A 44yr old female with Anaemia under Evaluation...

This is an online E log book to discuss our patients deidentified 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 problems with collective current best evidence based inputs.

This E log book also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case I have seen

Unit 4 admission on 11/02/2021

Interns 
Kota sowmya 
Amrutha 
Supriya 
Mohitha 
Sanjay 

Dr Durga krishna pgy1 
Dr Ajith pgy2
Dr Laxma pgy3 
Dr Manasa pgy3 
DrVijayalakshmi 

A 44 year old female came with c/o fever since 10 days intermittent not a/w chills and rigors and releived on medication ,nausea since 1 week ,loss of appetite since 1 week ,burning micturition since 1 week 
No h/o cough vomitings loose motions 
No h/o palpitations,excessive sweating 
H/o trauma 1 month back 3 times       

PAST HISTORY 
K/c/o DM type 2 since 2 years and not using any  medication

MENSTRUAL HISTORY
Age of menarche 13 years 
Bleeds 3/28 days 
No dysmenorrhea 
Not associated with clots 

O/E 
Patient is conscious coherent coperative 
Pallor present 
No icterus, clubbing, cyanosis ,koilonychia, edema
Vitals 
Bp -110/70
PR - 84bpm 
RR - 22 cpm 
Spo2 98@room air 

Systemic examination 
Cvs -s1s2 +
Respiratory system -BAE +NVBS +
P/A -soft , non tender ,no organomegaly 
CNS -normal 

Investigations :
On 11/2/21
Provisional diagnosis-anaemia under evaluation
Treatment:
1.Inj.HAI S/C
2.Inj.Optinguron 1amp in 100ml NS IU/OD
3.Inj.Iron sucrose 100mg in 100ml NS/IV/OD 
4.T.Limcee PO/OD
5.Inj.Zofer 4mg/IV/TID
6.T.PCM 650mg PO/TID
7.Temperature charting 4 hourly
8.T.Albendazole 400mg PO/Stat
9.Inj.FCM 1000mg in 100 ml NS 
10.Inform SOS

Popular posts from this blog

A 55yr old female with Acute Gastritis with type 2 Diabetes mellitus..

Image
This is an online E log book to discuss our patients deidentified 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 problems with collective current best evidence based inputs. This E log book also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case I have seen Unit 4 Admission Interns Amrutha Supriya Sowmya Sanjay Mohitha Dr.Durga krishna Pg1 Dr.Ajith pg2 Dr.laxma pg3 Dr.Manasa pg4 Dr.vijayalaxmi Ast pro A 55yr old female came with c/o fever since 7 days intermittent a/w chills and rigors & not relievied on medication Neck pain, Vomitings 2 episodes Pt was apparently asymptomatic 7 days back,then developed fever associated with chills and rigors and also developed  neck pain during the attack of fever.. She also d...
Read more

A 29yr female, with complaints of generalized body pains, difficulty in breathing, headache, abdominal discomfort,vomiting and with thrombocytopenia..

Image
This is an online E log book to discuss our patients deidentified 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 problems with collective current best evidence based inputs. This E log book also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case I have seen: Unit 4 Admission Interns A.Amrutha K.Sowmya Supriya Reddy Mohitha Sanjay Dr.Durga Krishna pgy1 Dr.Ajith pgy2 Dr.Laxma pgy3 Dr.Manasa pgy3 Dr.vijayalakshmi assistant professor(1st on call) A 29yr female, asha worker by occupation was apparently normal 10 days back and got vaccinated for covid 19 on 19/1/21 and felt generalized weakness for 2 days following which she developed fever  for about 3 days, which was not associated with chills and rigors, intermittent ...
Read more

General Medicine BIMONTHLY EXAM 2 March 2021...

Image
bimonthly examination - march 1) Please go through the patient data in the links below and answer the following questions: https://ashakiran923.blogspot.com/2021/03/60-years-old-male-fever-under-evaluation.html?m=1 a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?How specific is his dilated superficial Abdominal vein in making diagnosis? -Based on the clinical symptoms and signs, the clinical diagnosis of the patient can be-  UTI with cirrhosis of liver with portal hypertension.  b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? What is the cause of his hypoalbuminemia?Why is the SAAG low? -The etiology of the disease in this patient could be a chronic history of alcoholism. Chronic smoking leading to his apthous ulcers.  Based on his clinical finding there could be portal hypertension which could have ...
Read more