70 year old female with altered sensorium under evaluation

-

 Icu bed no 3 :

70y old female shopkeeper by occupation survived by 3 kids came to tha casuality with complaints of fever since 2 days insidious in onset gradually progressive subsided on taking medication, not associated with chills and rigour. patient attenders have observed irrelevant talk since yesterday mrng she was taken to a local hospital where she was referred to our hsptl for further management

 k/c/o HTN on telma 40 and DM on glimi M2 and antiplatelets 


O/E:

Pt is consious , non coherent , non cooperative 

Febrile :100.8

Bp :150/60

PR:79bpm

Grbs:158


CNS EXAMINATION:

Slurred speech 

Pupils dilated :Rt -2-3mm

                          Lt -2-3 mm 

Tone :          Rt                   Lt

          UL      Normal       Normal

          LL       Normal       Normal


Power:          Rt                   Lt

         UL      5/5                 5/5

         LL       5/5                 5/5


Relfex:    

                     Rt                  Lt

            B -   2+                 2+

            T -   2+                 2+

            S-    2+                 2+

            A -    -                   -

            K -    -                   -

            

P-    Flexor          Flexor 


neck stiffness +

Kernings +

Brudzinskis  +


LP DONE

V -1.5 cc

C -colourless

A-clear

TC-2 cells

DC-100% lymphocytes 

RBC- nil

Others-nil

Altered sensorium under evaluation 

CSF

Sugar:120

Proteins:31

Chlorides:119



Diagnosis : meningitis 

Popular posts from this blog

1601006071-(SHORT CASE)

-
Image
FINAL MBBS EXAM- SHORT CASE "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: A 35 year old male patient resident of ramchandrapuram,  daily labourer by occupation came to the  OPD with chief complaints of painless small lesions associated with redness since 3 months. He is a chronic alcoholic (drinks 90ml daily) and chronic smoker (smokes one beddi packet every 2 days).   The lesions initially appeared on the face and the progressed to involve the trunk, hands and feet.  Not associated with discharge
Read more

1601006071-(LONG CASE )

-
Image
  I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.  Case :  A 55year old male patient, resident of miriyalaguda, who is a toddy climber by occupation came to the medicine out patient department with Chief complaints of pain abdomen and fever. The chief complaints in order of chronology I found are  1) Severe pain abdomen since 10 days. 2) Fever since 7 days. HISTORY OF PRESENTING ILLNESS:                         Patient was apparently asymptomatic 10 days back and later developed - -severe  pain abdomen  in the right upper quadrant region of abdomen ,which was sudden in onset, gradually progressive , dragging type and non radiating pain. It is aggravated on standing and relieved for sometime upon taking medication. Not associated with nausea, vom
Read more

A 30 year old female with right sided pneumonia

-
A  30 year old female who is a house wife came to casualty  at 11.00 pm  with c/o fever since 10 days cough since 10 days and shortness of breath since 2 days.  Patient was apparently asymptomatic 10 days back later she developed fever which was insidious in onset low grade with evening rise of temperature not relieved on medication associated with chills and rigors  Fever is associated with dry cough since 10 days not associated with any postural or diurnal variation, cough is associated with pain in right side of chest. Cough was progressive associated with shortness of breath since 2 days more in the evening  No PND, orthopnea,  Not a k/c/o HTN, DM, asthma, epilepsy, CVA, CAD  No h/o pedal edema, chest pain, palpitations, headache, tinnitus, blurring of vision  On examination:  No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema  No signs of malnutrition or dehydration  Vitals:  Temp: 98.4OF  PR: 92/ min  RR- 28/min  BP- 90/60 mmhg  SpO2- 98% on RA  GRBS- 1
Read more