PLA BOOK PROJECT DRAFT OPD week-5

Week-5

22 May 2022,Monday

[22/05/23, 9:45:54 AM] ~ Prathyusha Singam: 1

Op. No. 20210318003

A 40year old male who is a tractor driver by occupation came with

C/o pedal edema (pitting type) since 1week, insidious in onset, aggravated on prolonged sitting, relieved on walking and limb elevation, presently mainly by the evening.

No C/o SOB, chest pain and decreased urine output.

K/c/o HTN since 3years. On T. Telma 40mg PO/OD.

K/c/o hypercholesterolemia and is on medication.

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

Vitals:

Pt is c/c/c

BP: 130/80 mm Hg

PR: 82bpm

RR: 19cpm

Temp: 98.7 F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Advised: walking for 10mins for every 2hours and limb elevation

Patient is not willing for admission as he is working today.

[22/05/23, 9:46:57 AM] Rakesh Biswas Sir: Clinical images of visceral fat and biceps lateral view asap

[22/05/23, 9:48:05 AM] Rakesh Biswas Sir: Familial hypercholesterolemia?

@917780285086 Is anti cholesterol drugs indicated for primary prevention of polygenic hypercholesterolemia?

[22/05/23, 9:53:50 AM] ~ vamsi Krishna: SL NO 2

OP NO: 20230534797

42 year old female

C/o giddiness since 3 days

2 to 3 times per day since 3 days

Spinning sensation of head mainly while (neck extension) rising the head above. Sitting sleeping position

No buzzing sensation in ear ear pain

Diplopia (+)

Not associated while walking or standing

No clo neck pain head ache nausea

H/o similar complaints 3 years ago subsided after using medication

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

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

No dysdiadokinesia

No fingers incordination

Rombergs test -no swaying

No nystagmus

Patient is advised for admission she will come back on wednesday

[22/05/23, 9:54:28 AM] ~ Dr.Sai Pavan👨‍⚕️: 5.op no :20210424391

A 30 year old female accountant by occupation ( goes to work at 9 am ,lunch at 1 pm at work and reaches home by 5 pm and continues his works at home ,dinner at 8 pm and goes to bed by 9 pm)

Came with c/o fever since 2 months not associated with chills, intermittent,evening rise of temperature present , associated with generalised body pains ,headache and cold

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

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

On examination:

Bp:120/80 mm hg

PR:78 bpm

RR:18 cpm

Cvs:s1 s2 + ,no murmurs

Rs: BAE+ ,no added sounds

P/A:soft; non tender

CNS: NFND

[22/05/23, 10:08:45 AM] ~ Dr.Sai Pavan👨‍⚕️: 6.op no :20210406079

A 45 year old male driver by occupation ( goes to work at 8 am ,lunch at 1 pm at work and reaches home by 7 pm and continues his works at home ,dinner at 9 pm and goes to bed by 10 pm)

Came with c/o right chest pain since 4 days,diffuse ,non radiating ,intermittent,no local tenderness,not associated with sweating, palpitations,sob,syncopal attacks

Pain increased on exertion and relieved on taking rest

K/c/o diabetes since 1 year and on tab.metformin 500 mg OD

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

On examination:

Bp:100/80 mm hg

PR:86 bpm

RR:18 cpm

Cvs:s1 s2 + ,no murmurs

Rs: BAE+ ,no added sounds

P/A:soft; non tender

CNS: NFND

[22/05/23, 10:14:06 AM] Rakesh Biswas Sir: Please don't waste our reading time by writing 'so much of useless negative history!!

Please tell us how her routine changed after she developed fever since two months from that before two months

[22/05/23, 10:14:59 AM] Rakesh Biswas Sir: Advise admission

What about his routine change since last 4 days?

[22/05/23, 10:28:46 AM] ~ vamsi Krishna: SL NO 4

OP NO: 20210219288

67M

C/o cough since 15 days

On and off cough since 1 year

Change in quality of cough dry to wet cough

Mucoid sputum mainly during night time

H/o similar complaints 1 year ago relieved on medication

C/o inguinal hernia ( noticed since 1mnth)

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

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Diagnosis- chronic cough with acute exacerbation with ? Right inguinal hernia

Patient is advised for admission he will come back after 1 week

[22/05/23, 10:34:21 AM] Rakesh Biswas Sir: Change of routine from one year back and after development of the cough?

[22/05/23, 10:36:09 AM] Rakesh Biswas Sir: Hope you are logging all the inputs including mine here?👇

https://manogynab87.blogspot.com/2023/05/collation-of-opd-data-for-pla-book-draft.html?m=1

Currently it appears to be falling on deaf ears or am I being biased?

[22/05/23, 10:50:52 AM] ~ Prathyusha Singam: 12

Op. No 20230535315

A 46year old male came with c/o bloating sensation since 6months, aggravated since 3 days and on intake of spicy food.

C/o low backache since 3days, aggravated on bending down.

C/o hard stools. Staining of stools +, passing stools regularly.

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

O/E: spinal tenderness+, SLRT - negative

Vitals:

Pt is c/c/c

BP: 130/90 mm Hg

PR: 86bpm

RR: 20cpm

Temp: 98.4 F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Provisional Diagnosis: Acid peptic disease

Advised:

Intake of plenty of oral fluids

Completely avoid spicy and oily food

Explained about high fibre diet.

Patient is advised admission and is willing to come after 3days.

[22/05/23, 11:04:26 AM] Manogyna: Yes sir

[22/05/23, 11:05:08 AM] ~ Prathyusha Singam: 9

Op. No. 20230535188

A 40year old female came with c/o lower abdominal pain since 2-3months, intermittent, dragging type of pain, present during micturition associated with low grade fever.

C/o epigastric pain since 20days, intermittent, stabbing type of pain.

C/o SOB (grade -III MMRC), orthopnea, profuse sweating since 1month.

K/c/o DM -II since 6years.

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

Vitals:

Pt is c/c/c

BP: 110/80 mm Hg

PR: 86bpm

RR: 20cpm

Temp: 98.4 F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Provisional Diagnosis: ?UTI

Patient is getting admitted

[22/05/23, 11:27:24 AM] ~ Prathyusha Singam: 13

Op. No. 20210217724

A 34year old female who is a housewife came with c/o tingling sensation in upper and lower limbs since 3-4months mainlyin soles upto knees and palms upto elbows.

C/o pain in right upper and lower limb with tingling sensation of right side of mouth since yesterday.

CT brain was done yesterday, report showed no abnormality.

O/E of upper and lower limbs: (L3-S1, C5-C8)

Sensory examination - normal

Fine touch - normal

Hb -7.4(done in last month)

Dietary history includes low protein diet. (eats Egg,dal, non veg only once in a week)

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

Vitals:

Pt is c/c/c

BP: 110/80 mm Hg

PR: 76bpm

RR: 20cpm

Temp: 98 F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Provisional diagnosis: Right sided paraesthesia with right sided tingling ?likely stress related

Advice:

Iron rich diet

Well balanced diet

[22/05/23, 11:42:27 AM] ~ vamsi Krishna: SL NO 10

OP NO: 20230535214

60F

C/o low backache since 5 to days radiating to left lower limb

Neck pain since 1 week with head ache associated with giddiness / tingling sensation of upperlimbs bilateral

k/c/o HTN since 3 years ,

n/k/c/o thyroid,epilepsy,cad,cva

H/o trauma to head due to slip and fall

IC bleed left hemiplegia since 2years

H/o lumbar and cervical spondylosis 1 year back

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

P/A - soft,nt

CNS HMF intact

Pupils b/l nsrl

Cranial nerves intact

Motor system normal

Tone normal

Power ul. Ll

Rt 4/5 4/5

Lt 3/5 2/5

Reflexes

B T S K A Plantar

Rt. - - - - - flxn

Lt +3 +3 +3 +3 +2. Extsn

Advice

Physiotherapy of left upper and lower limb

Patient is advised for admission but not willing.

[22/05/23, 11:53:38 AM] ~ Prathyusha Singam: 18

Op. No. 20230535393

A 38year old male came with c/o tingling sensation in right arm lasting for 2-3mins. Increased on feeling tensed, 4-5times/day.

Precipitated by loud sounds, stress, associated with intermittent palpitations, sweating, giddiness.

No SOB

O/E:

No tachypnea

Restriction of right shoulder adduction, extension

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

Vitals:

Pt is c/c/c

BP: 100/60 mm Hg

PR: 80bpm

RR: 20cpm

Temp: 98.1F

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Advised : Psychiatry referral I/v/o anxiety

[22/05/23, 12:00:52 PM] ~ Dr.Sai Pavan👨‍⚕️: 21.op no :20210535840

A 45 year old female Came with c/o headache and neck pain since 2 months associated with right upper limb pain

B/l shoulder joint pain since 2 months

B/l knee pains since 2 months

No early morning stiffness

Left sided chest pain since 20 days not associated with sweating , palpitations,sob ,syncopal attacks.

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

On examination:

Bp:130/80 mm hg

PR:86 bpm

RR:18 cpm

Cvs:s1 s2 + ,no murmurs

Rs: BAE+ ,no added sounds

P/A:soft; non tender

CNS: NFND

Patient advised admission but not willing

[22/05/23, 12:14:01 PM] ~ Dr.Sai Pavan👨‍⚕️: 23.op no :20230535394

A 70 year old male Came with c/o b/l pedal edema since 10 days pitting type till knees,used medication but not relieved associated with decreased urine output

Constipation since 2 -3 months ,passed hard stools

k/c/o HTN since 2 years and on medication

On examination:

Bp:130/80 mm hg

PR:82 bpm

RR:16 cpm

Cvs:s1 s2 + ,no murmurs

Rs: BAE+ ,no added sounds

P/A:soft; non tender

CNS: NFND

Patient advised admission but not willing

[22/05/23, 12:25:40 PM] ~ vamsi Krishna: SL NO 23

OP NO: 20230535402

45 M

C/o pain abdomen in epigastric region (burning typee) since 2 years associated with heart burn

Abdominal bloating sensation after taking food

Indigestion (+)

Palpitations (+)

No h/o chest pain /sob / syncopial attack

K/c/o HTN. Since 2years

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

[22/05/23, 12:35:00 PM] ~ Dr.Sai Pavan👨‍⚕️: 32.op no :20230535881

A 50 year old female Came with c/o b/l pedal edema since 10 days pitting type till mid calf ,low back ache non radiating since 15 days associated with tingling sensation in b/l lower limbs

K/c/o HTN since 6 yrs and on medication ( unknown).

On examination:

Bp:140/80 mm hg

PR:80bpm

RR:16 cpm

Cvs:s1 s2 + ,no murmurs

Rs: BAE+ ,no added sounds

P/A:soft; non tender

CNS: NFND

Patient advised admission but not willing

[22/05/23, 2:36:10 PM] Rakesh Biswas Sir: What kind of history is

H/o lifting weights!!

H/o bending neck and walking

The history needs to flow in continuity and not in a fragmented manner as presented above!!

[22/05/23, 2:38:03 PM] ~ Prathyusha Singam: Ok sir.

[22/05/23, 2:38:49 PM] Rakesh Biswas Sir: What about the history of the two patients of diabetes we saw in the opd ?

One getting admitted with basal ganglia involvement

Another with Diabetes getting admitted due to some other reason who's relative was blind.

Why are we not sharing all the patients?

[22/05/23, 2:43:30 PM] ~ Prathyusha Singam: This is the patient who's relative was blind sir.

[22/05/23, 2:51:11 PM] Rakesh Biswas Sir: Alright. What about the Hemiballismus and hemichorea patient?

[22/05/23, 3:08:51 PM] ~ vamsi Krishna: SL NO 42

OP NO: 20230598994

35F

Headache since 6months

Pricking type headache,continuous type

Not relieved on medication neckpain (+)

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

O/E:

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Diagnosis - tension headache

Advised for admission but patient is not willing as she has to go for work

[22/05/23, 4:13:44 PM] Rakesh Biswas Sir: From 32 we jumped to 42!!

What about the others?

How many total patients seen and how many admitted?

[22/05/23, 5:16:21 PM] Lohith Pg Gm : 5 admissions from OP sir

[22/05/23, 8:17:23 PM] Rakesh Biswas Sir: And seen 42?

[22/05/23, 8:22:50 PM] Lohith Pg Gm : No sir, around 35 cases were seen

[22/05/23, 8:33:42 PM] Rakesh Biswas Sir: 👆

23rd May 2023,Tuesday

[23/05/23, 10:21:03 AM] ~ Basani Sravanthi: No.1

Op :20230536999

20 F came to opd with C/o difficulty in breathing from today morning,acute,lasted for 5 mins,a/w headache.

No h/o chest pain , palpitations.

No H/o fever,cough,cold ,nausea,vomiting.

Past history:

H/o similar complaints in the past 20 days bac, relieved on taking rest.

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

Personal history: patient is allergic to dust to cold weather

Family history:not significant

VITALS:

BP: 120/80mm hg

Pr : 78bpm

Rr: 16 cpm

No pallor,icterus,cyanosis,clubbing,lymphadenopathy,edema

Patient is/c/c

R.s:bae+,nvbs

Cns:nfnd

Cvs:s1s2heard,no murmers

P/a:soft,non tender

Patient is advised for admission but not willing for admission

[23/05/23, 10:22:51 AM] Rakesh Biswas Sir:Need your team help to prepare their case reports and PaJR groups asap after obtaining their signed informed consents

[23/05/23, 10:41:21 AM] ~ Nikithchandra: 2

Op. No. 20230406375

A 38year old female who is a housewife came with

c/o pedal edema since 1week,on and off,non pitting type, insidious in onset,non progressive,decresed on sitting and increased on walking

No history of burning micturition,no history of decreased Urine output,no h/o chest pain, difficult in breathing

Past h/o known case of tinea corporis and tinea cruris on medication since 45days

Known case of htnsince 10years on medication tab.SARTEL AM

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

Vitals:

Pt is c/c/c

pedal edema:upto ankle,non pitting type

No pallor,icterus,cyanosis,clubbing,lymphadenopathy

BP: 120/80 mm Hg

PR: 88bpm

RR: 20cpm

CVS: S1, S2 heard. No murmurs.

RS: BAE+, NVBS heard.

P/A : soft, NT, no organomegaly.

CNS:NFND

Patient is advised for admission but not willing

[23/05/23, 11:28:15 AM] ~ Basani Sravanthi: No.3

Op :20230537092

35 F came to opd with c/o dragging type of pain over B/l upper limbs and lower limbs since 2 yrs.

C/o headache on and off since 2 yrs , diffuse in nature ,not a/w nausea and vomitings

Palpitations (+)

H/o fasciculations in the both hands, nerve conduction studies done -normal in study.

Past history:

Diagnosed as Right sided fibroedenoma with galctorrhoea 4 yrs back. Fibroedenoma was resected 1 yr back.

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

VITALS:

BP: 110/80mm hg

Pr : 68bpm

Rr: 16 cpm

No pallor,icterus,cyanosis,clubbing,lymphadenopathy,edema

R.s:bae+,nvbs

Cns:nfnd

Cvs:s1s2heard,no murmers

P/a:soft,non tender

Local examination:

Lump + in right upper quadrant of breast, soft in consistency, no tenderness, no local rise of temperature ,with galctorrhoea.

Provisional diagnoses:

Generalized weakness /lethergy,

H/o fibroadenoma with galctorrhoea suspected prolactinoma used cabergoline.

Patient is advised for admission.

[23/05/23, 12:12:59 PM] Kshitij Sharma: Okay sir!

[23/05/23, 12:19:30 PM] Rakesh Biswas Sir: Only three since morning!!

[23/05/23, 12:50:10 PM] ~ Basani Sravanthi: No.4

Op :20230537713

28 F came to opd with c/o pain in the epigastric region on and off since 1 month, intertermittent in nature,pricking type.

C/o SOB on exertion since 1 month, insidious in onset, relieved after taking rest.

No H/o chest pain, palpitations , sweating,

No h/o burning micturition, decreased urine output.

No h/o fever,cold,cough

Past history:

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

VITALS:

BP: 90/70mm hg

Pr : 88bpm

Rr: 16 cpm

No pallor,icterus,cyanosis,clubbing, lymphadenopathy,edema

R.s:bae+,nvbs

Cns:nfnd

Cvs:s1s2heard,no murmers

P/a:soft, and

tenderness in the epigastric region.

Patient is advised for admission not willing for admission.

[23/05/23, 12:51:37 PM] Rakesh Biswas Sir: Here is a link : http://medicinedepartment.blogspot.com/2020/05/informed-patient-consent-and.html?m=1,

we regularly use for every patient/relative to download and provide their informed signature after proper reading of the form along with asking us questions and they finally share back the signed image to our residents who keep the document confidential and safe.

[23/05/23, 12:51:38 PM] Rakesh Biswas Sir: Download the BMJ consent form from here :

https://authors.bmj.com/policies/patient-consent-and-confidentiality/

[23/05/23, 12:51:39 PM] Rakesh Biswas Sir: https://userdrivenhealthcare.blogspot.com/2022/09/deidentifying-and-anonymizing-patient.html?m=1

[23/05/23, 12:54:30 PM] ~ Rachana Gangula: No.6

Op : 20230537794

22/F

C/o headache on and off since 2 yrs , diffuse in nature ,a/w nausea

Eye strain + Photophobia + Phonophobia +

Headache increased since 3 days

Not associated with blurring of vision or giddiness or vomitings.

H/O fall from bike 6 years ago in RTA. No trauma to head. No ENT bleed, Loss of consciousness.

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

VITALS:

BP: 100/70mm hg

Pr : 77bpm

Rr: 17 cpm

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema

R/S- bae+,nvbs

CNS -nfnd

CVS- s1s2heard,no murmers

P/A- soft,non tender

Patient is advised for admission but not willing for admission as patient came alone and attender is not present

[23/05/23, 2:20:26 PM] ~ Basani Sravanthi: No.7

Op :20230537785

14 F came to opd with c/o cough which is productive since 3 days. Sputum is scanty, mucoid,white in colour.

C/o cold since 3 days, sneezing +.

No h/o fever, burning micturition.

No H/o chest pain, palpitations , sweating,

Past history:

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

VITALS:

BP: 100/60mm hg

Pr : 106bpm

Rr: 16 cpm

No pallor,icterus,cyanosis,clubbing, lymphadenopathy,edema

R.s:bae+,nvbs

Cns:nfnd

Cvs:s1s2heard,no murmurs

P/a:soft, and non tender

Patient is advised for admission not willing for admission.

[23/05/23, 2:54:39 PM] ~ Basani Sravanthi: No.8

Op :20230538194

40 M came to opd with c/o vomiting (multiple episodes) since 3 days. 1 -2 times a/w bile.

C/o hiccups since 3 days.

C/o low grade fever.

No h/o pain abdomen,loose stools

F/o case of bile reflux gastritis with hiatus hernia with reflux gastropathy

Past history:

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

VITALS:

BP: 130/80mm hg

Pr : 78bpm

Rr: 16 cpm

No pallor,icterus,cyanosis,clubbing, lymphadenopathy,edema.

R.s:bae+,nvbs

Cns:nfnd

Cvs:s1s2heard,no murmurs

P/a: Appears dehydration.

No tenderness.

Patient is getting admitted.

[23/05/23, 3:03:58 PM] ~ Rachana Gangula: Sno 10

Op no 20230538919

42/M

C/o diarrhea since 1 week around 5 episodes/day

C/O vomitings since 1 week around 3-4 episodes/ day

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.

[23/05/23, 3:08:55 PM] ~ Rachana Gangula: Sno 11

Op no 20250537727

45/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

VITALS:

BP: 110/70mm hg

Pr : 77bpm

Rr: 17 cpm

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema

R/S- bae+,nvbs

CNS -nfnd

CVS- s1s2heard,no murmers

P/A- soft,non tender

Patient is advised for admission but not willing for admission.

[23/05/23, 3:31:08 PM] ~ Basani Sravanthi: No.12

Op :20230536665

47 F came to opd with c/o SOB since 2 month,increased since 2 -3 days. More on exposure to cold water and fine dust .

SOB lasting for 30 mins ( now inhaler frequency increased but no relief) a/w wheeze.

Past history:

H/o similar complaints 6 mns back used nebulizer /inhaler and relieved.

Last inhaler used 15 days back.

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

VITALS:

BP: 140/90mm hg

Pr : 90bpm

Rr: 16 cpm

pallor +

No icterus,cyanosis,clubbing, lymphadenopathy,edema.

R.s:bae+,nvbs, no wheeze

Cns:nfnd

Cvs:s1s2heard,no murmurs

P/a: soft and non tender.

Patient is advised for admission, but not willing for admission.

[23/05/23, 4:25:53 PM] Rakesh Biswas Sir: Only 12 patients seen in opd today ?

[23/05/23, 4:34:32 PM] ~ Rachana Gangula: Sno 13

Op no 20210204066

29/M

clo fever with body pains since 2 days

C/o throat pain on swallowing

fever with evening rise of temperature

high grade, intermittent

Associated with chills and rigor. Nausea present

no c/o sob, cold, cough, pain abdomen.

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

VITALS:

BP: 120/70mm hg

Pr : 76bpm

Rr: 17 cpm

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema

R/S- bae+,nvbs

CNS -nfnd

CVS- s1s2heard,no murmers

P/A- soft,non tender

local examination - no congestion of throat.

Patient is advised for admission but not willing for admission.

[23/05/23, 5:17:57 PM] Lohith Pg Gm : 1 admission from OP sir

[23/05/23, 7:03:46 PM] Rakesh Biswas Sir: Thanks! How many cases seen in opd today?

24th May 2023,Wednesday

[24/05/23, 11:00:15 AM] ~ Navya: Op no. 20210118247

60/F

C/O chest pain since 10 days

(Right side and restrosternal)

No radiation of pain, no chest tightness, no sob, palpitations, giddiness.

H/O cough since 1 year(on herbal medication)

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

Vitals:

Bp:120/80mmhg

Pr:96bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:NVBS heard, decreased breath sounds in Right ISA, IAA

Patient is advised for admission but not willing for admission

[24/05/23, 11:06:10 AM] ~ Navya: 2.

Op no. 20230538522

40/M

C/O chest pain since 20 days, left sided, radiating to lt upper limb, palpitations present, pain more after eating food.

N/H/O sob, pedal edema, giddiness

H/O 2 episodes of tremors and weakness on working in sunlight.

N/H/O vomitings/loose stools

H/O 2 episodes of high BP(200/120) and used medication

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

Vitals:

Bp:108/78mmhg

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

[24/05/23, 11:06:22 AM] ~ A.R.T.TEJASRI: op no :2023053852

75/M

c/o fever since 10 days, high grade associated with chills and rigors , no diurnal variation, relieved with medication

Cough since 1 week , productive, more during day time

N/H/O SOB,Vomiting,chestpain, loosesttols, pain abdomen

not a clinical daze of DM ,HYN, THyroid, CAD, Seizures

O/E c/c/c

afebrile

PR 96 bpm

BP-100/60

CVS- S1,S2+

RS - BAE + , NVBS ,decreased breath sounds at IAA , ISA

h/o similar complaints 4 months ago relieved after medication

[24/05/23, 11:06:55 AM] ~ A.R.T.TEJASRI: patient is advised for admission not willing

[24/05/23, 11:11:22 AM] ~ A.R.T.TEJASRI: op no :20230539499

c/o pain in abdomen since 2 days

pain in lower abdomen(rif,lif,hyponchondrium), spasmodic ,intermittent, colic type increased intensity and frequency since 2days

h/o gall stones 6mm without cystitis 6 months back

denovohypertension with dyspepsia

advised T.buscopan po/bd for 3 days

[24/05/23, 11:16:59 AM] ~ Navya: 5.

Op no. 20230538950

30/F

C/O unintentional weight loss since 6 months

(>8 kg weight loss)

C/O constipation since 10 months(on homeopathic medication)

H/O surgery for hemorrhoids 8 months ago

H/O excessive hair fall

N/H/O Fever, cough, sob

N/H/O blood loss in stools, abdominal pain,

Normal apetite

H/O oral ulcers

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

Vitals:

Bp:90/60mmhg

Pr:88bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Patient has advised tab. Orofer xt po/of for 15 days.

[24/05/23, 11:29:00 AM] ~ Navya: 6.

Op no. 20230538933

37/M

C/O both lower limb swelling since one month

C/O burning sensation in chest since one month

H/O atrophic pancreas with pancreatic duct calculi since 2021 and on pancreatin 300 mg and esmaprazole 20 mg

But stopped medication one month back since then pedal edema and burning sensation in chest increased

K/c/O DM since 10 years and on inj. Mixtard

H/O erectile dysfunction since 2 months

H/O bulky stools present

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

Vitals:

Bp:100/60mmhg

Pr:78bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Provisional diagnosis:? GERD with chronic pancreatitis

Patient is advised for admission but not willing for admission

[24/05/23, 11:36:27 AM] ~ Navya: 7.

Op no. 20230538966

75/M

C/O fever since 4 days, high grade, associated with chills and rigors , relieved with medication

Throat pain during swallowing present

N/h/O cough. Cold

Sob 1 week back relieved after treatment at RMP

K/C/O HTN since 6 years and on medication and DM-2 since 6 years and on glimiM1 po/od

Vitals:

Bp:110/80mmhg

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

[24/05/23, 11:44:48 AM] ~ Navya: 8.

Op no. 20230539475

73/M

K/C/O epilepsy on tab. Levipil, last episode in 2020

K/C/O HTN since 30 years on tab. Telma AM

No h/O FND

Last MRI brain 2020:-b/l microhemorrhages in thalamus and ganglia

C/O one episode of vasovagal syncope while urinating at night.

One episode of sweating, giddiness, without lossof consciousness, without fnd, no seizures, lasting for 10 min

O/E

Gait:- normal

Tone:-b/l upper limb and lower limb-normal

Power:-5/5 in all limbs

Reflexes :-2+

Vitals:

Bp:130/80mmhg

Pr:78bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

R.s:BAE,NVBS heard

Patient is advised for admission but not willing for admission

[24/05/23, 12:02:38 PM] ~ A.R.T.TEJASRI: 9.

OP no.20230538960

45/M

c/o giddiness since2 weeks,intermittently occurring,aggravating on getting up from sitting position or changing head position

c/o blurring of vision from 5years,which has increased following giddiness

c/o b/l pedal edema from 1year,pitting type,occurring intermittently

c/o occasional sob,grade2 from 1year

no h/o vomitings with giddiness,no h/o reduction in urine volume

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

Vitals:

Bp:120/80mmhg

Pr:68bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:NVBS heard, BAE present

provisional diagnosis:-?BPPV

Patient is advised for admission but not willing for admission

[24/05/23, 12:17:14 PM] ~ A.R.T.TEJASRI: 10.

OP no.20230538962

40/F

c/o chest pain since 6 years,on and off,right and left side,no radiation of pain, pain more after eating food,burning sensation in the chest present.

h/o execessive weight(97kgs) gain,occasional sob on exertion.no orthopnea,wheeze

h/o hairloss present

n/h/o pedal edema,palpations

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

Vitals:

Bp:130/80mmhg

Pr:88bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:NVBS heard,bae present

6 min walk test:-

after 4min of walking,she's complaining of sob

pr:-

before 6 min walk -100bpm

after 6 min walk-122bpm

Patient is advised for admission but not willing for admission

[24/05/23, 12:19:17 PM] ~ Navya: 11.

Op no. 20230536663

55/M

f/c/o TB peritonitis (low SAAG,high protein)on ATT with cld

came for regular checkup.

c/o epigastric pain after eating food

occasional pedal edema present,more in the evening, relieved by morning

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

Vitals:

Bp:120/80mmhg

Pr:86bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:NVBS heard, bae present

Patient has advised TAB.akurti -3 po/od and tab.benadon 40mg po/od

[24/05/23, 12:23:18 PM] ~ Navya: 12.

Op no. 20230538935

21/M

C/O fever since 3 days

C/O redness of both eyes since 5 days

C/O cold and sore throat since 3 days

C/O 1 episode of vomiting yesterday

Fever-high grade, intermittent, a/w headache, cold, cough, body pains

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

Vitals:

Bp:110/60mmhg

Pr:110bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Provisional diagnosis:-

?viral pyrexia

?URTI

?allergic conjunctivitis

Patient is advised for admission but not willing for admission

[24/05/23, 12:32:30 PM] ~ Navya: 13.

57/M

B/Lower limb swelling from knee-ankle (pitting type) more on walking, present occasionally at rest.

No sob, chest pain.

Non smoker

O/E:-

B/l calf tenderness present

No restriction of joint movements

No local rise of temp

Peripheral pulses felt

No discoloration

ABI :-100/140=0.7

Provisional diagnosis:-? PAD claudication pain

Patient is advised for admission but not willing for admission

[24/05/23, 2:15:40 PM] ~ Navya: 14.

50/F

C/O both lower limb swelling since20 days

H/O right lowerlimb filariasis since 25 years

C/O decreased urine output

Since 20 days

H/O burning micturition on and off

N/K/C/O HTN, DM, Asthma, TB, epilepsy

She was told to have kidney disease 1 year back

O/E:-

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard

Advised tab. Lasix40mg po/bd

Patient is advised for admission ,she will come on next Wednesday for admission

[24/05/23, 2:26:42 PM] ART: op no :20230538951

A 43F

Taylor

c/o giddiness since 2-3months

fever since 10 days

b/l lower limb swelling since 3 days

Giddiness occurs for 5-10seconds aggravates on standing resolves by itself

fever is low grade intermittent

b/l lowerlimb swelling 3 days back till above ankles decreased gradually h/o decreased urine output

burning micturition

o/e pt is c/c/c

cvs - s1s2+

rs bae+, nvbs

perabdomen soft, non tender

cns tinnitus +

nystagmus negative

tone normal in all four limbs

pper u/l 4/5 4/5

l/l 4/5 4/5

reflexes B(2+,2+), T(2+,2+),S(2+,2+),K (2+,2+),A(+,+), p ( f,f)

gait normal

tandem walk normal

advised for admission not not willing for admission as she has kids at home

[24/05/23, 2:51:00 PM] ART: op no :20230540066

complaints of headache since 2 years

b/l frontal pain

c/o neckpains radiating to shoulder joint associated with photophobia, lhonophobia, no aura no giddiness

o/e ccc

afebrile

bp-120/80

pr- 84/mon

CVS-s1,s2+

no murmurs

Rs bae+, nvbs

LE: sinuses normal

[24/05/23, 2:52:16 PM] ART: 27 F advised admission not willing to admit

[24/05/23, 2:58:48 PM] Rakesh Biswas Sir: What was her daily routine two years back and how was that disrupted?

[24/05/23, 3:16:55 PM] ART: op no:20230540088

10 M

c/o burning sensation in the bilateral palms and execessive sweating in bilateral palms and soles since 2 years

walking on wool like sensation present

distal paresthesia with isolated hyperhidrosis secondary to ?vitamin b12 deficiency?

rombergs negative

decreased finetouch and decreased proprioception in dip,mtp

motor

power 5/5 in all four limbs

tone normal in all four limbs

reflexes

btska(2+,2+,3+,3+,2+,2+,3+,3+,2+2+, plantar flexor

advised admission , will come tomorrow for admission.

[24/05/23, 3:26:43 PM] ART: op no 20230540093

45/F

c/o tingling and numbness, all over the body more in palms

tingling sensation is more during exertion.

no h/o weakness, giddiness,difficulty in walking, no h/s/o loss of sensation.

not a clinical case of, DM, HTN, TB , asthma , epilepsy

o/e

c/c/c

afebrilePR-88

BP-130/80mmhg

CVS- S1,S2+, No murmurs

RS- BA E +,NVBS

pA- soft no tender

[24/05/23, 3:30:12 PM] Rakesh Biswas Sir: Since when?

What was her daily routine before that and how was that disrupted since her symptoms began?

[24/05/23, 4:06:41 PM] ART: 28F

OPNO: 2023440089

complaints of generalised weakness since 1 week

low grade fever with lesions( resolved ) in angle of mouth, bitterness in mouth

similar complaints since 1 month

right ear infection on treatment since 20 days fungal spores( resolving)

also being treated for bilateral pterygium inflamed in both eyes( resolved)

o/e

mild pallor +

oral cavity: right tonsillar hypertrophy, no congestion, no lymphadenopathy

[24/05/23, 4:07:28 PM] Rakesh Biswas Sir: Fungal spores?

How were they isolated?

[24/05/23, 4:18:32 PM] ART: otomycosis sir .. it can be seen in ear canal ..

[24/05/23, 4:24:11 PM] Rakesh Biswas Sir: Yes but that's a clinical assumption not a organismal diagnosis? Any clinical image of that for this patient?

25th May 2023,Thursday

[25/05/23, 9:33:11 AM] ~ Pranati: Serial no.1

op no 20210524998

41/M

c/o left sided chest pain since today morning radiating to left shoulder and left side of neck.

no h/o SOB,palpitations, giddiness, PND,orthopnea, fever.

C/O generalised weakness since today morning.

No nausea or vomiting

Not a clinical case of, DM, HTN, TB , asthma , epilepsy,CVA,CAD,thyroid disorders

o/e

c/c/c

afebrilePR-88

BP-130/80mmhg

CVS- S1,S2+, No murmurs

RS- BAE +,NVBS

pA- soft no tender

[25/05/23, 9:36:08 AM] ~ Pranati: Patient was adviced for admission but patient not willing to admit.

[25/05/23, 9:46:12 AM] Rakesh Biswas Sir: Clinically what does the chest pain look like?

Get an ECG

Share the clinical images of his visceral fat and biceps and chest with a pointer around the pain area

[25/05/23, 9:50:18 AM] Rakesh Biswas Sir: OK mention in the opd ticket that while there are no current gross changes of myocardial infarction the patient needs admission for a chance that it may evolve further

[25/05/23, 9:50:47 AM] Rakesh Biswas Sir: Thanks

Always take this image in standing

[25/05/23, 9:51:51 AM] ~ Pranati: Okay sir

[25/05/23, 9:53:03 AM] Rakesh Biswas Sir: Lateral view

[25/05/23, 10:12:37 AM] ~ Pranati: Serial no 2

Op no 20230540007

C/O facial puffiness

no c/o decreased urine output.

Tailor by occupation

Pedal edema after walking

C/o headache - frontal region only increased on working

no c/o chestpain , sob, palpitations,

Orthopnea , PND.

no c/o fever,pain abdomen, burning micturition.

not a clinical case of, DM, HTN, TB , asthma , epilepsy,CBA,CAD,thyroid disorders

Hysterectomy done 15 years back.

o/e

c/c/c

afebrilePR-88

BP-130/80mmhg

CVS- S1,S2+, No murmurs

RS- BA E +,NVBS

pA- soft no tender

Patient was adviced for admission but patient not willing to admit.

[25/05/23, 10:15:50 AM] Rakesh Biswas Sir: Today the sharings have improved?

[25/05/23, 10:15:53 AM] ~ Rishitha: Serial no.3

op no 20230540366

45/M

C/o decreased appetite since 2-3 days

C/o pain abdomen since 1 month pricking type in lumbar region

Vomitings since 6 days

3-4 episodes

non-projectile, non bilious, with food particles as contents non blood stained.

productive couch since 2 days

whitish mucoid sputum.

No c/o fever

C/o pedal edema pitting type extending upto knee exaggerated by walking relieved on lying down

Not a known case of DM, HTN, TB,asthma , epilepsy,CVA,CAD,thyroid disorders

o/e

c/c/c

afebrile

PR-82bpm

BP-120/80mmhg

CVS- S1,S2+, No murmurs

RS- BAE +,NVBS

pA- soft, tenderness in right iliac region,obese

Patient was advised admission,will come on Saturday for admission

[25/05/23, 10:22:53 AM] ~ Rishitha: Serial no.4

op no 20210210383

59/M

C/o burning micturition since 1 and half month

No c/o decrease in urine output

Non foul smelling,no hematuria

Occasionally c/o frothy urine

Nocturia present

No c/o fever,loose stools,vomitings

K/c/o HTN since 2 yrs(on tab.amlodipine 5mg)

Not a known case of DM,TB,asthma , epilepsy,CVA,CAD,thyroid disorders

o/e

c/c/c

afebrile

PR-76bpm

BP-130/80mmhg

CVS- S1,S2+, No murmurs

RS- BAE +,NVBS

pA- soft,non tender

B/L pedal edema pitting type till mid calf

Patient was advised admission,and getting admitted

[25/05/23, 10:36:07 AM] ~ Rishitha: Serial no.5

op no 20210118247

60/F

C/o chest pain(retrosternal) since 10 days

Non radiating intermittent no local tenderness

Not associated with sob,palpitations,syncopal attacks,sweating

Pain not increased or decreased on exertion

Not a known case of HTN,DM,TB,asthma , epilepsy,CVA,CAD,thyroid disorders

No H/O blood loss

o/e

c/c/c

afebrile

PR-80bpm

BP-110/60mmhg

CVS- S1,S2+, No murmurs

RS- BAE +,NVBS

pA- soft,non tender

B/L pedal edema pitting type till mid calf

Patient was advised admission,but not willing to get admitted

[25/05/23, 10:54:28 AM] ~ Rishitha: Serial no.6

op no 20230540867

45/M

C/o tingling sensation in both the palms since 1 year

aggravated on riding bike or on pressure

Relieved after taking rest

B/L knee pain since 2 months intermittent

Not increased or decreased on doing work

Not a known case of HTN,DM,TB,asthma , epilepsy,CVA,CAD,thyroid disorders

o/e

c/c/c

afebrile

PR-88bpm

BP-120/80mmhg

CVS- S1,S2+, No murmurs

RS- BAE +,NVBS

pA- soft,non tender

CNS

Sensory examination -fine touch present

Vibration normal 10secs on both mcp

Proprioception present

Crude touch present

Pain present

Temperature normal

Patient was advised admission to evaluate paresthesias,but not willing to get admitted

[25/05/23, 11:07:37 AM] Rakesh Biswas Sir: Clinical images of visceral fat and biceps lateral view?

[25/05/23, 11:11:27 AM] ~ Pranati: Serial no.7

Op no 20210502855

C/O heaviness of chest since 10-15 days with cough(dry) occasionally with sputum blood tinged

Chest heaviness a/w sweating, SOB

Numbness of right leg since one week a/w tingling sensation.

SOB aggravated on exertion and relieved after taking rest

no h/o fever, loss of appetite

Smoker- daily 2-3 chuttas per day since 40 years

Toddy drinker

not a clinical case of, DM, HTN, TB , asthma , epilepsy,CVA,CAD,thyroid disoreders

Patient was adviced for admission for cardiac evaluation but patient not willing to admit.

[25/05/23, 11:36:27 AM] ~ Pranati: Serial no.8

Op no 20230540874

C/O fever since one week low grade, continuous, relieved by medication not a/w chills and rigors.

C/O right loin pain since 10 days.

C/O burning micturition

Normal urine output

Nausea+ ,vomitings+

C/O decreased appetite

No c/o pain abdomen, SOB

not a clinical case of, DM, HTN, TB , asthma , epilepsy,CVA,CAD,thyroid disorders

Patient was adviced for admission for further evaluation of fever but patient not willing to admit.

[25/05/23, 11:45:09 AM] ~ Rishitha: Serial no.9

op no 20230540876

45/M

C/o bilateral pedal edema pitting thpe till knees since 1 month

Facial puffiness 1 month back

Foul smelling urine

H/o fever with chills 1 month back for 3 days relieved after taking medication

No c/o decreased urine output,hematuria

H/o left CVA 3 years back

Not a known case of HTN,DM,TB,asthma , epilepsy,CVA,CAD,thyroid disorders

O/E

No raised jvp

CNS-

HMF intact

Pupils-B/L NSRL

TONE: RT. LT

UL NORMAL. DECREASED

LL NORMAL DECREASED

POWER:

UL 5/5. 3/5

LL 5/5. 3/5

REFLEXES:

B: 2+ -

T: 2+ -

S: 2+ -

K: 2+ -

A: 2+ -

P: Flexion. Extension

Patient was advised admission to evaluate ?AKI but not willing to get admitted

[25/05/23, 12:01:54 PM] ~ Pranati: Serial no.10

Op no 20230541396

C/O low backache since one week , non radiating.

C/O left loin pain non radiating since 5 days.

Constipation since 1 week

Pain abdomen (diffuse) squeezing type 1 week back, now relieved.

No fever, cough , SOB, vomitings

Known case of DM, HTN since 10 years and on medication not known

H/O CVA (left hemiparesis) 10 months back. (?Hypertensive bleed)

Patient was adviced for admission for further evaluation but patient not willing to admit.

[25/05/23, 12:02:58 PM] ~ Rishitha: Serial no.11

op no 20230535904

45/F

C/o headache with neckpain since 1 month

Associated with blurring of vision

Not a/w phonophobia,tinnitus,diplopia,lacrimation

Headache not increased/decreased with change in position

Headache relieved after taking medication and not relieved after taking rest

Not a known case of HTN,DM,TB,asthma , epilepsy,CVA,CAD,thyroid disorders

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

[25/05/23, 12:19:14 PM] ~ Rishitha: Serial no.12

op no 20230541388

47/M

C/o headache in parietal region since 10-15 days sometimes radiating to occipital region

Associated with giddiness,diplopia and blurring of vision

Associated with neck pain

Headache lasting for 20 mins relieved on itself.no medications used

No tingling sensation,numbness

K/c/o DM2 on medication since 1 yr(T.Metformin 500mg PO OD)

Not a known case of HTN,TB,asthma , epilepsy,CVA,CAD,thyroid disorders

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

[25/05/23, 12:35:35 PM] ~ Pranati: Serial no.13

28/F

Op no 20230541425

C/O cough since 3-4 months with sputum (whitish colour, non foul smelling and not a/w blood)

26th May 2023,Friday

[26/05/23, 9:59:46 AM] ~ Tharunkumar: 1.Op no:20210420287

75/M

C/o cough since 2-3 months associated with sputum, whitish,non blood stained,no diurnal variation associated with SOB Grade 2-3 ,no orthopnea, no PND ,no pedal edema

No H/o fever

C/o decreased urine output, burning micturition

K/c/o HTN since 2

10 yrs and on regular medication Telma kind-H

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

Daily routine -

Wakes at 6am eats breakfast and goes for farming and lunch at 1pm(rice and curry) and takes rest in the afternoon and dinner at 8pm(Roti) and sleeps at 9pm.

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

Wheeze present in right IMA,ISA and left IMA,ISA

P/A- soft non tender

CNS-NFND

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

[26/05/23, 10:01:38 AM] Rakesh Biswas Sir: Share his clinical images with visceral fat and muscle mass

[26/05/23, 10:08:27 AM] Deepthi Ma’am : 2.Op no:20210223311

52 M

C/o fever since3-4days associated with chills and rigors

C/o cough which is non productive c/o heartburn occasionally

No c/o sob ,orthopnea,pnd

No c/o vomiting,diarrhea

C/o of decreased urine output

C/o burning micturition since 15days

H/0renal calculi

N/k/c/o DM,HTN

Daily routine :wakes up at 7:00am, ,takes breakfast at 8:00am ,lunch at12pm

Goes to work comes back at 5:00pm,takes dinner chapati and curry at9:000pm sleeps at 10pm

No change in daily routine

O/E :

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willinng

[26/05/23, 10:23:10 AM] ~ Tharunkumar: Op no:20230542255

43/F

C/o distension of abdomen since 20 days, insidious onset gradually progressive.

C/o swelling over the B/L DIP,PIP and wrist joint not associated with pain.

No H/o fever,cough,cold,pain abdomen

No c/o decreased urine output, burning micturition

K/c/o hypothyroidism since 5 years on T. Thyronorm 25mcg

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

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft tenderness present over left iliac region

Shifting dullness absent

CNS-NFND

Patient was advised admission but not willing for admission as she has kids at home

[26/05/23, 10:36:41 AM] ~ Tharunkumar: Op no:20210217754

45/F

C/o chest pain since 2 days, radiating to left arm, aggravating on inspiration and while doing work

C/o low grade fever associated with dry cough

No c/o SOB,Orthopnea,PND

No c/o burning micturition,no pedal edema

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

Tenderness present over the left 2nd and 3rd costocondral junction

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-NFND

Diagnosis - ? Costochondritis

Advised Tab.Ultracet 1/2 QID for 3 days

Patient was advised admission but not willing

[26/05/23, 10:40:16 AM] Rakesh Biswas Sir: For every opd patient shared here :

Please share their

Sequence of events beginning with the time they had absolutely no problems they can recall.

AsK what was their routine when they were perfectly alright

Next ask what happened to their routine once the disease took hold on their lives

Specifically ask which part of their hourly routine was disrupted

Ask them their current requirements from us like if we had to give them a single medicine which problem would they prefer it to address

Take their examination findings with images of visceral fat and muscle mass for everyone among other more specific findings

Prepare their problem list and perceived requirements list in order of priority

Formulate a plan for each one of the problem requirements you have listed

[26/05/23, 10:42:06 AM] Rakesh Biswas Sir: Who will take over from you the job of preparing this 👇

https://manogynab87.blogspot.com/2023/05/collation-of-opd-data-for-pla-book-draft.html?m=1

from next month?

[26/05/23, 10:42:50 AM] Manogyna: I can still do it myself sir

[26/05/23, 10:43:05 AM] Manogyna: Even from next month

[26/05/23, 10:43:48 AM] Rakesh Biswas Sir: Provide serial numbers

Please find someone who can assess each post here for the data missing as per the guidelines shared here in the description box

[26/05/23, 10:44:10 AM] Rakesh Biswas Sir: Give others a chance 🙂

[26/05/23, 10:45:12 AM] Manogyna: Okay sir😅,so should I do it till this Sunday? I will be finished Week-5 of data

[26/05/23, 10:45:40 AM] Manogyna: Finishing *

[26/05/23, 10:45:44 AM] Rakesh Biswas Sir: 👆Can you find someone to do this?

This is the actual process of opd audit that I am currently doing single handedly now

[26/05/23, 10:46:23 AM] Manogyna: Okay sir

[26/05/23, 10:48:40 AM] Rakesh Biswas Sir: PLA R : OPD workflow audit

Audit Platform : https://chat.whatsapp.com/EDHF6pD8BM56f371ypSrqs

Retrospective data :

https://manogynab87.blogspot.com/2023/05/collation-of-opd-data-for-pla-book-draft.html?m=1

Prospective check list and conversation transcripts for transactional knowledge👇

[5/26, 10:40 AM] Rakesh Biswas: For every opd patient shared here :

Please share their

Sequence of events beginning with the time they had absolutely no problems they can recall.

AsK what was their routine when they were perfectly alright

Next ask what happened to their routine once the disease took hold on their lives

Specifically ask which part of their hourly routine was disrupted

Ask them their current requirements from us like if we had to give them a single medicine which problem would they prefer it to address

Take their examination findings with images of visceral fat and muscle mass for everyone among other more specific findings

Prepare their problem list and perceived requirements list in order of priority

Formulate a plan for each one of the problem requirements you have listed

[5/26, 10:43 AM] Rakesh Biswas: Provide serial numbers

@918317669334 Please find someone who can assess each post here for the data missing as per the guidelines shared here in the description box

[5/26, 10:45 AM] Manogyna 2018 Kims Ug: Okay sir😅,so should I do it till this Sunday? I will be finished Week-5 of data

[26/05/23, 10:49:38 AM] Rakesh Biswas Sir: Do it till you can find and train someone else to do it well

See one, do one, teach one

[26/05/23, 10:50:39 AM] Manogyna: Okay sir

[26/05/23, 11:06:00 AM] ~ Tharunkumar: 5.Op no:20230542633

35/M

C/o facial puffiness since 20 days with intermittent pedal edema on and off relieved on its own

C/o SOB grade 2 since 6 months

No Orthopnea,PND

No c/o decreased urine output,burning micturition

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

Addictions-Alcoholic since 15 yrs occasionally and regular since 2 years.

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

No shifting dullness

CNS-NFND

Daily routine- wakes up at 5am does farming and eats breakfast,each lunch at 1pm(rice and curry) and does household work and eats dinner at 8pm and sleeps at 9:30pm.

No change in daily routine after his complaints

Patient was advised admission but not willing and he wants to after 2 days

[26/05/23, 11:07:54 AM] Deepthi Ma’am : 6.Op no2023042444

Sequence of events

Difficulty swallowing since 1year ,

On december2022 she went to hospital ,o/E ear ,nose ,throat was normal.s

Daily routine :wakes up at 6:oo am

Has breakfast at8:00am,has lunch at 12:00pm rice and curry ,watches tv goes to sleep at 9:oopm

No change in daily routine

32year female who is a home maker by occupation came with c/o complaints since 1year

C/o sore throat on and aoff

C/o giddiness 2episodes since 1year

No tinnitus

No nystagmus

H/o weight gain

N/k/c/o of DM,HTN,Tb,epilepsy ,asthma,thyroid

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[26/05/23, 11:11:22 AM] Deepthi Ma’am : 7Op no20230542587

50 M who is a farmer by occupation came with complaints of retrosternal burning sensation since 1year

C/o regurgiattion of food since 1year which aggravates on eating spicy food

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

Daily routine:wakes up at 4:ooam has breakfast at 8:ooam ,goes to work , has lunch at12:oo pm(rice and curry ) watches tv, has dinner at 9:00pm

No change in daily routine affter his complaints

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Diagnosis:GERD? ?apd

Patient is advised for admission but not willing.

[26/05/23, 11:17:46 AM] Rakesh Biswas Sir: @918885066656 @918309113758 Can we explore this hypothesis that : those who may not have had any significant changes in their daily routine due to the disease are the least likely to be admitted?

[26/05/23, 11:20:40 AM] Manogyna: Yes sir

[26/05/23, 11:23:17 AM] Manogyna: Like how it might be aligning with the assumption that the disease might not be considered severe enough by patients if their Quality of life is not affected by it!?

[26/05/23, 11:28:43 AM] ~ Rithika: 8. Op no 20230542606

26M

C/o decreased appetite since 1month with significant weight loss

No h/o low grade fever , cough ,cold

No h/o constipation, diarrhoea

Increased sleepiness present

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

Daily routine

3am wake up

Goes for fishing

7 freshen up

9-10 has his breakfast

10-1 takes rest

1-2 lunch

2-7 does electrician works

7-8 food

8-11 uses mobile and takes rest

11 sleep

No change in daily routine

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft, tenderness over umbilical region

Patient is advised for admission but not willing.

[26/05/23, 11:38:27 AM] Kshitij Sharma: Also pt. Those who have accustomed themselves to the changes don't want to get admitted

[26/05/23, 11:41:20 AM] ~ Rithika: 9.op no.20230542255

43 F

C/o distension of abdomens since 20 days, insidious in onset and gradually progressive

C/o swelling over bilateral dip,pip and wrist joint , no pain

No history of cough, cold, fever ,burning micturition

K/c/o hypothyroidism since 5 yrs on tab.thyronorm 25 mcg

N/k/c/o htn,dm, cad ,cva

Daily routine

5am wake up

5-6 prayers

At 7 freshens up

9 has her breakfast

9:30 goes for supervisor work

At 1 she has her lunch

Returns to home at 5pm

5-6 takes rest

6-8:30 House works

8:30 lunch

9 goes to sleep

No change in daily routine

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft, tenderness over left iliac region

Patient is advised for admission but not willing.

[26/05/23, 12:01:47 PM] ~ Rithika: 10.op no.20230542646

66M

Complaints of pain over the scrotum which is dragging type radiating downwards since 2 months

Complaints of cough since 2 months ,dry cough

C/o sob grade 3 since 2 months, orthopnea - pnd-

Complaints of generalised itching since 5 days

(After consuming fish)

No history of cough, cold, fever ,burning micturition , decreased urine output

History of usage of ATT 6 months back

N/k/c/o htn,dm, 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.

[26/05/23, 12:05:03 PM] Deepthi Ma’am : 11.Op no20210124203

sequence of events

On 2020 ,patient had complaints of polyuria ,went to hospital

she was diagnosed to have diabetis

2022 ,she was diagnosed to have hypertension

40F

Who is a homemaker by occupation came with c/o

Fever since 1week which is high grade ,intermittent ,aasociated with chills, and rigors bodyache,relieved by taking medication

C/o cough which is dry ,on and off since 1week

K/c/o HTN since 1year and on regular medication (TAB TELMA)

K/c/o DM since 3years and on medication

Daily routine:wakes up at 7am takes raagi jaava, does household work

And has lunch at1pm riceand curry

And then watches tv has dinner at 9pm

Appetite decreased

Sleep is disturbed

O/e:

cvs-s1s2 heard

RS-BAE +

NVBS heard

p/A -soft ,non tender

Patient advised admission but not willing

[26/05/23, 12:20:15 PM] Deepthi Ma’am : 12Op no20230543225

34/M

who is a old male who works in private transport office came with

C/o

Left side headache since 10days

Headache -unilateral left sided in left fronto parietal region associated woth left retro orbital pain

N/k/c/o DM ,HTN ,tb epilepsy, asthma,cva,cad,thyroid disorders

Daily routine: wakes up at 6:am

Has chai biscuit goes to work ,has lunch at 1pm ,comes back from work at 6pm then has dinner (chapati and cury )at 9 goes to sleep at 10pm

No change in daily routine,even after his complaints

Pr c/c/c

Cvs:S1s2heard

RS:BAE + NVBs

P/Asoft nontender

Cns:NFND

Patient advised admission but not willing

[26/05/23, 12:25:11 PM] ~ Rithika: 12 . Op no 20230542615

35M

Sequence of events found to have Hypertension since 1 year on regular checkup and on irregular medication

C/o sob grade 2 since 1 year

Orthopnea- , pnd -

No chest pain, palpitations

Complaints of burning micturition since one year on and off

History of renal calculi 6months back -2 mm

Known case of hypertension since 1 year and on irregular medication

Daily routine

6 wake up

8 break fast

8:30 work system

1pm lunch rice curry

6 returns home

6-8 takes rest

8 dinner(chapathi and curry)

8-9 takes rest

9 goes to sleep

Feeling weakness since 1 yr

Difficulty in climbing stairs due to sob

N/k/c/o dm, 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.

[26/05/23, 12:34:21 PM] ~ Rithika: 13.op no .20210512892

39F

Complaints of fever since one week

Low grade fever ,on and off, relieved on medication associated with elbow, shoulder,knee joint pains

No retro orbital pain

No complaints of burning micturition

Known case of asthma since childhood , uses inhaler during attacks

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

Daily routine

She is a homemaker by occupation

At 6am she wakes up and does hosehold work

11 am has her break fast

Difficulty in doing household chores due to Fever , weakness, body pains since 10 days

2pm lunch

Takes Rest house hold works

9 pm dinner

10 pm - sleeps

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[26/05/23, 12:39:08 PM] ~ Rithika: 14 . Op no 20230542663

56 M

Pt was found to have grade 1 fatty liver on incidental checkup and patient is anxious about it and wanted to get it rechecked

No new complaints presently

He was counselled for dietary modification and lifestyle modification

N/k/c/o htn,dm, 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.

[26/05/23, 12:44:23 PM] ~ Tharunkumar: 15.Op no:20230543294

79/F

C/o Generalized body pains since 6months aggravating during night

C/o Burning micturition since 3months associated with pain during micturition

No c/o decreased urine output

C/o constipation since 3 months

H/o similar complaints 4 years back admitted in our hospital

Used Tab. Nitrofurantoin 100mg and syp.citralka

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

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-NFND

Daily routine- wakes up at 6am does household work and eats breakfast(Gatka), lunch at 1pm(rice and curry) and does household work and eats dinner at 8pm and sleeps at 9:30pm. Unable to do work in the evening time since 4 months and sleep is disturbed.

Patient was advised admission and getting admitted.

[26/05/23, 1:06:49 PM] ~ Rithika: 17. Op no .20230543714

30 F

Complaints of left sided headache since 6 months associated with nausea , photophobia

No phonophobia

Complaints of chest pain, non radiating type

Complaints of heartburn on increased spicy food intake

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

No history of cough, cold, fever ,burning micturition

No history of palpitations, orthopnea ,pnd.

Daily routine

4:30am wakes up

5-10am freshens up and does Household chores

10 am break fast

10:30 goes to bank work (on computer)

1pm lunch ( rice +curry)

6pm returns to home

10pm dinner

11 pm goes to sleep

No change in daily routine

O/E

Tenderness over entire chest region

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft,nt

Patient is advised for admission but not willing.

[26/05/23, 1:10:30 PM] ~ Tharunkumar: 18.Op no:20230543172

40/F

C/o Pain on left side of neck,face and left side of body since 6 days

H/o cervical lymphadenopathy (left side) in 2012 and s/p cervical lymph node dissection

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

O/E

Tenderness present in left breast medial side

Restriction of neck neck movements in left lateral flexion

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-NFND

Daily routine- wakes up at 6am and goes for work,eats breakfast at around 8am and lunch at 1pm(rice and curry) and does household work in the evening and dinner at 8pm and sleeps at 10pm.

Unable to go for work these 7 days and daily routine is disturbed

Patient was advised admission but not willing

[26/05/23, 2:21:26 PM] Rakesh Biswas Sir: Goes for fishing everyday at 3:00 AM? Is that his hobby or occupation?

[26/05/23, 2:22:21 PM] ~ Rithika: Occupation sir

[26/05/23, 2:24:29 PM] Rakesh Biswas Sir: @Manogyna Uploading these clinical images may be an additional work but why not establish a system of coordination between interns working from home doing the uploading and PaJR group online tasks and interns working from hospital capturing and feeding them all the necessary data including the signed informed consent forms? @Kshitij

[26/05/23, 2:25:09 PM] Rakesh Biswas Sir: Clinical images?

[26/05/23, 2:26:35 PM] Rakesh Biswas Sir: Clinical images

[26/05/23, 2:27:16 PM] Kshitij Sharma: Sir I don't think we have interns working from home. Even Manogyna has exams from 5th June ?,! May be we can get juniors to do it?

[26/05/23, 2:27:21 PM] Rakesh Biswas Sir: Fisherman electrician?!!

How does he catch fish?

[26/05/23, 2:27:39 PM] Kshitij Sharma: By giving electric shocks in the pond?

[26/05/23, 2:27:49 PM] Kshitij Sharma: All the fishes die and float 😂

[26/05/23, 2:27:58 PM] Rakesh Biswas Sir: Any interested medical student will be welcome

[26/05/23, 2:28:13 PM] Kshitij Sharma: Which batch is posted from 2019 batch in june sir?

[26/05/23, 2:28:26 PM] Rakesh Biswas Sir: Yes that's an illegal technique though

[26/05/23, 2:29:45 PM] Rakesh Biswas Sir: May be able to tell. Again one doesn't need to be posted to work from home?

[26/05/23, 2:30:01 PM] Kshitij Sharma: Well yes sir!

[26/05/23, 2:31:04 PM] Kshitij Sharma: May be can add more of her classmates (interested medical students) here?

[26/05/23, 4:35:24 PM] Lohith Pg Gm : 1 admission from op sir

[26/05/23, 4:38:57 PM] Rakesh Biswas Sir: How many seen? 18?

27th May 2023,Saturday

[27/05/23, 6:31:27 AM] Rakesh Biswas Sir: Please make sure Shailaja sister puts this print out in the ICU today

[5/26, 3:24 PM] Shailaja Sister Kims: https://www.researchgate.net/figure/Criteria-of-readiness-for-weaning-trial_tbl1_297439524

[27/05/23, 10:08:34 AM] ~ Dr.ramyareddypebbeti🩺: 1.Op no:20230544119

61/F

Came for general health checkup

K/c/o type 2 DM since 8 yrs (on biphasic insulin)

K/c/o CKD

H/o pedal edema (on and off),till ankle ,pitting type since 5months

H/o polyuria +

H/o tingling sensation of both upper and lower limbs

No h/o burning micturition

N/k/c/o HTN,TB, Thyroid,epilepsy and asthma

O/E

Pallor +

Oedema +

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-

Sensory examination:

UL. LL

Fine touch R :N. N

L:N. N

Crude touch : normal on both limbs

Pain :normal

Joint position: normal

Vibration sensation: decreased in both lower limbs

Patient was advised for admission for further evaluation but want to leave and come back on Monday for admission

[27/05/23, 10:08:57 AM] ~ Rajkumar Adepu: 2

Op no 20210500884

62/ F

Pt came for follow up

C/o pain in popliteal fossa of right lower limb since 10days

Dragging type radiating to ankle aggrevated on standing for long hours and relieved on lifting

Calf tenderness absent

Edema /swelling of RT Lower limb absent

Difficulty in walking after standing from sitting position

K/c/o DM 2 since 10 years on medication tab metformin 500mg po OD

K/c/o HTN since 10 years on medication telmisartan+amlodipine

K/c/o CAD post PTCA done 4 years back on medication aspirin 75 mg+ atorvastatin 20mg po OD

K/c/o hypothyroidism since 10 years on thyronorm 100mcg

O/e

Pt is c/c/c

Bp 150/80mmhg

PR 67bpm

Cvs S1 S2+

RS BAE+

CNS NFD

P/A soft non tender

[27/05/23, 10:22:40 AM] ~ Dr.ramyareddypebbeti🩺: 3.Op no:20230544118

56/F

C/o pedal edema since 2 weeks

B/L knee Pain since 1 month

C/o polyuria

No h/o decreased urine output,burning micturition

No h/o chest pain ,SoB,palpitations

K/c/o type 2 DM since 10years (on regular medication GLIMI M2 Po/BD

O/E :

Knee joint examination:

Crepitus + in B/L knees

Joint line tenderness + b/L

Restriction of movements +

SLRT: right knee- 90degrees

Left knee -80 degrees

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

[27/05/23, 10:23:33 AM] Rakesh Biswas Sir: Clinical images?

Check the group description box for the check list for your complete workflow around every patient and do accordingly

Let me know if you are unable to locate the checklist

[27/05/23, 10:24:08 AM] Rakesh Biswas Sir: Relieved on lifting?

[27/05/23, 10:24:33 AM] Rakesh Biswas Sir: Clinical images?

Check the group description box for the check list for your complete workflow around every patient and do accordingly

Let me know if you are unable to locate the checklist

[27/05/23, 10:24:39 AM] ~ Rajkumar Adepu: Yes sir

[27/05/23, 10:24:51 AM] Rakesh Biswas Sir: Clinical images?

Check the group description box for the check list for your complete workflow around every patient and do accordingly

Let me know if you are unable to locate the checklist

[27/05/23, 10:25:05 AM] Rakesh Biswas Sir: What does that mean?

[27/05/23, 10:45:41 AM] ~ Rajkumar Adepu: 4

Op no 20230544125

48 F

Daily routine

Farmer by occupation

Wakes up at 7 am in the morning and completes her household chores by 9 am and eats her breakfast and goes to work and eats lunch at 1 pm and continues to work and comes back home by 5pm will do house work and prepare dinner and eat by 8pm and goes back to sleep

Pt came with

C/o chest pain rt sided chest pain since 2 days

H/o tingling sensation +

C/o loss of appetite

K/c/o DM 2 since 6 years on tab glimi 3mg + metformin 1000mg

K/c/o HTN since 2 weeks on tab met xl 25mg

CVS S1 S2+

RS BAE

CNS NFD

P/A soft non tender

Pt advised for admission but want to visit again

[27/05/23, 10:48:24 AM] ~ Dr.ramyareddypebbeti🩺: 5.Op no:20230543172

55/M

C/o tingling sensation of both upper and lower limb since 1 month

Perioral tingling + since 3 weeks

Associated with generalised weakness

No h/o polyuria ,polyphagia and polydypsia

No h/o burning micturition,nocturia

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

O/E

No pallor ,icterus ,clubbing ,lymphadenopathy and edema

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-NFND

Daily routine- wakes up at 5am and goes for work(farming )eats breakfast at around 8am and lunch at 1pm(rice and curry) and does household work in the evening and dinner at 8pm and sleeps at 9pm

daily routine is disturbed due to tingling sensation since 1 month

Patient was advised admission but want to come back on Monday for admission

[27/05/23, 10:54:04 AM] ~ Rajkumar Adepu: 6

Op no 20230544569

35/F

Pt came with c/o headache in both temporal region since 5-6 months

Headache everyday relieved on medication

Aggrevated by sunlight

Photophobia +

N/k/c/o htn,dm, cad ,cva

Daily routine

7am wake up and does house work by 9am

9 has her breakfast

9:30 goes for work

At 1 she has her lunch

Returns to home at 5pm

5-6 takes rest

6-8:30 House works

8:30 lunch

10pm goes to sleep

No change in daily routine

O/E

Cvs- s1s2 heard

RS - BAE + , NVBS heard

CNS- NFND

P/A - soft, non tender

[27/05/23, 11:04:06 AM] ~ Dr.ramyareddypebbeti🩺: 7.Op no:20230544599

23/F

23 yr old female ,nursing student,came to opd with c/o b/L lower limb swelling up to ankle since 1 week (on and off)

Insidious in onset ,gradually progressive ,aggravating on sitting for prolonged time and relieving on walking for some distance

No h/o burning micturition,frothy urine ,decreased urine output

No h/o chest pain,sob , palpitations

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

O/E

pallor+

Noicterus ,clubbing ,lymphadenopathy and edema

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS

P/A- soft non tender

CNS-NFND

Patient was advised for admission but not willing

[27/05/23, 11:12:28 AM] ~ Rajkumar Adepu: 8

Op no 20230544725

55 M

Driver by occupation

H/o head trauma in 2007 in RTA not associated with loc , vomitings

Currently presented with c/o giddiness since 3months relieved on lying in supine position

H/o alcohol consumption 180ml/day (whiskey)

Pt is c/c/c

Afebrile on touch

Bp 130/90 mmHg

CVS S1 S2+

RS BAE+

P/A soft and non tender

CNS

cerebellum

Nystagmus absent

Finger nose test normal

Dix hallpike negative

Pt advised for admission but wants to come back on Thursday

[27/05/23, 11:51:30 AM] ~ Rajkumar Adepu: 9

Op no 20210322768

47 M

Works in PAN shop

Lifts weights

C/o pain in both shoulders since 6 months

No restriction of movement

Pain increased on activity, lifting weights

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

O/e

Pt is c/c/c

Shoulder examination

Pain on abduction of >90 degree on both sides

Pain on extension+

Cvs S1 S2+

RS BAE

CNS NFD

P/A soft and non tender

Advised physiotherapy

[27/05/23, 12:03:20 PM] ~ Rajkumar Adepu: 10

Op no 20210412828

Works as shopkeeper

Daily routine

6am wakes up

8am Breakfast

9 goes to work

12pm lunch

4pm back to home

Does house work and takes rest

8pm dinner

9pm sleep

C/o headache in parietal , frontal region

Since 1 yr on and off weekly once

Aggrevated on sunlight and travel relieved on taking medication

Photophobia +

Nausea+

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

Pt is c/c/c

Bp 90/60 mmHg

Pr 80bpm

Cvs S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender

[27/05/23, 12:23:53 PM] ~ Rajkumar Adepu: 11

Op no 20230545154

Pt came with c/o left side of chest and back pain since 15 days pricking type

K/c/o herpes zoster since 1 month

H/o fever for 5 day high grade Associated with chills and resolved

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

O/e

Pricking type of pain along the dermatomes on front and back of chest

CVS S1 S2+

CNS NFD

RS BAE+

P/A soft and non tender

[27/05/23, 12:24:44 PM] ~ Rajkumar Adepu: Pt advised for admission but not willing

[27/05/23, 12:34:57 PM] ~ Dr.ramyareddypebbeti🩺: 12.

Op no 20210122502

Follow up case of DVT since April 10/23

C/o pain and swelling of left leg

(On tab .acetrom 2mg)

On examination of lower limb tenderness absent at calf region

Swelling + (pitting type)

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

H/o 2 SDP transfusion i/v/o thrombocytopenia

Pt is c/c/c

Bp 100/80mmHg

Pr :72bpm

Cvs S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender

Pt advised for admission but not willing

[27/05/23, 12:35:57 PM] ~ Rajkumar Adepu: 13

Op no 20230545164

48M

Pt came for general health check up

C/o pain of left upper limb dragging type below elbow

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

Pt is c/c/c

Bp 140/100 mmHg

CVS S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender

Pt advised for admission but not willing

[27/05/23, 1:45:06 PM] Rakesh Biswas Sir: How to prepare a case report :

Please share their

Sequence of events beginning with the time they had absolutely no problems they can recall.

AsK what was their routine when they were perfectly alright

Next ask what happened to their routine once the disease took hold on their lives

Specifically ask which part of their hourly routine was disrupted

Ask them their current requirements from us like if we had to give them a single medicine which problem would they prefer it to address

Take their examination findings with images of visceral fat and muscle mass for everyone among other more specific findings

Prepare their problem list and perceived requirements list in order of priority

Formulate a plan for each one of the problem requirements you have listed

[27/05/23, 3:13:03 PM] ~ Dr.ramyareddypebbeti🩺: 14.

Op no 20230545673

C/o right neck pain since 5days ,insidious in onset ,gradually progressive,dragging type ,radiating to both the shoulders

No h/o restriction of neck movements

C/o pain in left hand and swelling of hand since yesterday

No h/o trauma to the hand

H/o cough since 10 days ,non productive,no h/o wheeze ,chest pain ,Sob

K/c/o hypothyroidism since 3 months (on thyronorm 50mcg)

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

Pt is c/c/c

Bp 100/80mmHg

Pr :72bpm

Cvs S1 S2+

RS BAE+

CNS NFD

P/A soft and non tender

Pt advised for admission but not willing

[27/05/23, 4:06:48 PM] Rakesh Biswas Sir: Age? Gender?

[27/05/23, 4:07:27 PM] ~ Dr.ramyareddypebbeti🩺: 45/M

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