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Showing posts from August, 2023

PLA BOOK PROJECT DRAFT OPD(August 14-August 19)

 14th August 2023-19th August 2023 14th August 2023,Monday [14/08/23, 9:49:03 AM] ~ Rahul: Ip no: 20210209964 A 38 year old female patient came with  C/o of swelling in the neck, dysphagia,sweating, weightloss, fearfullness, generalized weakness,  K/c/o hashimoto thyroiditis  No c/o of orthopnea, pnd, sob No c/o of  chestapain palpitations O/E pt is c/c/c Afebrile PR - 60bpm RR - 16cpm Bp - 110/70mmHg No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy Cvs - S1S2 +, no murmurs RS - BAE+, NVBS Cns - NFND Per abdomen -soft and  non tender Advice  Symptomatic treatment   Daily routine- SHe is farming Patient is a paddy field farmer, She wakes up by 5:30 in the morning, drinks tea, she will do  household work (cleaning house) and goes to work by 8:00 am.  SHe does farming till 12-12:30 pm and has lunch. He rests for 45mins - 1 hour and again gets back to work. SHe will reach home by 5:00pm and watches television and goes for a walk with his friends till 8:00pm, comes back and

PLA BOOK PROJECT DRAFT OPD (August 12-August 13)

12th August 2023-13th August 2023 12th August 2023,Saturday [12/08/23, 10:36:00 AM] ~ Bhargavi: Op mly: 2023819058  A42 year old female came with the c/o of chest pain on the left side non radiating, aggravated on taking spicy food,c/o of occasional palpitations, No c/o of sob ,pnd, orthopnea  Not a k/c/o DM ,CAD,CVA,seizures,HTN ,TB,Asthma   On Examination-  Patient is conscious, coherent, cooperative  Temp: afebrile Pr: 82 bpm Bp: 120/70 mm Hg Rr - 22cpm Mild pallor  No signs of , icterus, cyanosis,clubbing and lymphadenopathy. Cvs: S1 S2 heard,No murmurs Rs: bae+, NVBS heard P/a:  soft, non tender, bowels sounds+ CNS - NFAD    Daily routine- pateint is home maker Patient wakes up at 7 and freshens up and does her household chores and sends her children to school and has her breakfast by 9 am . Then spends her time by taking rest or helping in household chores , 1 pm she has herlunch , then takes nap till 5 pm , then by 8:30 pm eats her dinner and goes to sleep by 9:00 pm . Her daily

A 48 yr old female with low back ache

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 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centred online learning portfolio and your valuable comments on comment box is welcome. I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.  HOPI- Patient was apparently asymptomatic 25 years ago then she developed pain from back of neck to lower back throughout the day aggregated by work and relieved by rest. Apparently th

70M WITH SEPTIC SHOCK 2 TO UROSEPSIS WITH B/L RENAL CALCULUS WITH B/L HYDOROURETERONEPHROSIS

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 This is an online e log book to discuss our patient de-identified health data shared after taking his/her/guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evidence based input This E blog also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan CHEIF COMPLAINTS: Patient came with cheif complaints of abdominal pain in Right lower quadrant of abdomen since 1week  HISTORY OF PRESENT ILLNESS:  Patient was apparently asymptomatic 1week back then he developed p

A 45 YRS OLD MALE PATIENT WITH ALTERED SENSORIUM

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 This is an online e-log book to discuss our patient de-identified health data shared after taking his / her / guardian's signed informed consent. Here we discuss our individual patients' problems through a series of inputs from the available global online community of experts with an aim to solve those patients' clinical problems with collective current best evidence-based information. This E blog also reflects my patient-centered online learning portfolio and your valuable input in the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and coming up with diagnosis and treatment plans. is an online e-log book to discuss our patient's de-identified health data shared after taking his / her / guardians' signed informed consent. Here we discuss our indivi