S.Rakesh kumar roll.no.153

Patient was apparently asymptomatic 2weeks back then she developed right leg swelling associated with wound on  the right ankle and right leg anterior region. Swelling extended from the right foot to the mid part of shin.debridement of infection was done four days back.she had h/o of atrial fibrillation before surgery which is controlled. After surgery due to stress  induced  factor atrial fibrillation which-eventually  lead to left heart failure and then right heart failure she developed shortness of breath and pedal edema. No h/o of fever, vomiting Past history: Not known Case of HTN,DM, asthma, qq1 Personal h/o Diet: mixed Bowel and bladder! Regular. Family ho:- No significant family history. GENERAL EXAMINATION:   pt is cc and non cooperative, moderately built and moderately nourished, well oriented with place and time, No pallor, no icterus, no cyanosis, no clubbing, no lymphadenopathy. Vitals: Pulse rate- 123 Bp - 110/80 Rr- 22 Temp- 98.4F Oxygen saturation 96% Systemic examinati

A 60 year old female came to GM OPD with Chief Complaints of fever since ③ days and cough associated with sputum since ③ days. Difficulty in swallowing and pain during swallowing since ③ dogs, hoarseness of voice since ③ days shortness of breath since ③ days HOPI : The patient was apparently asymptomatic ③ days back then she developed high grade fever, cough with sputum which is whitish in coour non foul smelling and  non blood stained. There was a history of difificult in swallowing & pain  during swallowing there  h/o shortness  of breath ③ days back grade -II. decreased appetite since 5-6 months, loss of weight since 1 year.( 20kg wt loss) PAST HISTORY : History of giddiness and fall ,followed by unconsciousness. Known case of hypertension since 1 year but since 5-6 months not on regular medication . Known case of thyroid  disorder since 1 year on medication. known case of DM || since ⑨ years and medication since then, tab- glibeclamide in morning, citagliptin and metformin afte