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GM CASES

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Date of admission: 10-08-2021 63 year old male presented to the casualty with history of one episode of involuntary movements of both upper and lower limbs around 11:00 pm, lasting for 5-10 min associated with ictal cry, uprolling of eyeballs and deviation of mouth with ?cheek bite followed by post ictal confusion lasting for 10-15 min. No H/o involuntary micturition or defecation. He was taken to a local hospital, where he was administered epitoun and was referred to KIMS (around 1am) After presentation there was another episode of involuntary movements of both upper and lower limbs, GTCS type with deviation of mouth, lasting for 1-2 mins followed by post ictal confusion for 2-3 min. He is a known case of seizures since 30 years and on medication carbamazepine 200mg OD & 400mg HS. But he didn't take medication since 2 days. H/o seizures yearly once or twice for 10 years and was seizure free for the past 10 years. Known case of type 2 DM since 6 months and on GLIMI 1mg, METFOR
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GM CASES

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80 year old female, daily wage labourer by occupation came with chief complaints of Constipation since 3 weeks, pedal edema since 1 week, shortness of breath, cough, abdominal distension and decreased urine output since 3 days. History of present illness : She was apparently asymptomatic 3 weeks back. Then c/o difficulty in passing stools (once in 3-4 days) and decreased appetite.  From the past 1 week, patient c/o pedal edema which is of pitting type, extending upto knees. She c/o sob since 3 days, which was sudden in onset, progressed from grade 3 to 4. C/o cough since 3 days which was productive, mucoid and non blood stained. History of abdominal distension and decreased urine output since 3 days. No c/o palpitations, chest pain, syncopal attacks No history of significant weight loss. Past history : History of TB 30 years back and used ATT for 4-6 months Not a known case of hypertension, diabetes mellitus, asthma, epilepsy, CAD, CVA, Thyroid disorders. Personal history : She consume
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GM CASES

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50 year old female came with complaints of abdominal distension, shortness of breath, burning micturition, decreased appetite, nausea since 5 days and dry cough since yesterday. History of present illness: Patient was apparently asymptomatic 2 years back, then diagnosed with pancreatitis and AKI, for which she underwent 2 sessions of hemodialysis. At that time, she also tested positive for dengue. 2 months back, she tested positive for covid 19 and received medication at home. She was also diagnosed to be diabetic and hypertensive, but on irregular medication. Now, she c/o abdominal distension, decreased appetite, nausea, burning micturition and sob on exertion (grade 2); for which she went to local hospital but her symptoms did not subside. So, she came here for better treatment. No h/o palpitations, chest pain, fever, decreased urine output, pedal edema, orthopnea, PND, vomitings. Past history: Not a known case of asthma, TB, epilepsy, CAD, CVA, thyroid disorders. No h/o surgeries an
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JUNE ASSESSMENT

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JUNE ASSESSMENT: Q 1: What is the reason for anaemia in this case? Ans: When you have kidney disease, your kidneys cannot make enough EPO. Low EPO levels cause your red blood cell count to drop and anemia to develop. Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO Link: https://www.kidney.org/atoz/content/what_anemia_ckd My analysis: In this case, the most probable reason for anemia could be CKD---> due to reduced erythropoietin production. I agree with his answer. Ans 2: Link to my cases: http://pallavi191.blogspot.com/2021/06/gm-cases_30.html Ans 3&4: *MULTISYSTEM: https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1 My analysis: Problem list: Vomitings Diarrhea Fever  Icterus Hematuria Low backache Critical appraisal: Events which occurred before & after the presentation were mentioned in an order Fever chart was very
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