ma’am : 9.op no :20230531693

26/F who is a homemaker by occupation came with

c/o pain in epigastrium since 2months ,on and off aggravated on taking spicy food. Relieved on taking medication.

No c/o fever , vomitings,chestpain,diarrhea

No c/o sob,palpitations,

No c/o burning micturition

O/E

Cvs- s1s2 heard,no murmers

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Diagnosis -? Dyspepsia

Patient is advised for admission but not willing.

[19/05/23, 12:22:04 PM] ~ Tharunkumar: Op no:20230531708

63/M

K/c/o DM2 since 14 years and on medication T.METFORMIN 500mg PO/OD came for regular checkup

Daily routine -

Wakes at 4am goes for walking and does farming. Eats breakfast at 8am and lunch at 1pm(rice and curry) and takes rest and does household work and dinner at 8pm(rice and curry) and sleeps at 9pm.

Advised Diet control and regular exercise

O/E

CVS-S1 S2 heard no murmurs

RS-BAE + NVBS

P/A- soft non tender

CNS-NFND

Not willing for admission as he came to see his relative in hospital.

[19/05/23, 12:30:09 PM] ~ Rithika: 11. Op no.20230531691

50/F

Complaints of breast tenderness (more over right than left)

Complaints of burning micturition since 2 months

No urgency, frequency, hesitancy

No h/o fever, vomiting, diarrhoea,sob,chest pain , palpitations

N/k/c/o htn,dm, thyroid disorder ,cad,cva.

O/E

Cvs- s1s2 heard,no murmers

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Breast : No local rise of temperature

Right side - tenderness present over right side upper outer quadrant

Swelling 1cm x 1cm , mobile, firm in consistency

Left side - No tenderness

Patient is advised for admission but not willing.

[19/05/23, 12:46:27 PM] ~ Tharunkumar: 12.Op no:20230531635

76/M

C/o lower back ache since 2 years

Both knee pain since 2 yrs

Neckpain since 2 yrs

Headache since 2 yrs

K/c/o HTN since 2 yrs and on regular medication

N/k/c/o DM,TB, epilepsy and asthma

O/E

Tenderness present in cervical and lumbar spine

Extension of neck is limited

Crepitus present in knee joint

Daily routine -

Wakes at 6am eats breakfast at 8am and lunch at 1pm(rice and curry) and dinner at 8pm(Roti).

Used to do farming before 2 yrs but stopped working due to backpain.

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-NFND

Patient not willing admission as he came only for tests

[19/05/23, 1:00:40 PM] Deepthi Ma’am : 13.Op no:20230531718

34/F

C/o neckpain since 3days associated with headache

No h/0 lacrimation ,photophobia phonophobia

No h/o fever, vomitings,diarrhea

No h/o giddiness ,chestpain,palpitations,orthopnea,pnd

O/e

Cvs:s1,s2+ no murmers

RS: BAE+NVBS

P/A:soft,non tender

Patient advised admission but not willing for admission

[19/05/23, 1:02:21 PM] ~ Rithika: 13.op no.20230531779

50/F

Complaints of pain over the right shoulder radiating down to hand since 1 month

Complaints of pain over the right hip joint extending down to the ankle

No h/o any trauma

No history of fever ,burning micturition

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

K/c/o type 2 DM since 10 years and on medication

N/k/c/o htn, thyroid disorder , cad ,cva

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[19/05/23, 1:21:30 PM] ~ Manohar Nadella: 14.Op no. 20230531684

45 / M

Is a Tailor ,Dancer , Singer , Mimicry artist by occupation but stopped 8 months back due to Lower back ache since then .

Now ,he wakes up by 4:45 am, get ready for his job which takes around 90-100mins from his residence ,carries lunch and have it by 10 am in the morning , has mild food like biscuit or fruit at lunch time if hungry ..completes by 5 30 pm and return back.Also adds that he wakes up 2 3 times during sleep for urinating ,also 2 3 times at work place.

C/o of burning sensation in both the feet since 1 month

C/o both knee joint pain since 1 month.

C/o neck pain since 1 month.

K/c/o of DM2 since 10 years and on regular medication T.Metformin 500mg

Y.Glimipride

Diag:Peripheral Neuropathy.

O/E:

CVS: S1 S2 heard , no murmurs

RS:BAE +, NVBS +

P/A :soft , nontender

CNS Tone normal all the limbs

Power 4/5 all the limbs

Reflexes

B:2+

T : 2+

S: 1+

K : 2+

A: 1+

Plantar: flexor

Sensory: fine , crude touch

Vibration proprioception intact.

Adviced for admission but not willing due to children at home.

[19/05/23, 1:54:18 PM] Rakesh Biswas Sir: No MR? What about her apex beat?

[19/05/23, 4:33:25 PM] Lohith Pg Gm : 1 admission from OP sir

[19/05/23, 11:06:26 PM] Rakesh Biswas Sir: What you have shared above is largely opinion.

Please discuss one single RCT of iv Ig in the PICO format in the ward group

20th May 2023,Saturday

[20/05/23, 9:46:00 AM] Ankit 18: 1.op no: 20230532541

55/F

C/0 polyuria and generalised weakness since 1 year

No c/o polydilsia, polyphagia,pedel edema , blurring of vision, tingling sensation

Patient is a k/c/o DM since 4 years on GLIMI M1 once daily

Patient non compliant to previous OHA regimen , though GLIMI-M1 was prescribed twice a day she only consumes once daily

N/k/c/o HTN,,thyroid,epilepsy

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[20/05/23, 9:51:52 AM] Ankit 18: 1.op no: 20230532542

37/M

C/0 headache, bilateral temporal region since 2 months daily , 1 hour in the morning and 1 hour at night approximately associated with phonophobia

C/o decreased sleep since 1 month

No c/o photophobia,nausea and vomiting

Patient is a k/c/o DM since 3 months not on any medication

N/k/c/o HTN,,thyroid,epilepsy

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

TAB .DOLO 650 MG for 3 days

Patient is advised for admission but not willing.

[20/05/23, 10:00:55 AM] Ankit 18: 3.op no: 20210319796

62/M

K/C/O of type 2 DM since 15 years on tab.VOGLIBOSE 0.2mg + GLIMUIPERIDE 2 mg+ DAPAGLIFLOZIN 10 +METFORMIN 500mg once daily

C/o decreased sleep since 1 month

c/o polyphagia

No c/o tingling sensation , polyuria, pedel edema

N/k/c/o HTN,,thyroid,epilepsy,cad,cva

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

1) TAB.GLIFLOZIN 10 mg po/od

2)TAB.GLUOBIT- GM2 po/od

3) diabetic diet

Patient is advised for admission but not willing.

[20/05/23, 10:02:10 AM] Lohith Pg Gm : Crop the patient identifiers Ankit

[20/05/23, 10:11:46 AM] Ankit 18: 4.op no: 20210319796

62/M

C/O chest comfort of burning type associated with bloating and indigestion and belching which Increases post consumption of food

H/o tingling sensation in both the upper and lower limbs

No C/o regurgitation of food, burning micturition, polyuria, polyphagia

k/c/o of DM type 2 since 10 years on TAB.VOGLIBOSE 0.2 mg + TAB GLIMIPERIDE 2 mg+METFORMIN 500 mg po/od

K/C/O of HTN since 5 years on telma 40 mg

Not A K/C/O/,thyroid,epilepsy,cad,cva

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

1) PAN 40 mg po/od for 10 days

2) continue diabetec regimen.

3) avoid spicy food

Patient is advised for admission but not willing.

[20/05/23, 10:17:28 AM] Ankit 18: 5.op no: 20230519416

38/M

C/O fever since yesterday afternoon decreased on taking medication associated with body aches and cough , cough is not associated with sputum

H/o tingling sensation in both the upper and lower limbs

Not a k/c/o HTN,DM thyroid,epilepsy,cad,cva

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

1) TAB .DOLO

2) ADEQUATE rest

Patient is advised for admission but not willing now will come later

[20/05/23, 10:24:16 AM] Ankit 18: 6.op no: 20210221236

54/F

C/O shortness of breath since 10 days ( grade 2)

C/o left sided chest pain of pricking type not associated with any palpitations

H/o pedel edema pitting type right more than left

No c/o PND, orthopnea, fever , cough ,cold

K/c/c thyroid on thyronorm 25 mg

Not a k/c/o HTN,DM ,epilepsy,cad,cva

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

1) continue thyroid medication

Patient is advised for admission but not willing now will come later

[20/05/23, 10:34:12 AM] Ankit 18: 7.op no: 2021

55/M

K/C/O CAD 1 Year back advised by a cardiologist for CABG

H/o admission 1 years back at our hospital and was discharged on rosuvatstatin 10 since December 2023

K/c/o DM type 2 on metformin 500 mg for the last 3 years

K/c/o thyroid on TAB .thyronorm

50 mcg since 1 year

Not a k/c/o HTN,DM ,epilepsy,cad,cva

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

Patient is advised for admission but not willing for stay due work obligations

[20/05/23, 10:57:42 AM] Ankit 18: 8.op no: 20230533000

70/M

C/o of difficulty in breathing since yesterday evening on walking around 250 mts

C/o of fever since yesterday received on medication

C/o cough with sputum since 1 month on and off on inhaler budesonide and formetrol 1 puff morning and evening

H/o admission 7 months back at our hospital with acute GE and cor pulmonale

Not a k/c/o HTN,DM ,epilepsy,cad,cva

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Rx:

1)TAB .DOLI 650 MG po/od

2)ascoril d po/tid 15 ml

3) continue inhaler

4) tab .MVT po/of

Patient is advised for admission will join on Monday

[20/05/23, 11:03:44 AM] ~ Rajkumar Adepu: 9

Op no 20230532998

65 M

C/o fever since 7 days

High grade Associated with chills

Cough with sputum since 15 days white in colour

History of weight loss present

History of sob grade 3 since 1 month

No h/o orhtopnea , PND

H/O loss of appetite present

H/o renal calculi 6 months back

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

O/E

Febrile on touch

RS wheeze present in B/L IMA,MA and Inter scapular area

CVS S1 S2+

CNS NFD

Tab Dolo 650mg po/tid

Syp ascoril ls 10ml po/tid

Pt is advised for admission he will come on Monday

[20/05/23, 11:34:40 AM] Ankit 18: 10

Op no 20230533023

40 M

C/o left sides headac in the occipital region since 1 day , giddiness occasionally

C/o chest pain, localised , burning type, non radiating not associated with any SOB , no aggravating or reliving factors

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

O/E

RS NVBS+ , BAE +

CVS S1 S2+

CNS NFND

Tab pantop 40 mg po/od

Pt is advised for admission not willing

[20/05/23, 12:09:05 PM] ~ Rajkumar Adepu: 11

Op no20230533031

45F

C/o burning type of Pain in the chest since 1 yr radiating to back

H/o bloating present

H/o regurgitation of food

C/o tingling sensation of left lower limb associated with low back pain since 6 months

H/o pain in small joints of hand and pain in elbow joints not associated with swelling

H/o fever 2 yrs back after which she developed weakness of limbs and pain in multiple joints

Pain b/l hip joints

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

O/E

SLRT

RT 70

LT 70

inspection deformity difficulty in flexion of index finger at distal phalynx

Palpation swelling absent

Tenderness present

CVS S1 S2+

CNS NFD

RS BAE+

Pt is advised for admission he will come back on Monday

[20/05/23, 12:12:31 PM] Ankit 18: 11

Op no 20230516680

55/ M

C/o difficulty in breathing since yesterday night on supine position

increases on post meal

C/o bloating and belching

C/o retrorbital pain since 2-3 days

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

O/E

RS NVBS+ , BAE +

CVS S1 S2+

CNS NFND

Acute gastroenteritis with cervical paraspinal spasms

Tab pantop 40 mg po/od

Pt is advised for admission not willing

[20/05/23, 12:42:25 PM] ~ Rajkumar Adepu: 12

Op no 20210313130

66/M

C/o sob grade 3 since 2 days

C/o b/l pedal edema since 6 months extending till knee pitting type

No h/o decreased urine output

No h/o fever , facial puffiness

H/o analgesic abuse

No h/o chest pain, palpitations, PND,orthopnea

K/c/o pulmonary TB 5 yrs back used medication for 6 months

Not K/c/o HTN DM CVA CAD

O/E

CVS S1 S2+

RS BAE+

P/a soft and non tender

Pt is getting admitted for further evaluation

[20/05/23, 6:05:49 PM] Lohith Pg Gm : 2 admissions from OP sir

21st May 2023,Sunday

None

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