Urosepsis ,post renal AKI with B/L Hydronephrosis secondary to bladder calculi

 Gen med case presentation;

Jan 22,2022

Name;Ramya reddy pebbeti.

 Roll no;105 .

This is 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 patients’ clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient centred online learning portfolio and your valuable inputs 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 diagnosis and treatment plan

Following is the view of my case :

CASE PRESENTATION ;

DOA:20/01/22

chief compliants: A 66 yr old female , residence of mothkur came to the opd with C/O

*Burning micturition  since 10 days

*Decreased urine output since 10 days

*Fever on and off since 10 days

*Abdominal pain since 3 days 

ON 18/01/22 She went to private hospital near their house with the same complaints , where they did some investigations like shown below;

CUE;

CBP;

CT ABDOMEN;

CT ABDOMEN showed the large calculus in the bladder and also B/l Hydronephrosis .

She is referred to our hospital .

On 20/08/22 she came to our opd with the same complaints,

And there is no H/o loin pain,hematuria.

Past history; 

She was hysterectomised 18 years back for fibroid uterus.

Not a k/c/o DM,HTN,epilepsy,asthma,TB

Personal history;

Diet ;mixed

Appetite;normal

Bowel movements;normal

Sleep; adequate

General physical examination;

Pt is conscious, coherent, cooperative

Vitals; 

Temp;afebrile now

Bp;110/80mm of hg

PR;86bpm

RR;20cpm

SPO2; 98%on room air

Systemic examination;

RS; BAE+

CVS:S1,S2 HEARD

P/A;

Inspection;

Distended,no scars and sinuses

Position of umbilicus; central and inverted

Palpation;

 soft,tender, a hard mass of 12*8 cm size is palpable in suprapubic region.

Normal bowel sounds heard.

CNS:NAD

The investigations are;

Xray abdomen;

USG ABDOMEN;

Serum electrolytes;

HBsAg ;

BLOOD SUGAR;

BLOOD GROUP AND TYPING;

CUE;

ECG;

#Diagnosis:

Urosepsis ,post renal AKI with B/L Hydronephrosis secondary to  bladder calculi.

Treatment:

*Plan of treatment; 

Tab.Nitrofurantoin 100 mg oD

Tab.orofer xT Po OD

Tab nodosis  500 mg po oD

Tab.shelcal po OD

Tab .Lasix 20 mg PO BD

Tab .PCM 650 mg po OD

*Planned for OPEN CYSTOLITHOTOMY ON 4/5 Feb 

Adrenal crisis , secondary adrenal insufficiency and iatrogenic cushing syndrome

 Gen med case presentation;

Jan 22/01/22

Name;Ramya reddy pebbeti.

 Roll no;105 .

This is 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 patients’ clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient centred online learning portfolio and your valuable inputs 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 diagnosis and treatment plan

Following is the view of my case :

CASE PRESENTATION ;

DOA:20/01/22

CC -17 year old male came to casuality with c/o Giddiness since 1week, SOB on exertion since 2days with nausea and vomiting

HOPI- patient was apparently asymptomatic 1week ago then he doveloped giddiness which was sudden in onset no aggravating factors relieved on consumption of food. Later he doveloped SOB 2 days ago with no aggravating and reliving factors along with nausea and vomiting with consumption of food as aggravating factor.

PAST HISTORY- K/C/O cushings syndrome

PERSONAL HISTORY-

occupation -student

Mixed diet

appetite -normal 

bowel and bladder - Normal

no addiction 

FAMILY HISTORY - not significant 

PHYSICAL EXAMINATION-

no pallor, icterus, cyanosis, clubbing,  dehydration 

VITALS-

temperature - afebrile 

pulse rate - 80 bpm 

RR - 12 cpm 

BP - 80/50 mm hg 

SPO2 - 98 on RA 

GRBS - 117.mg %

SYSTEMIC EXAMINATION-

CVS-S1 ,S2 heard ,no murmurs 

RS -BAE +

 P/A - soft ,non tender 

CNS -

speech - normal 

 power 

U.L - 5/5 

L.L - 3/5 at presentation in opd ,now 4/5 

TONE - normal 

REFLEXES 

KNEE - + 

BICEP - + 

TRICEP-+

ANKLE - + 

BRACHIORADIALIS - + 

PLANTAR - withdrawal

Images of the patient; (recent)

Old image of the pt;

PROVISIONAL DIAGNOSIS-

Adrenal crisis (Distributive shock secondary to adrenal insufficiancy)

Investigations;

RBS;

CUE;

CBP;

LFT;

Seruma creatinine;

Serum electrolytes;

ABG;

BLODD UREA;

TREATMENT -

1)Inj norad 2amp in 46ml NS infusion @ 0.02mcg/kg/min if BPis low 

2)Inj hydrocortisone 100mg/iv/od

3)Inj pantop 40mg/iv/od

4)Inj zofer 4mg/iv/tid

5)IVF NS,RL,DNS-100ml/hr

6)BP charting

PR/Spo2/Temp charting

GRBS 8th hrly

A 55 yr old female with Sob and pedal edema

 Gen med case presentation;

Jan 20,2022

Name;Ramya reddy pebbeti.

 Roll no;105 .

This is 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 patients’ clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient centred online learning portfolio and your valuable inputs 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 diagnosis and treatment plan

Following is the view of my case :

CASE PRESENTATION ;

DOA:19/01/22

chief compliants: 

A 55 yr old female who is a farmer by occupation came to the opd with a chief compliants of

* Sob since 15 days

* Pedal edema since 15 days

Illness events In her life are;

8 yrs back she is diagnosed to have hypertension and she is on regular medication

5 years back  she had an upper limb fracture for which she went to hospital and got treated for that and her creatinine levels were high ( from hospital reports) serum creatinine-2.8mg/dl

6 months back she tested positive for covid 

5 months back her Cr level are 4.5 mg/dl

Current Cr levels are 7.9 mg/dl( on 17/01/22)

Now she came to our opd complaining of 

*Sob since 15 days ( grade - 3)

*Pedal edema - since 15 days ,non pitting type

*Decreased urine output

Past history;

K/c/o HTN since 8 years

H/o taking NSAIDS for 1 year for OA ( given By  a local doctor)

 

Personal history:

Diet- mixed

Appetite; normal

Bowel and bladder: regular

Sleep - adequate

No addictions

General examination;

Pt is conscious, coherent, cooperative and well oriented to time ,place and person

She is moderately built and moderately nourished

Pallor, clubbing , cyanosis, lymphadenopathy- absent

Edema - present ( up to ankles) and non pitting type .

Systemic examination; 

RS: BAE+

CVS: S1,S2 heard

Per abdomen: soft and non tender

CNS: intact 

Provisional diagnosis: 

#CKD with hyperkalemia

Investigations;on 19/01/22

Hemogram:

CUE;

Serum electrolytes;

Blood urea;

Serum creatinine;

Anti HCV antibodies;

HBsAg;

USG ;

ECG;

Treatment ; (On 20/01/22)

*Neb.with duolin 

*Inj.HAI 12U

*Inj.Lasix 40mg/IV/BD

*Tab .nodosis 500 mg /po/Bd

*Tab.shelcal CT po/oD

*Tab orofer XT Po/BD

*Inj.erythropoietin 400IU/sc

*Tab.Nicardia 20 mg/po/Bd

*Strict I/O monitoring

*One round of hemodialysis on 20/01/22

And another on 22/01/22

Prefinal examination answer sheet paper_2

 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. 

THE BELOW ARE THE SCANNED IMAGES OF THE ANSWER SHEET OF  PRE-FINAL EXAMINATION CONDUCTED ON 3RD AND 4TH JANUARY 2022

PREFINAL EXAMINATION PAPER 2

DATE :4 th jan22 

1) Enumarate etiology , pathophysiology, treatment of heart failure.

Ans;                                                                                     

2) Describe etiology, localisation,and management of acute ischemic cerebro vascular accident

Ans;                                                                      

 3)leptospirosis

Ans:

4) Gullian Barrie syndrome

Ans;

5) leprosy

Ans;

6) Diagnostic approach of young onset hypertension

Ans;

7) Dilated cardiomyopathy

Ans;

8) Dengue hemorrhagic fever

Ans;