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67F PTB ACUTE CALCULOUS CHOLECYSTITIS

66 YEAR OLD FEMALE CAME WITH -C/O ABDOMINAL DISTENTION SINCE TODAY MORNING(8/6/23). -C/O BURNING TYPE OF PAIN IN UPPER ABDOMEN SINCE 2 DAYS. HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 2 DAYS BACK AND THEN DEVELOPED BURNING TYPE OF PAIN IN UPPER ABDOMEN. NO AGGRAVATING AND RELIEVING FACTORS, PAIN NOT RADIATING TO ANY OTHER QUARDRANT. NO H/O FEVER, CONSTIPATION, VOMITING, BURNING MICTURITION. NO H/O TRAUMA. H/O DECREASED APPETITE SINCE 20 DAYS(SINCE USAGE OF ATT). PAST HISTORY: H/O HYSTERECTOMY DONE IN 2001. N/K/C/O DM, HTN, CVA, CAD, EPILEPSY. H/O ASTHMA SINCE 35 YEARS. H/O TB, DIAGNOSED LAST MONTH AND STARTED ATT. PATIENT HAD C/O PAIN IN RUA 20 DAYS BACK AND GOT ADMITTED UNDER GS-VI AND USG WAS DONE SHOWING CHOLELITHIASIS. HRCT CHEST- MULTIPLE CENTILOBULAR NODULES IN BOTH LUNGS. ON EXAMINATION: PALLOR(+) NO SIGNS OF CLUBBING, CYANOSIS, ICTERUS, EDEMA TEMP-AFEBRILE, BP-120/80 MMHG, PR-86BPM, RR-32CPM,SPO2-99% @2L 02,GRBS-136MG% PER ABDOMEN INSPECTION: -ABDOMEN IS DISTEN
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19/F EPTB

 19 FEMALE STUDENT BY OCCUPATION  CAME TO GENERAL SURGERY OPD WITH COMPLAINTS OF PAIN IN LOWER ABDOMEN SINCE 3MONTHS  HOPI: PATIENT WAS APPARANTELY ASYMPTOMATIC 3MONTHS BACK THEN SHE NOTICED PAIN IN UPPER ABDOMEN,SQUEEZING TYPE OF PAIN,INTERMITTENT AND RELIEVED ON DEFECATION AND NO AGGRAVATING FACTORS. PAI IS CONTINUOUS SINCE 10DAYS AND PAIN RELIEVED ON DEFECATION AT MORNING. H/O FEVER ASSOCIATED WITH CHILLS AND RIGOR AND MORE AT EVENING AND RELIEVED AFTER MEDICATION H/O CONSTIPATION SINCE 3MONTHS H/O VOMITINGS AND LOOSE MOTIONS 1MONTH BACK H/O OLIGOMENORRHEA SINCE 6MONTHS H/O WEIGHT LOSS 10KG OVER 6MONTHS NO H/O BURNING MICTURITION NO H/O NAUSEA NO H/O LOSS OF APPETITE  N/K/C/O HTN,DM,ASTHMA,CVA,CAD  NO PAST SURGICAL HISTORY FAMILY H/O FATHER WAS DIAGNOSED WITH TB IN 1995 AND 2007 AND TOOK ANTI TUBERCULOSIS TREATMENT  ON EXAMINATION  PT IS C/C/C BP-90/60 MMHG PR-80BPM RR-17CPM TEMP-AFEBRILE SPO2-99% ON ROOM AIR L/E ON INSPECTIONABDOMEN IS SCAPHOID UMBILICUS-CENTRAL AND INVERTED ALL Q
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40/M LEFT MODERATE PLEURAL EFFUSION SECONDARY TO TUBERCULOSIS WITH TYPE II DM

40 M CAME TO PULMONOLOGY OPD WITH CHIEF COMPLAINTS: C/O COUGH (DRY) :1 WEEK C/O :FEVER: 7DAYSHOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH BACK, LATER HE DEVELOPED INITIALLY COUGH WITH SPUTUM LATER NON PRODUCTIVE COUGH FOR WHICH HE GOT ADMITTED AND DIAGNOSED AS LEFT PLEURAL EFFUSION.NOW PRESENTLY WITH DRY COUGH SINCE 1 WEEK ,MORE IN THE NIGHT.NO AGGRAVATING AND RELIEVING FACTORS. FEVER SINCE 1 WEEK,LOW GRADE EVENING RAISE PRESENT, SUBSIDED WITH MEDICATION. NO COMPLAINTS OF CHEST PAIN, DECREASED URINE OUTPUT, SWEATING, PALPITATIONS. H/O SIMILAR COMPLAINTS IN THE PAST FOR WHICH DIAGNOSED AS LEFT PLEURAL EFFUSION (TAP DONE 1500ML ON 23/3/23AND 25/3/23 AND SENT FOR PLEURAL FLUID ANALYSIS. TC-5400,DC-100%L, PLEURAL FLUID ADA -41 IU/L, PLEURAL SUGAR - 211MG/DL, PROTIENS-5.4G/DL NO H/O USAGE OF INHALERS IN PAST NO ALLERGIC H/O K/C/O DM ON GLIMESTER M1 FORTE BD 7YEARS N/K/C/O HTN, THYROID,CAD. SMOKER FOR 5 YEARS(1 BEED PER DAY)STOPPED SMOKING FOR 2 YEARS TOBACCO CHEWING 3 YEAR
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50 F PTB DM2

 PATIENT CAME WITH COMPLAINS OF COUGH WITH SPUTUM SINCE 15 DAYS,FEVER SINCE 15 DAYS , SHORTNESS OF BREATH SINCE 2 DAYS  HISTORY OF PRESENTING ILLNESS  PATIENT WAS APPARENTLY ASYMPTOMATIC 15 DAYS BACK , THEN SHE DEVELOPED COUGH WITH SPUTUM SINCE 15 DAYS WHICH IS WHITISH,MUCOID,NON FOUL SMELLING , NON BLOOD STAINED , NO AGGREVATING AND RELIEVING FACTORS . C/O FEVER SINCE 15 DAYS ,EVENING RISE OF TEMPERATURE ,LOW GRADE NOT ASSOCIATED WITH CHILLS. C/O SHORTNESS OF BREATH SINCE 2 DAYS , GRADE 3 MMRC , NO WHEEZE , AGGREVATED ON EXCERTION , NO RELIEVING FACTORS. NO ORTHOPNEA, NO PND . C/O LOSS OF APPETITE , C/O LOSS OF WEIGHT 5KG IN 1MONTH. C/O CHEST PAIN ON RIGHT SIDE SINCE 2DAYS,NON RADIATING. BIOMASS EXPOSURE PRESENT SINCE 30YEARS.  PAST HISTORY  NO H/O SIMILAR COMPLAINTS IN PAST  NO H/O TB IN PAST,NO INHALER USAGE NOT K/C/O DM,HTN,CAD,EPILEPSY,HYPOTHYRODISM  PERSONAL HISTORY  WEIGHT:60 KG  OCCUPATION : HOUSEWIFE NON SMOKER BETEL LEAF CONSUMPTION OCCASIONALLY.   FAMILY HISTORY : NOT SIGNIF
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77 M PERICARDIAL EFFUSION

 C/O DECREASED URINE OUTPUT AND SOB SINCE 4 DAYS  C/O PEDAL EDEMA SINCE 1 DAY  HOPI:  PATIENT WAS APPARENTLY ALRIGHT 4 DAYS BACK THEN HE HAD DECREASED URINE OUTPUT NO HESITANCY, NO DRIBBLING OF URINE C/O SOB GRADE III, ORTHOPNEA +, NO PND C/O PEDAL EDEMA SINCE 1 DAY WHICVH WAS PITTING TYPE COUGH SINCE TODAY ASSOCIATED WITH SPUTU, MUCOID, NON FOUL SMELLING, GENERALISED BODY PAINS+ LOSS OF APPETITE+ 3 EPISODES OF VOMITING+ 3 DAYS BACK, FOOD AS CONTENT  PAST HISTORY NO HISTORY OF DM, HTN,ASTHMA,EPILEPSY,CAD,CVA  PERSONAL HISTORY: DIET:MIXED SLEEP:ADEQUATE BOWEL: PASSED 4 DAYS BACK BLADDER: URINE OUTPUT DECREASED  ADDICTIONS:ALCOHOL DAILY SINCE 50 YEARS, BEEDI 10 SINCE 50 YEARS APPETITE:NORMAL  GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE,WELL ORIENTED TO TIME,PLACE AND PERSON.  NO PALLOR,ICTERUS CYANOSIS,CLUBING,LYMPHADENOPATHY,EDEMA. VITALS: TEMPERATURE:101 F BP:100/60 MM HG PR:90 BPM RR:18 CPM  SYSTEMIC EXAMINATION: CVS:S1,S2 HEARD NO MURMURS. RS:BAE +,NO MURMURS PER A
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32 M PTB

 PT C/O CHEST PAIN ON LEFT SIDE SINCE 2-3MONTHS WITH SOB SINCE 2-3 MONTHS WITH COUGH WITH EXPECTORATION  HOPI: PT WAS APPARENTLY ALRIGHT 2-3MONTHS AGO THEN HE DEVELOPED SOB(GRADE II)WITH COUGH WITH EXPECTORATION ,GREEN COLOURED WITH PALPITATIONS,COUGH INCREASES AFTER FOOD INTAKE AT NIGHT NIGHT TIME RISE OF TEMPERATURE PRESENT ASSOCIATED WITH SWAETING AND WEIGHT LOSS SINCE 3 MONTHS(15-20KGS) LOSS OF APPETITE,NAUSEA PRESENT NO C/O ABDOMINAL PAIN,VOMITINGS,DIARRHEA NO ORTHOPNEA,PND  PAST HISTORY: N/K/C/O DMII, HYPERTENSION,TB,EPILEPSY,CVA,CAD,ASTHAMA,THYROID DISORDERS.  GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE, WELL ORIENTED TO TIME,PLACE AND PERSON.  MODERATELY BUILT AND NOURISHED.  NO SIGNS OF PALLOR,ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA  VITALS: TEMP: AFEBRILE BP: 120/80 MM HG RR: 76 BPM RR: 18 CPM  CVS: S1, S2 HEARD ,NO MURMURS RS: BAE +, NVBS CNS: NFND P/A: SOFT, NON TENDER, BOWEL SOUNDS HEARD  Investigation HEMOGRAM: HB: 9.6 GM/DL TOTAL COUNT: 116
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60 M HTN PERIANAL ABSCESS D12- L1 INFECTIVE SPONDYLODISCITIS

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CHIEF COMPLAINTS   60YEARS OLD MALE DRIVER BY OCCUPATION CAME WITH COMPLAINTS OF LOW BACKPAIN SINCE 3 MONTHS RADIATING TO RIGHT LOWER LIMB HISTORY OF PRESENT ILLNESS PATIENT WAS APPARENTLY ASYMPTOMATIC 3 MONTHS BACK AND THEN DEVELOPED LOW BACK PAIN WHICH IS INSIDIOUS IN ONSET, PROGRESSIVE AGGRAVATING ON WALKING, SQUATTING AND ON STANDING AND NOT RELEIVED ON USING MEDICATION.PAIN IS RADIATING TO RIGHT LOWER LIMB AND ASSOCIATED WITH TINGLING OF RIGHT THIGH REGION. PERSONAL HISTORY BOWEL AND BLADDER MOVEMENTS ARE REGULAR APPETITE NORMAL EX ALCOHOLIC EX SMOKER STOPPED 3 YEARS AGO PAST HISTORY: HISTORY OF SURGERY FOR RENAL CALCULI ONE AND ONE N HALF MONTH BACK  HISTORY OF CVA USED ALTEPLANE STATUSING MEDICATION TAB. ATORVASTATIN, TAB ASPIRIN, TAB ESMOPRAZOLE, TAB RIFAMPICIN SINCE ONE AND HALF MONTH  KNOWN CASE OF TYPE II DM SINCE 2 YEARS USING TAB.METFORMIN 500MG PO BD  K/C/O HYPERTENSION SINCE 2 YEARS USING TELMA 40MG, TAB HYDROCHLORTHIAZIDE  GENERAL EXAMINATION BP:120/8
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