Dr Raga Deepika Chakravarthula

 PAPAIAH 70/M  C/O DIFFICULTY IN WALKING SINCE 3 WEEKS POOR STREAM OF URINE SINCE 3 WEEKS BURNING MICTURITION AND FEVER SINCE 2 WEEKS HISTORY OF PRESENTING ILLNESS PATIENT WAS APPARENTLY ASYMPTOMATIC 1 YEAR BACK AFTER WHICH HE HAD DEVELOPED SUDDEN ONSET WEAKNESS OF LEFT HAND AND LEG WITH UNCONTROLLED BLOOD PRESSURE AND WAS DIAGNOSED WITH CVA AND TREATED. FROM THE HE GRADUALLY STARTED WALKING WITH THE HELP OF A WALKER .NOW SINCE 2 WEEKS PATIENT AGAIN STARTED DEVELOPING LEFT SIDED WEAKNESS WITH DIFFICULTY IN GETTING UP AND WALKING HE ALSO HAD DECREASED URINE OUTPUT , RIGHT LOIN PAIN WITH BURNING MICTURITION FOR WHICH HE WAS INVESTIGATED AND FOUND TO HAVE RIGHT URETERIC CALICULI CAUSING SEVERE HYDROURETRONEPHROSIS HISTORY OF FEVER ON AND OFF FOR WHICH HE IS ON IREEGULAR MEDICATION SINCE 2 MONTHS PAST HISTORY - K/C/O HTN SINCE 1 YEAR( ON IRREGULAR MEDICATION) N/K/C/O DM, SEIZURE DISORDER ,TB,ASTHMA, PERSONAL- DIET MIXED DECREASED APPETITE CHRONIC SMOKER AND  OCCASIONAL ALCOHOLIC GENERAL EX

N ANJAIAH Case History and Clinical Findings C/O WEAKNESS OF LEFT UPPER AND LOWER LIMB , DEVIATION OF MOUTH TO RIGHT SIDE SINCE MORNING SLURRING OF SPEECH PRESENT SINCE MORNING HOPI: PATIENT WAS APPARENTLY ALRIGHT TILL TODATY MORNING ,THEN HE DEVOLOPED WEAKNESS OF LEFT UPPER AND LOWER LIMB,INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE ASSOCIATED WITH DEVIATION OF MOUTH TO RIGHT SIDE,SLURRING OF SPEECH PRESENT SINCE MORNING NO H/O TRAUMA HEAD ,NAUSEA ,VOMITING , SCIZURES ,GIDDINESS NO H/O FEVER,COLD ,COUGH NO H/O CHEST PAIN,PALPITATIONS ,PND,ORTHOPNEA,BREATHLESSNESS NO H/O ABDOMINAL PAIN,BURNING MICTURITION , PAST H/O : K/C/O HTN ON T METXL 75MG PO.OD SINCE 3 YRS K/C/O CVA LEFT HEMIPARESIS 10 YRS BACK GENERAL EXAMINATION : PT IS CONCIOUS , COHERENT AND COOPERATIVE , MODERATLY BUILT AND NOURISHED . NO PALLOR, ICTERUS , CYANOSIS, CLUBBING ,LYMPHADENOPATHY, EDEMA TEMP - AFEBRILE PR- 60 BPM RR-19 CPM BP- 130/80 MMHG GRBS -123MG /DL SYSTEMIC EXAMINATION : CVS - S1,S2 HEARD , NO MURMURS RS - VESI

 NAGENDRAMMA CHIEF COMPLAINTS :  PATIENT CAME WITH CHIEF COMPLAINTS OF LOSS OF SPEECH SINCE 3 DAYS. HISTORY OF PRESENTING ILLNESS :  PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS THEN SHE DEVELOPED LOSS OF SPEECH AND DIFFICULTY IN SWALLOWING , WHILE OBEYING COMMANDS. PATIENT HAD SIMILAR COMPLAINTS IN PAST 2 MONTHS AGO WITH RIGHT UPPER LIMB PLEGIA WITH SWALLOWING DIFFICULTY AND LOSS OF SPEECH FOR WHICH SHE WAS TAKEN TO LOCAL HOSPITAL AND WAS DIAGNOSED AS ISCHEMIC CVA (CHRONIC INFARCTION IN RIGHT HIGH FRONTOTEMPORAL REGION). NO C/O FEVER, VOMITIMG, HEADACHE, LOOSE STOOLS, BURNING MICTURITION. NO C/O CHEST PAIN,PALPITATIONS,SOB. PAST HISTORY: K/C/O HYPERTENSION SINCE 4YEARS (ON TAB TELMA 40 MG PO/OD). NOT A K/C/O DM,CAD,CVA,EPILEPSY,TB,ASTHMA. PERSONAL HISTORY: DIET: MIXED  SLEEP: ADEQUATE BOWEL AND BLADDER MOVEMENTS: NORMAL ALCOHOL: NO SMOKING: REGULAR SMOKER SINCE 35 YEARS AROUND 1 CHUTTA PACKET/DAY. LAST SMOKE WAS 1 WEEK AGO GENERAL EXAMINATION: THE PATIENT IS CONSCIOUS, COHERENT, COOPERA