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ALTERED SENSORIUM SECONDARY TO ACUTE INFARCT IN LEFT MCA TERRITORY (LEFT FRONTAL,TEMPORAL,PARIETAL LOBES) WITH RIGHT HEMIPARESIS GENERALISED TONIC CLONIC SEIZURES ASPIRATION PNEUMONIA HEART FAILURE WITH MID RANGE EJECTION FRACTION(EF=49%) WITH ACUTE PULMONARY EDEMA K/C/O HYPERTENSION SINCE 3 YEARS K/C/O CKD K/C/O HYPOTHYROIDISM SINCE 1.5 YEARS K/C/O COPD

Case History and Clinical Findings A 85 YEAR OLD MALE PRESENTED TO CASUALTY IN UNRESPONSIVE STATE AT 10 AM -DIFFICULTY IN WALKING SINCE 3-5 YEARS HOPI:-PATIENT WAS APPRENTLY ASYMPTOMATIC TILL TODAY MORNING AND THE PATIENT HAD AN HISTORY OF FALL AT HOME FROM CHAIR AT 10 AM AND AFTER THAT PATIENT WAS NOT TALKING SINCE THEN AND NO INVOLUNTARY MOVEMENTS. FROTHING FROM MOUTH –NEGATIVE INVOLUNTARY DEFECATION- NEGATIVE ; MICTURITION + ; DEVIATION OF MOUTH TOWARDS LEFT SIDE+ POST-ICTAL CONFUSION+ H/O HEARING LOSS NO H/O SIMILAR COMPLAINTS IN THE PAST. NO H/O FEVER,COLD,COUGH ALLERGIES,ABDOMINAL PAIN,NAUSEA,VOMITING K/C/O HEART FAILURE WITH MID RANGE EJECTION FRACTION(45%)?SECONDARY TO CAD ON T. ECOSPIRIN AV 75/40 OD AT 9PMCARDIVAS 3.125 MG BD NON OLIGURIC AKI ON CKD X 9-10 YEARS ON CONSERVATIVE MANAGEMENT K/C/O HYPERTENSION SINCE 3 YEARS ON TAB. TELMA 20 MG OD K/C/O HYPOTHYROIDISM SINCE 1.5 YEARS ON T. THYRONORM 25MCG OD FAMILY HISTORY:-INSIGNIFICANT PERSONAL HISTORY:- DIET-MIXED SLEEP-ADEQUAT
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ALTERED SENSORIUM (RESOLVED)SECONDARY TO SEPSIS- SEPTIC ENCEPHALOPATHY WET GANGRENE OF LEFT 3RD TOE- S/P DISARTICULATION OF 3 RD TOE ON 10-08-2023 WITH CELLULITIS OF LEFT LEG WITH UNCINTROLLED SUGARS WITH THYOE II DM AND HTN WITH ANAEMIA (NCNC)

Case History and Clinical Findings  C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS  PAST HISTORY: K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/OD PERSONAL HISTORY :  SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA  VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON RA CVS :S1,S2 HEARD,NO M
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ALTERED SENSORIUM SECONDARY TO HYPONATREMIA EUVOLEMIC ? SIADH ? WITH HYPOKELEMIA WITH SMALL HEMORRHAGIC CONTUSION FRONTAL LOBE WITH AKI ( RESLOVING ) WITH HYPERTENSION SINCE 4 YEARS,WITH TYPE 2 DIABETES SINCE 18 YEARS

Case History and Clinical Findings  A 60 YEAR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE YESTERDAY NIGHT PATIENT WAS APPARENTLY ASYMPTOMATIC 10YEARS BACK THEN HE DEVELOPED DM-2 SIMILAR EPISODE THEN HE DIAGNOSED TO HAVE DM-2 AND STARTED ON OHA LATER AFTER FEW YEARS PATIENT WAS SHIFTED TO INSULIN 4YEARS BACK PATIENT DEVELOPED GIDDINESS AND WHILE WORKING PT HAF FALL, FRACTURE RT UL &RT LL, DIAGNOSED WITH HTN ( ON TAB.METOSARTAN CH50, METOPROLOL 50, TELMA 40 ) 2 YEARS BACK PT DEVELOPED SIMILAR COMPLAINTS OF ALTERED SENSORIUM AND WAS HAVING HYPERGLYCEMIA AT PRIVATE HSPTL THEN WAS DIAGNOSED TO HAVE ? DKA ; -GIVEN INSULIN AND TREATEDAFTER THAT;10 DAYS BACK PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WENT TO PUT PRACTITIONER AND DIAGNOSED TO HAVE DIABETIC FOOT AND WAS TREATED WITH REGULAR DRESSINGS AND ANTIBIOTICS LATER 4 DAYS BACK PATIENT DEVELOPED NAUSEA , VOMITING - 2 EPISODES / DAY ASSOCIATED WITH FOOD INT
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ALTERED SENSORIUM (RESOLVED)SECONDARY TO SEPSIS- SEPTIC ENCEPHALOPATHY WET GANGRENE OF LEFT 3RD TOE- S/P DISARTICULATION OF 3 RD TOE ON 10-08-2023 WITH CELLULITIS OF LEFT LEG WITH UNCINTROLLED SUGARS WITH THYOE II DM AND HTN WITH ANAEMIA (NCNC)

Case History and Clinical Findings  C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS  PAST HISTORY: K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/ODPERSONAL HISTORY : SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA  VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON RA CVS :S1,S2 HEARD,NO MUR
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ALTERED SENSORIUM SECONDARY TO HYPONATREMIA EUVOLEMIC ? SIADH ? WITH HYPOKELEMIA WITH SMALL HEMORRHAGIC CONTUSION FRONTAL LOBE WITH AKI ( RESLOVING ) WITH HYPERTENSION SINCE 4 YEARS,WITH TYPE 2 DIABETES SINCE 18 YEARS

Case History and Clinical Findings  A 60 YEAR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE YESTERDAY NIGHT PATIENT WAS APPARENTLY ASYMPTOMATIC 10YEARS BACK THEN HE DEVELOPED DM-2 SIMILAR EPISODE THEN HE DIAGNOSED TO HAVE DM-2 AND STARTED ON OHA LATER AFTER FEW YEARS PATIENT WAS SHIFTED TO INSULIN 4YEARS BACK PATIENT DEVELOPED GIDDINESS AND WHILE WORKING PT HAF FALL, FRACTURE RT UL &RT LL, DIAGNOSED WITH HTN ( ON TAB.METOSARTAN CH50, METOPROLOL 50, TELMA 40 ) 2 YEARS BACK PT DEVELOPED SIMILAR COMPLAINTS OF ALTERED SENSORIUM AND WAS HAVING HYPERGLYCEMIA AT PRIVATE HSPTL THEN WAS DIAGNOSED TO HAVE ? DKA ; -GIVEN INSULIN AND TREATEDAFTER THAT;10 DAYS BACK PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WENT TO PUT PRACTITIONER AND DIAGNOSED TO HAVE DIABETIC FOOT AND WAS TREATED WITH REGULAR DRESSINGS AND ANTIBIOTICS LATER 4 DAYS BACK PATIENT DEVELOPED NAUSEA , VOMITING - 2 EPISODES / DAY ASSOCIATED WITH FOOD INT
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ALTERED SENSORIUM SECONDARY TO SEPTIC ENCEPHALOPATHY ?UREMIC ENCEPHALOPATHY(RESOLVING)HYPOGLYCEMIA(RESOLVED) WITH ULCER OVER ANTERIOR ASPECT OF LOWER LIMB SECONDARY TO FILARIASIS WITH AKI(PRE RENAL)WITH K/C/O HTN SINCE 10 YRS,K/C/O CAD SINCE 2 YRS S/P : 5 SESSIONS OF HAEMODIALYSIS DONE

Case History and Clinical Findings  PATIENT WAS BROUGHT TO CASUALTY WITH COMPLAINTS OF PAIN ABDOMEN SINCE 4 DAYS AND SWELLING OF LEFT LOWER LIMB SINCE 4 DAYS  HOPI:  PATIENT WAS APPARENTLY ASYMPTOMATIC 4 DAYS AGO THEN SHE DEVELOPED PAIN ABDOMEN WHICH IS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE. NO AGGRAVATING AND RELEIVING FACTORS. SQUEEZING TYPE OF PAIN PRESENT. H/O FEVER CONTINUOUS TYPE AND RELEIVED ON MEDICATION H/O ANOREXIA,NAUSEA PRESENT NO H/O VOMITINGS H/O ITCHING PRESENT OVER LEFT LEG 5 DAYS AGO K/C/O HTN AND ON REGULAR MEDICATIONN/K/C/O TB,ASTHMA,DM,CVA,CAD,THYROID DISORDERS,EPILEPSY PERSONAL HISTORY:APPETITE IS NORMALDIET IS MIXEDSLEEP ADEQUATEBOWEL AND BLADDER REGULARADDICTIONS- NO FAMILY HISTORY: NO RELAVANT FAMILY HISTORY GENERAL EXAMINATION: PATIENT IS CONSCIOUS, COHERENT,COOPERATIVE.MODERATELY BUILT AND NOURISHEDNO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,LYMPHEDENOPATHY, VITALS:TEMP: 98.6FPR: 78BPMBP: 130/90MMHGRR: 18CPM CVS: S1S2 HEARDRS: BAE+ P/A: SOFT AND NON TENDER
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ACUTE ON CHRONIC DECOMPENSATED LIVER DISEASE, NORMOCYTIC NORMOCHROMIC ANEMIA [HYPOPROLIFERATIVE] WITH ANEMIA OF CHRONIC DISEASE HRS-CHRONIC KIDNEY DISEASE? DIABETIC NEPHROPATHY WITH ?PORTO PULMONARY HTN

Case History and Clinical Findings  C/O ABDOMINAL DISTENSION SINCE 4 MONTHS ON AND OFF SHORTNESS OF BREATH SINCE 4MONTHS   HISTORY OF PRESENTING ILLNESS PATIENT WAS APPARENTLY ASYMOTOMATIC 4 MONTHS AGO THEN HE STARTED C/O ABDOMINAL DISTENSION WHICH WAS DISTENSION WHICHWAS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE SINCE 1 MONTH ABDOMINAL DISTENSION IS PROGRESSIVE IN NATURE FOR WHICH HE VISITED GANDHI HOSPITAL AND WAS DIAGNOSD AS ALD WITH PORTAL HTN WITH DECOMPENSATED LIVER LIVER DISEASE WITH HEPATIC ENCEPHALOPATHY GRADE 1 WITH RT PLEURAL EFFUSION -MILD.PEDAL EDEMA SINCE 4 MONTHS INSIDIOUS IN ONSET GRADUALIIY PROGRESSIVE ,RELIEVED AT NIGHT ,AGGRAVATED IN THE MORNING [PITTING EDEMA] -SOB DUE TO ABDOMINAL DISTENSON , PRESENT EVEN ON REST ORTHOPNEA AND PND PRESENT NO CHEST PAIN,PALPITATION. C/O DECREASED URINE OUTPUT SINCE 1 MONTH PATIENT IS ON FOLEYS CATHETER SINCE THEN-K/C/O DM 2 SINCE 15 YEARS-OPERATED FOR ILIOPSOAS ABSCESS [10MONTHS AGO]  TREATMENT HISTORY INJ.MIXTARDBD FOR DM2 SURGE
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