General medicine case history






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Introduction

A 26 yr old male patient came to causality on 18/12/21 from nakerekal with the complaints of fever with chills, cough and breathlessness since 3 days and vomiting since 1day

History of present Illness 

Patient was apparently asymptomatic 5 months back. 

4 months back under the influence of alcohol he had a history of fall from bike and at the time of fall he had sustained head injury with no history of consciousness, ent bleeding and then he was admitted to local hospital there while he was receiving the treatment he developed fever with chills, cough with sputum, and bipedal edema and then he was admitted to the kims. And he received the treatment for about 10 days and later his symptoms subsided and he was discharged. 

In between duration gap between these august and the date of admission he developed the same episodes of symptoms for about 3times then he consulted a local doctor (RMP) and later the symptoms subsided on taking medication. 

3days back patient developed fever with chills, cough with sputum, and shortness of breath (grade-3) and before the admission-1 he had history of vomiting which is in bilious colour

Sob aggravates on lying down position and relieves when he turned to one side. 

Patient gave a history of consanguineous marriage of his parents And he was diagnosed with dextrocardia on the 4th day of his birth for which he was given treatment and later he was discharged after reliving the symptoms

History ofpastillnes


No history of diabetes , hypertension, asthma, tuberculosis and epilepsy

Personal history

No loss of apetite

Diet:mixed

No sleep disturbances

Bowel and bladder movements :-normal

Patient has history of consuming alcohol (90ml per day) and now he withdrawn the habit 

No history of smoking

Family history

No similar complaints in the family

General examination

Patient is concious, coherent, and cooperative

No pallor

No icterus

No clubbing

No cyanosis

No regional lympadenopathy

Vitals:-

Temperature :-99.3F 

Respiratory rate:-38cycles/min

Pulse rate :-104beats/min

Blood pressure:-90/60mmHg






























































































Systemic Examination:-
Cardiovascular system

Inspection:chest wall is bilaterally symmetrical

No precordial bulge

No visible pulsations, engorged veins, scars, sinuses,carotid artery was prominent

Palpation:-jvp is not seen
Auscultation - s1ands2 heard,apex beat is heard in the 5th rib interspace medil to the nipple. 

Respiratory system:-

No dysponea
No wheezing
Trachea is centrally positioned
Vesicular breath sounds
Adventitious sounds:-BLcreptsIAA/IMA

Per abdomen:-
Sound of abdomen:-scaphoid 
No tenderness
No palpable mass
Hernial orifice:-normal
No free fluid present
No bruits
Liver and slpeen not palpable
Bowel sounds present
 
Provisional diagnosis

Kartagener syndrome associated with viral pneumonia. 

Investigations:-

























Chest x-ray

















Haemoglobin:-16.6%
Total leukocyte count:-14, 800/ml
Platelet count:-2, 91,000

Liver function test

Total bilrubin :-2.62mg/

Direct bilrubin:0.62mg/dl

Ast:-25IU/L

ALT:-22IU/L

Total protiens:7.3g/dl

Albumin :2.2g/dl

Renal function test:-

Urea-37mg/dl

Creatinine-1.1mg/dl

Serum electrolytes

Calcium-10.2mg/dl

Sodium-140mEq/L

Pottasium-5.5mEq/L

Chloride-92mEq/L

TREATMENT 

Neb-budecort-12th hourly

       -ipravent-8th hourly 

Inj Lasix 20mg/IV/BD

Inj PANTOP 40mg/IV/OD

Inj NORAD 2amp in 48ml normal saline

Inj Augmentin 1.2gm/IV/BD

Tab Azithromycin 500mg/PO/OD

Tab Paracetamol 650mg

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