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Bimonthly assessment 2

https://medicinedepartment.blogspot.com/2020/11/blended-learning-bimonthly-assignment.html?m=1 1st case: https://sreejaboga.blogspot.com/2020/11/is-online-e-log-book-to-discuss-our.html?m=1 Chest pain:epigastric region-may be in esophagus (Gerd)or pancreatitis, peptic ulcer, inferior wall MI Abdominal distension : hepatitis,cirrhosis hypoalbuminemia or renal failure or heart failure. In surgical point of view we can also consider peritonitis as he also have abdominal pain (site not mentioned), hollow viscus perforation.  He is a known case of alcoholic so we can also think of hepatorenal syndrome. He also have SOB which can be attributed to lung pathology or heart failure or renal failure which lead to pulmonary edema or pleural effusion causing SOB. He is also a smoker so it goes in favour of lung pathology. His chest X-ray showed pleural effusion. So that explains the crepts in systemic examination.His ABG also shows acidosis which can also cause SOB.  Events: Congenital bow leg defo
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41M with chest pain and polyarthralgia

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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-centered online learning portfolio and your valuable inputs on the comment box is welcome.  This history is of a 41 M, bus cleaner by occupation, which dates back to February when he came to our hospital with complaints of loss of appetite, dyspnea, fatigue which was present since 6 months I.e., since August.Patient was apparently asymptomatic before August of 2019 when he first started feeling weak and out of breath while doing his daily activities which hindered his routine, making him unable to do his work like he used to do. He also has lost weight of app
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71M with Giddiness and nausea since yesterday

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This is a history of 71 M who is a drama director by occupation. His history dates back to 2017 when he first developed shortness of breath where he couldn't even walk more than 20 steps (grade 3) and is associated with increased efforts to take air in, he also gives history of heavy bound palpitations. He gives negative history for pedal edema, cough,cold,fever, night sweats,weight loss at that time. And for his shortness of breath he first came to KIMS hospital and here they got to know that his ecg was abnormal (findings unknown) and they were referred to higher centres in view of need for cardiologist. They went to another hospital in Hyderabad where the cardiologist suggested an angiography. They agreed for it and the result came out to be blockade of three vessels to the heart according to patient's attendant words(patient's wife). For which he had undergone Coronary artery bypass grafting. Later the patient with his attenders repeatedly visited the hospital for follo
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Bimonthly assessment

 CASE 1: 1) Patient have hypoalbunemia which is common in  a case of liver pathology ,this answer can be supported by the albumin levels, even though the levels were normal outside the hospital , but there is hypoalbunemia as per reports from our hospital. Due to starling forces acting here there is ascitis seen.  2) a) The pedal edema may also be explained by the hypoalbunemia hypothesis. But it can also be explained in terms of increased pressure in the abdomen in gross ascitis which may have caused obstruction to the lymphatic vessels and causing pedal edema (this is mostly supported for unilateral pedal edema)  b) in case of pedal edema there is stretching of skin and start cracking up this may alter the defence mechanisms of skin. So when there is compromise of these defence mechanisms even the commensals start acting against us as when they are outside the body (on the skin)  they are criminals but when they enter through the cracks they start acting as pathogens and may develop
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45 M with shortness of breath since two years

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  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-centered online learning portfolio and your valuable inputs on the comment box is welcome.  Case presentation: History is taken  from patient's wife as patient is not able to talk.  A 45 year old male, auto driver by occupation complaints of sudden onset of shortness of breath post dialysis(2/10/2020) since 3 am on 3/10/2020. Patient was apparently asymptomatic 3 years back when one day around 6pm he met with road traffic accident and had fracture of right lower limb. For the fracture rod (Nailing and plating) was inserted.He was incidentally found to h
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55 F with right sided weakness and slurring of speech

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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-centered online learning portfolio and your valuable inputs on the comment box is welcome.  CASE PRESENTATION: History taken by Dr. Aditya samitinjay History is taken from the attenders as the patient is unable to speak. A 60 year old lady presented with a 2 day history of progressive right sided weakness. The patient was feeling well until last Saturday afternoon when she complained of difficulty in mixing food which gradually progressed to an inability to clench her fist by that night. The next morning too this difficulty persisted and she reported that she
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