Download MBBS Medicine Case Scenario 37

FirstRanker.com

Part A

55 year Mr. Y, Agriculturist by occupation presenting complaints

--- Content provided by​ FirstRanker.com ---

Breathlessness - 7 months

Palpitation - 2 Months

Swelling of lower limbs - 1 & half months

1. Discuss history of presenting illness of each symptom
2. What leading questions you would like to ask this patient?

--- Content provided by FirstRanker.com ---

3. What past history you would like to ask ?

Information at this stage

i) Inabilities to move left, upper and lower limbs- one month

ii) What Personal and treatment history you would to ask?

Part B

--- Content provided by​ FirstRanker.com ---

Conscious, oriented, tachypnoic

Pulse - 100/ m, irregularly irregular

BP 120/80mmhg, RR-26/min, Temp - 101° F

Pallar +, jaundice+, clubbing +, cyanosis+, lymphnode+, odema +, JVP raised.

1. What other specific general examination findings you would like to search for

--- Content provided by​ FirstRanker.com ---

CVS: Silent features:

1. Apex beat (L) 6th intercostals space 2 cm lateral to mid clavicular line
2. Left parasternal pulsation seen
3. Left parasternal bulge present
4. pulsation seen(L) 2nd ICS

--- Content provided by⁠ FirstRanker.com ---

5. Systolic thrill at apex
6. Left parasternal heave present
7. Pan systolic murmur at apex
8. mid diastolic murmur at apex

Abdominal examination

--- Content provided by‌ FirstRanker.com ---

1. Painful hepatomegaly
2. Painful splenomegaly
3. CNS: Left sided hemiparesis

What is your final diagnosis

Part C

--- Content provided by‌ FirstRanker.com ---

HB: 10.0 gm, TC: 18,000, ESR 60 RFT – Normal, SB-4.6 mg, CB-1.4 mg , UB 3.2 Mg

Ultrasound abdomen, Echo, blood culture

How do you manage this patient?

FirstRanker.com

--- Content provided by​ FirstRanker.com ---