G.Pradeep Kumar

60 YEARS OLD FEMALE WITH SOB CASE DETAILS 60 year old female patient came with c/o SOB  since 3 days SOB ( grade III  progressed to grade IV ) over 3 days Aggravated while lying down (orthopnea ) HISTORY OF PRESENT ILLNESS  Pt. was apparently asymptomatic 3 days back then developed SOB  ( grade III  progressed to grade IV ) over 3 days Aggravated while lying down (orthopnea ) No c/o cough, fever, vomiting, loose stools No c/o pedal edema  PAST HISTORY    K/c/o HTN SINCE 10 YEARS and on medication ( metoprolol & Amlodipine tab. ) DM since 5 years and on medication ( metformin & glimiperide tab.) Not k/c/o CAD, TB, EPILEPSY PERSONAL HISTORY  DIET - MIXED APPETITE - NORMAL SLEEP - INADEQUATE BOWEL & BLADDER - REGULAR NO ADDICTIONS  GENERAL EXAMINATION  VITALS  Pt. Is c/ c/ c Temp - Afebrile  B.P. - 160/ 80 mm Hg P.R - 102 bpm R.R - 15 cpm GRBS - 340 mg /dl Spo2 - 95 % @ 5 lt o2 PHYSICAL EXAMINATION  PALLOR  - ICTERUS -  CYANOSIS - KOILONYCHIA -  LYMPHADENOPATHY - PEDAL EDEMA 

46 YEAR OLD FEMALE PATIENT WITH CKD ON MHD WITH HTN+ DM+ CASE DETAILS  46 YEAR OLD FEMALE PATIENT CAME TO HOSPITAL FOR DIALYSIS C/O PEDAL EDEMA (LT >RT) AND CELLULITIS IN LT LOWER LIMB  K/C/O CKD WITH DM SINCE 15 YEARS,  HTN SINCE 20 YEARS HISTORY OF PRESENT ILLNESS  PATIENT WAS APPARENTLY ASYMPTOMATIC   5 YEARS   AGO THEN SHE UNDERWENT EYE CATARACT SURGERY FOR RIGHT EYE  WHICH WAS NOT SUCCESSFUL AND THE PATIENT WAS ON CONTINUOUS PAIN KILLERS SINCE THEN FOR 4 MONTHS THEN SHE WENT FOR REGULAR MEDICAL CHECK UP 2 YEARS BACK AND FOUND OUT SERUM CREATININE TO BE 7.0. 10 MONTHS BACK DIAGNOSED AS KIDNEY INFECTIONS UNDERWENT MEDICAL TREATMENT AND DJ STENT HAS BEEN KEPT On 18 JAN 2022 PATIENT HAD SEVERE SOB (EVEN AT REST ) AND WAS ADMITTED TO LOCAL HOSPITAL FOLLOWING WHICH HER SERUM CREATININE WAS FOUND TO BE 14.0, SO A FEMORAL LINE WAS PLACED FOR DIALYSIS. SHE UNDERWENT 4 SESSIONS OF DIALYSIS FOLLOWING WHICH THE VEIN GOT CLOTTED AND LEAD TO PROGRESSIVE SWELLING OF THE LEFT LOWER LIMB AND DI

55 YEAR OLD MALE PATIENT WITH PEDAL EDEMA AND SOB WITH DIABETES  CASE DETAILS  A 55 YEAR OLD MALE PATIENT CAME TO THE CASUALITY   WITH  C/O PEDAL EDEMA SINCE 3 MONTHS NAUSEA AND VOMITING SINCE 10DAYS SOB SINCE 10 DAYS HISTORY OF PRESENT ILLNESS  PATIENT WAS APPARENTLY ASYMPTOMATIC 1 YEAR BACK THEN HE SUFFERED WITH FEVER ASSOCIATED WITH HEMATEMESIS FOR 10 DAYS AND RECOVERED AFTER USING MEDICATION AND WAS LATER DIAGNOSED AS DIABETIC AND STARTED MEDICATION. 3 MONTHS BACK HE DEVELOPED PEDAL EDEMA( GRADE III - IV ) WHICH WAS GRADUALLY PROGRESSIVE AND PITTING TYPE ALONG WITH FACIAL PUFFINESS PRESENT NAUSEA AND VOMITING SINCE 10 DAYS  SOB SINCE 10 DAYS  NO H/O REDUCED URINE OUTPUT, BURNING MICTURITION  PAST HISTORY    K/c/o DM SINCE 10 YEARS  NO H/O HTN, ASTHMA, EPILEPSY PERSONAL HISTORY  DIET - MIXED  APPETITE  - NORMAL  SLEEP  -  ADEQUATE  BOWEL AND BLADDER - REGULAR  NO ADDICTIONS GENERAL EXAMINATION Patient is conscious/ coherent /cooperative Moderately built and nourished Vitals : Temp -

  70 YEAR OLD MALE PATIENT WITH PEDAL EDEMA AND SOB CASE DETAILS : 70 year old Paddy farmer, came to OPD with c/o B/L pedal edema and shortness of breath since 6 months HISTORY OF PRESENT ILLNESS : Pt was apparently asymptomatic 6 months back, then developed B/L pitting type of pedal edema upto thighs, facial puffiness, anasarca. Then he went to a private hospital in Hyderabad, during routine investigations was told to have elevated creatine levels and was told to undergo dialysis Pt then came to KIMS, NKP for further management.  Pt has lost his livelihood since the last 6 months because he's been unable to work. He's survived by his wife and his son who lives elsewhere. He also has two daughters but they don't live with him. C/o B/L hip pain since 6 months  No c/o decreased output of urine No h/o Fever, cough, cold In KIMS, KNO, pt underwent 10 sessions of dialysis 1st-8/12 2nd-11/12 3rd-15/12 4th-22/12 5th-27/12 6th-31/12 7th-8/1 8th-17/1 9th-22/1 10th-26/1 PAST HISTORY

82 YEARS OLD MALE PATIENT WITH SOB AND PEDAL EDEMA CASE DETAILS 82 year old male patient came to the OPD with chief complaints shortness of breath and bilateral pedal edema since 3 months associated with intermittent chest pain and cough since 15 days HISTORY OF PRESENT ILLNESS Patient was apparently asymptomatic 4 years back then developed fever with burning micturition and diagnosed HTN by local RMP doctor and was on medication,  3 months back he developed shortness of breath more while lying down (orthopnea) associated with cough (wet type sputum present)  H/O bilateral pedal edema since 3 months and pitting type H/O chest pain which is intermittent since 15 days No H/O burning micturition, decreased urine output, fever, palpitations. PAST HISTORY K/C/O Hypertension Since 4 years on medication Tab Telmisartan 40 mg Not a K/C/O DM, TB, Asthma, Epilepsy PERSONAL HISTORY Diet - Mixed Appetite - Decreased Sleep - Adequate Bowel & Bladder - Regular  GENERAL EXAMINATION Patient is con