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 routine is not affected by the above mentioned complains

[12/08/23, 10:36:49 AM] ~ Bhargavi: Op no:  20230819461

A 40 year old female came with the cheif complains of fever since 2 days associated with chills and rigor ,no loose stools and vomitings,no h/o of cough amd cold

C/o retroorbital pain ,c/o of  generalized weakness and chest pain on and off, c/o of sob grade one mmrc, no aggravating and relieving factors,  

Not a k/c/o DM ,CAD,CVA,seizures,HTN ,TB,Asthma 

 On Examination-

 Patient is conscious, coherent, cooperative 

Temp: 99.7 f

Pr: 82 bpm

Bp: 100/70 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 has her breakfast by 8 am mostly eats idilli /dosa . Then spends her time by taking rest or helping in household chores , 1 pm she has herlunch , then takes nap till 5 pm after waking up she drinks his tea and then spends her time talking with her neighbours , then by 8:30 pm eats her dinner and goes to sleep by 9:00 pm .

Her daily routine is not affected by the above mentioned complains

Advice: 

Patient managed conservatively with medication and adviced adequate hydration

[12/08/23, 11:10:34 AM] ~ Bhargavi: Op no:  20210111742

A 25 year old female came with the cheif complains of pain in both lower limbs since 2 days,  dark coloured patch on left leg since 2 days, fever since 2 days,  generalised body pains since 2 days, no h/o of fever, vomitings, watering of eyes, burning micturition, photophobia

Not a k/C/o-DM ,CAD,CVA,seizures,HTN ,TB,Asthma 

 On Examination-

 Patient is conscious, coherent, cooperative 

Temp: febrile

Pr: 82 bpm

Bp: 120/80 mm Hg

Rr - 22cpm

No signs of pallor, 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:

She is house wife she is preparing for group one

She wakes up early in the morning and studies for one hour and does her household works amd has ger Breakfast at 9 am and has her lunch at one pm and studies later and has her dinner at 9pm sleeps at 10 pm

Her daily routine is not affected by the above mentioned complains

Advice:

Pt was advised symptomatic treatment

Adequate rest and hydration

[12/08/23, 11:54:05 AM] ~ Bhargavi: Op number - 20230820065

32 year old female came with complaints of headache which is diffuse type since 5 days

Headache is diffuse type more during the morning and night , no c/o of nausea , vomitings photophobia, photophobia giddiness , headache relieved on medication 

Not k/c/o Dm, Htn, epilepsy, asthma, CVD, CVA 

On examination

Pt is c/c/c 

PR - 84bpm

RR - 14cpm

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 home maker, she wakes up around 5am and checks her smartphone upto 6am then she prepares breakfast for her children and make them ready for school and send them to school by 9clock. She does her household works from 9 to 11 am and cooks for lunch by 12pm.then she goes to school to give lunch box to their children and then she returns home by 1pm. She has her lunch at 1 30pm andshe spends watching television in the afternoon upto 4pm and in the evening she picks her kids from school at 5pm and makes snacks ready for the kids by 6pm, she helps her kids finish their homework by 8pm.then prepares for dinner and has dinner by 9 30 and sleep by 11pm

[12/08/23, 12:38:36 PM] ~ Bhargavi: Op no 20230820092

A 35 year old came with the C/o of pain abdomen since  3 days 

No c/o of fever, cough cold, palpitations orthopenea, pnd , vomitings and loose stools, burning micurition

O/E pt is c/c/c

Afebrile

PR - 94bpm

RR - 17cpm

Bp - 120/70mmHg

No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy

Cvs - S1S2 +, no murmurs

RS - BAE+, NVBS

Cns - NFND

Per abdomen -soft and  tender in the lower qudrants of abdomen

Advice 

Symptomatic treatment

And adequate hydration

Daily routine

She helps her husband in farming in paddy feilds

Wakes up early in the morning does her household work and has breakfast at 9am and goes to paddy feilds has her lunch at one and cones back to home and takes rest and prepares dinner , has dinner at 9pm and sleeps at 10pm

Her daily routine is not affected by above mentioned complaints

[12/08/23, 2:15:16 PM] ~ Bhargavi: Ip no: 20230820176

A 35 year old male came with 

C/o of lower back ache radiating to lower limbs since 6 months

C/o of pain in the right hypochondrium, generalized weakness 

No c/o of orthopnea, pnd, sob

No c/o of  chestapain palpitations

O/E pt is c/c/c

Afebrile

PR - 78bpm

RR - 18cpm

Bp - 130/70mmHg

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

And adequate hydration

 

Daily routine-

He is farming

Patient is a paddy field farmer, he wakes up by 5:30 in the morning, drinks tea, helps his wife with household work (cleaning house) and goes to work by 8:00 am. 

He does farming till 12-12:30 pm and has lunch. He rests for 45mins - 1 hour and again gets back to work. He will reach home by 5:00pm and watches television and goes for a walk with his friends till 8:00pm, comes back and has dinner and sleeps by 10:00pm  

The above mentioned complains haven’t effected his daily routine yet.

[12/08/23, 2:29:46 PM] ~ Bhargavi: Ip no:20230820084

A 44 year old male 

C/o sob at rest since 10 days

C/o pf chest pain radiating to back since 10 days and occasionally palpitations

Associated with cough with sputum

And not associated with fever vomitings

Not k/c/o Dm, HTN ,epilepsy, asthma, CVD, CVA 

On examination

Pt is c/c/c 

PR - 91bpm

RR - 14cpm

Bp - 130/70mmHg

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

he is sarpanch of the village near valligonda

He wakes up early in the morning goes to walking and later he freshens up has his breakfast at 9am and goes to  attend gram panchayat meetings if any or guiding the workers to do the work for the development of village has lunch at 1pm and dinner at  9 pm sleeps at 10 pm

His daily routine is not disturbed by the above mentioned complains ‎<This message was edited>

[12/08/23, 2:33:42 PM] ~ Bhargavi: Op no: 20230820090 

A 33 year old female came with chief complaints of chest pain non radiating to left arm. Increased pain on intake of spicy food.No complaints of fever, vomitings, no h/o SOB,orthopnea,PND.

N/k/C/O HTN,DM, thyroid disorders, seizures,TB,Asthama

On Examination -

Patient is conscious, coherent, cooperative

Temp: afebrile

BP: 110/60mmHg

Pr: 103bpm

No signs of pallor, icterus, cyanosis, clubbing and lymphadenopathy.

CVS: S1,S2 heard, No murmurs

RS : bae+ , NVBS heard

P/a : soft,non tender,bowel sounds+

CNS : NFAD

 

Daily routine-

The patient is a homemaker. She wakes up at 5:30 am, freshens up, nd  does her household work by 8:00 and after that she has her breakfast at 8:30am. After that she watches tv amd spends time with family. She has her lunch at 2 pm and sleeps till 5:00 pm. If there's any requirement regarding groceries she goes to marketplace after 5 and has her dinner by 8:00 pm. She goes to bed by 9:00 pm. Her daily activities don't get disturbed because of the complaints.

Her daily routine is not affected by the above mentioned complaints

[12/08/23, 3:38:36 PM] ~ Lasya Reddy: Op no: 20230816332

A 31 year pld female came with c/o pf headache since 2 months , diffuse type associated with nausea and photopobia,no h/o pf phonophobia, loose stools, constipation, burning micturition

N/k/C/O HTN,DM, thyroid disorders, seizures,TB,Asthama

On Examination -

Patient is conscious, coherent, cooperative

Temp: afebrile

BP: 120/80mmHg

Pr: 98bpm

No signs of pallor, icterus, cyanosis, clubbing and lymphadenopathy.

CVS: S1,S2 heard, No murmurs

RS : bae+ , NVBS heard

P/a : soft,non tender,bowel sounds+

CNS : NFAD

 

 Daily routine- pateint is home maker

Patient wakes up at 7 and freshens up and does her household chores and has her breakfast by 8 am mostly eats idilli /dosa . Then spends her time by taking rest or helping in household chores , 1 pm she has herlunch , then takes nap till 5 pm after waking up she drinks his tea and then spends her time talking with her neighbours , then by 9 pm eats her dinner and goes to sleep by 10:00 pm .

Her daily routine is not affected by the above mentioned complains

Advice: 

Patient managed conservatively with medication and adviced adequate hydration

[12/08/23, 3:57:21 PM] ~ Bhargavi: Op no  20230818780

A 21 year old female came with

C/o 0f passage of stools 3 to 4 times a day

C/o of abdominal pain relieved after passing of stools

N/o history of nausea ,fever cough and cold,vomiting burning micturition, no h/o sob, headache

Not a k/c/o -HTN, DM, CAD, CVA, thyroid problems, asthma, epilepsy

Examination: Patient is conscious, coherent, cooperative 

Temp: Afebrile

Pr: 69 bpm

Bp: 120/80 mm Hg

Rr: 16 cpm

No signs of pallor, icterus, cyanosis,clubbing and lymphadenopathy, 

Cvs:-S1 S2 heard, no added sounds

Rs:-BAE+, NVBS +

P/a: - soft, non tender

CNS: - NFD

Daily routine-

Patient is a nursing student 

She wakes up at 6:00 in the morning, uses mobile for a while and freshens up by 7:30 and has breakfast before leaving for college at 8:00am. Attends classes till 1pm and has her lunch by 1pm. 

She has snacks in the evening around 5pm and goes back to home and does her academic works after that

She has her dinner by 9:00 pm and goes to sleep by 10:00 pm. 

The above mentioned complains have not effected her daily routine yet.

[12/08/23, 4:28:33 PM] ~ Keerthi Madireddi: requesting all the interns to take internship completion assessment on the last 2 days of posting in general medicine department and your extensions will be finalised at the end of your general medicine posting of 60 days.

[12/08/23, 4:52:26 PM] Rakesh Biswas Sir: Also to log every offline activity around their patients into this system 'so that later they can provide the tracebacks of all their work and also so that it helps us to use that logged work to take better decisions about the patients 

Also present their cases daily offline in the rounds 

Prepare osce around their cases as shared in @Vaishnavi Maguluri 's portfolio

13th August 2023,Sunday

[13/08/23, 8:27:20 AM] Rakesh Biswas Sir: Sunday journal club :

Participatory learning action PĹA between patient and health professional context : 

https://chat.whatsapp.com/CBgzuhBODNp2En97jeOfPY

[8/12, 7:31 PM] Penchala Manogna KIMS 2018 Intern: - Population: Patients diagnosed with type 2 diabetes

- Intervention: Treatment with

Glimepiride 

- Comparison: Treatment with vildagliptan

- Outcomes:

  - Vildagliptin increased active glucagon-like peptide-1 levels by 2.36-fold (p ≤ 0.0001) and suppressed glucagon by 8% (p = 0.01).

  - Glimepiride significantly increased insulin levels by 21% (p = 0.012) and C-peptide levels by 12% (p = 0.003).

  - Vildagliptin treatment demonstrated reduced glucose level fluctuations compared to glimepiride as assessed by a 24-hour continuous glucose monitoring (CGM) device.

  - Implication: Vildagliptin may have potential long-term benefits in preventing diabetes complications for patients with type 2 diabetes.

https://pubmed.ncbi.nlm.nih.gov/23782529/

[8/13, 8:16 AM] Rakesh Biswas: Share the numbers in PICO 

How many P 

How many in I? How many in C?

In outcomes you have to share comparable outcomes in terms of absolute numbers and not just percentages. 

For example you have mentioned glp1 and glucagon level outcomes in your C group while you mentioned insulin levels and C peptide levels in your I group!! How do we compare? How does GĹP1 work? Through insulin?

[13/08/23, 7:20:15 PM] Rakesh Biswas Sir: https://chat.whatsapp.com/Dnvfte8N0D96RMId0t1Xeq

Would it be possible to identify the questions in this patient and then utilize them to develop the known and unknown learning points that can further help to positively impact the illness outcomes of this patient?