Dr.Keerthi Madireddy

  case of 90 year old male came with complaints of c/o cough since 15 days SOB since 1 week  Loss of appetite since 1 week  Altered sensorium since 3 days   HOPI:  Patient was apparently asymptomatic 15 days ago then he developed cough insidious onset initially dry later productive and scanty.white to yellow not blood stained more during night. SOB since 1 week insidious onset gradually progessive ,progressed to grade 4, no orthopnea, No PND.No h/o seasonal/diurnal variation. Loss of appetite since 1 week. No h/o fever, vomiting,pain abdomen,loose stools,giddiness. Altered sensorium since 3 days.  No relevant history in the past Personal history: Diet: mixed  Appetite: normal Sleep: Adequate  Bowel and bladder: increased micturition(since 1week), normal bowel movements  No addictions and allergies GENERAL EXAMINATION: Vitals: BP 120/70 MMHG PR 92 BPM RR 28/MIN GRBS 93 MG/DL SpO2 100% ON 6L O2  No pallor,No icterus, cyanosis, clubbing, lymphadenopathy.  SYSTEMIC EXAMINATION :: GIT INSPE

  A 60yr old male hailing from peddagattu,nalgonda district presented with complaints of fever since 6days and pain abdomen since 6days and shortness of breath since 6days. He was apparently asymptomatic 6days back then he developed fever with chills associated with pain in right upper quadrant of abdomen. No H/O vomitings. No aggrevating or reliving factors. H/O pain radiating to right chest and right shoulder region. H/O burning micturation since 6days. C/O cough since yesterday which is productive,whitish mucoid sputum,non blood tinged,non foul smelling No H/O loss of weight,loss of apetite. Past History: No similar complaints in past. Not a K/C/O DM,HTN,Asthma,Epilepsy,TB,CAD,Thyroid. No significant surgical history. Personal History: Appetite is normal Diet is mixed Bowels are regular Micturation is normal Not known allergies Habits-chutta smoking since 40years and 2chutta per day FamilyHistory: No relevent family history. Physical Examination: Patient is C/C/C No pallor,icterus,c

 A 55 YEAR OLD MALE CAME WITH C/0 ABDOMINAL DISTENTION SINCE 1 MONTH DECREASED APPETITE SINCE 20 DAYS FEVER SINCE 10 DAYS HOPI: 55YEAR OLD MALE RESIDENT OF NARKETPALLY MECHANIC BY OCCUPATION , CHRONIC ALCOHOLIC SINCE 30 YEARS 2 QUARTERS PER DAY AND CHRONIC SMOOKER SINCE 30 YEARS , 10 BEEDIS PER DAY HIS WIFE EXPIRED 3 YEARS AGO FROM THEN HE INCREASED THE ALCOHOL INTAKE .  PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH BACK, THEN DEVELOPED ABDOMINAL DISTENTION WHICH IS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE.  FEVER SINCE 10 DAYS WHICH IS OF HIGH GRADE, ASSOCIATED WITH CHILLS AND RIGORS, RAISED DURING EVENING AND NIGHT AND RELIEVED ON MEDICATION.  HE ALSO HAD DECREASED APPETITE SINCE 20 DAYS H/O BLACK COLOURED STOOLS FROM 10 DAYS NO H/O PAIN ABDOMEN NO H/O VOMITING NO H/O LOOSE MOTIONS/CONSTIPATION NO H/O BURNING MICTURITION NO H/O HEMOPTYSIS PAST HISTORY: N/K/C/O    HTN/DM/TB/CAD/CVA/THYROID DISORDER/EPILEPSY PERSONAL HISTORY: DIET- MIXED APPETITE- DECREASED SLEEP- ADEQUATE BOWEL AND