Dr.Lahari Kantoju

Diagnosis  IRON DEFICIENCY ANEMIA TO BLOOD LOSS (ANAL FISSURE) Case History and Clinical Findings C/O HEADCHE SINCE 1 WEEK C/O VOMITINGS 2 DAYS BACK C/O HEAVINESS OF CHEST SINCE 2 DAYS PT WAS APPARENTLY ASYMPTOMATIC 1MONTH BACK THEN SHE HAD 2 EPISODES OF VOMITING TREATED SYMPTOMATICALLY A/W HEADACHE NON PROJECTILE NON BILIOUS FOOD PARTICLES CONTENT MENSTRUAL HISTORY - 3 DAYS/30DAYS CLOTS - , PAIN - H/O IRREGULAR MENSTRUATION CYCLES MENARCHE AT 17Y NO H/O CHEST PAIN, SHORTNESS OF BREATH ,PAIN ABDOMEN ,LOOSE STOOLS, NAUSEA+ ,VOMITING -, FEVER -, WORM INFESTATION - ,PICA- H/O BLEEDING PER RECTUM 1 EPISODE - TODAY [FEW RED DROPS IN STOOL] -HEMOPTYSIS -, HEMETEMESIS - ,BLEEDING GUMS HEADACHE - UNILATERAL THROBBING TYPE NON RADIATING - NO NAUSEA , VOMITING , - PHOTOPHOBIA HEAVINESS OF CHEST - NOT A/W FOOD INTAKE NOT A/W EXERTION NUTRITIONAL HISTORY; MORNING - TIFFIN[IDLY , DOSA , BONDA , POORI ] AFTERNOON - SAMBAR /CURRY/CURD+RICE NO SNACKS NIGHT - CURRY/PICKLE/CURD - RICE NO SIMILAR COMPLAI

FIBROMYALGIA OF RIGHT SHOULDER TRAPEZIUS TENDERNESS ACID PEPTIC DISEASE IRON DEFICIENCY ANEMIA SECONDARY TO NUTRITIONAL DEFICIENCY MELESMA +PITYRIASIS VERSICOLOR DENEVO DIABETES MELLITUS DENEVO HYPERTENSION Case History and Clinical Findings C/O RIGHT SHOULDER PAIN SINCE 6MONTHS LOWER BACKACHE SINCE 6 MONTHS CHEST PAIN SINCE 1 WEEK HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC AND ALRIGHT 6 MONTHS BACK AND THEN SHE DEVELOPED SHOULDER PAIN @ RIGHT SIDED OF SUPRASCAPULAR AREA,PAIN+,INSIDIOUS ONSET GRADUALLY PROGRESSIVE,TENDERNESS - ,NO RESTRICTION OF MOVEMENTS,AGGREVATING ON DOING HEAVY WORK AND NO RELIEVING FACTORS A/W LOWER BACK ACHE SINCE 6 MONTHS,PAIN+ ,TENDERNESS- ,AGGREVATING ON BENDING AND WORKING AND RELIEVED BY TAKING REST CHEST PAIN SINCE 1 WEEK AT RETROSTERNAL REGION, EPIGASTRIC REGIONAL PAIN +,BURNING SENSATION +,REGURGITATION -,BELCHINGS -,AGGREVATING ON EATING SPICY FOOD AND NO RELIEVING FACTORS N/H/O FEVER,COLD,COUGH,ALLERGIES N/H/O ABDOMINAL PAIN,NAUSEA,VOMITING,LOOSE STOOLS

 Diagnosis IRON DEFICIENCY ANEMIA SECONDARY TO ? NUTRITIONAL CAUSE WITH LEFT EAR OTOMYCOSIS Case History and Clinical Findings CHIEF COMPLAINTS : SOB ON EXERTION SINCE 1 MONTH GENERALIZED WEAKNESS SINCE 1MONTH LT.EAR PAIN SINCE 1 MONTH HISTORY OF PRESENTING ILLNESS: Patient was apparently asymptomatic 1 month back and then she noticed SOB on exertion(while doing work) since 1 month and stopped her work 20 days back & aggeneralised weakness since 1 month. No h/o fever,cough ,PND, orthopnea SEQUENCE OF EVENTS: 5 years back(in 2017) patient had chest pain and SOB on exertion and was diagnosed with anemia and had PRBC transfusion.she used to take oral iron(orofer) for 1 yr after that. In 2021,August she came with complaints of headache(right occipital region),vomitings and giddiness and got treated for the same.she had one more PRBC transfusion Now,she complaints of left ear pain and left ear discharge since 1 month and diagnosed with otomycosis,is on medications DAILY ROUTINE: She use

 Diagnosis DIMORPHIC ANAEMIA(BICYTOPENIA) WITH CKD(STAGE 4) WITH 4 SESSIONS OF HEMODIALYSIS DONE (2019) Case History and Clinical Findings COMPLAINTS: 80 YEAR MALE WITH C/O TINGLING AND NUMBNESS OF BOTH UL AND LL SINCE 1 WEEK. HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC TILL LAST WEEK,THEN DEVELOPED HAEMATURIA SINCE LAST FRIDAY, IN EACH EPISODE OF URINE OUTPUT, WHICH LASTED FOR 4 DAYS.NO AGGREVATING FACTORS, NO RELIEVING FACTORS. H/O DECREASED URINE OUTPUT SINCE 1 MONTH, BUT INCREASED FREQUENCY. NO H/O BURNING MICTURITION, HESITANCY OR URGENCY NO H/O BLEEDING MANIFESTATIONS,PETECHIAE,RASH,NO HEMATURIA,NO BLOOD IN STOOL(MELENA),NO BLLEDING GUMS. NO H/O FEVER, COUGH, COLD, PAIN ABDOMEN NO H/O CHEST PAIN, PALPITATIONS, ORTHOPNEA AND PND ,TINGLING AND NUMBNESS OF UL AND LL SINCE 1 WEEK. NO POLYPHAGIA,POLYDYPSIA,NOCTURIA POLYURIA PRESENT UROLOGY REFERRAL TAKEN IN VIEW OF HEMATURIA ?URINARY BLADDER CARCINOMA DIAGNOSIS:BPH WITH GRADE 2 RPD CHANGES ADVICE:T.TAMSULOSIN 0.4 MGX2 WEEKS T.PANTOP 40M

DIAGNOSIS SEVERE IRON DEFICIENCY ANEMIA SECONDARY TO NUTRITIONAL DEFICIENCY Case History : 35 YEARS OLD FEMALE, CAME WITH CHIEF COMPLAINTS OF 1) SHORTNESS OF BREATH SINCE 3 MONTHS , 2) FEVER SINCE 1 MONTH 3) GENERALISED WEAKNESS SINCE 1 MONTH HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 3 MONTHS BACK THEN SHE HAD SHORTNESS OF BREATH WHICH RELIEVED ON TAKING REST ,NO ORTHOPNEA, NO PND. -C/O GENERALISED WEAKNESS SINCE 1MONTH ,13 DAYS BACK SHE WENT TO THE SURYAPET HOSPITAL ,THERE THEY DID HAEMOGRAM AND DIAGNOSED AS ANEMIA, AT THAT TIME HER HB WAS 3 GM/DL. -C/O FEVER SINCE 1 MONTH, INTERMITTENT IN NATURE.10 DAYS BACK SHE HAD HIGH GRADE FEVER, ASSOCIATED WITH CHILLS AND RIGORS,RELIEVED ON TAKING MEDICATION. -C/O COUGH SINCE 2 DAYS ,WHICH IS PRODUCTIVE, YELLOWISH IN COLOUR AND NON FOUL SMELLING -H/O HEAVY BLEEDING LAST MONTH (LASTED FOR 11 DAYS(1ST 6 DAYS HEAVY BLEEDING THEN NEXT 2 DAYS BLEEDING, STOPPED THEN AGAIN 5 DAYS BLEEDING OCCURED) -NO H/O BLOOD IN THE STOOLS, HEMATEMESIS , MALENA,HEMO

 46,F Diagnosis  MILD ANTRAL GASTRITIS ? SJOGRENS / ? MIXED CONNECTIVE TISSUE DISORDER ANAEMIA SECONDARY TO INFLAMATORY DISEASE  Case History and Clinical Findings  CHIEF COMPLAINTS : PT CAME WITH C/O NAUSEA ,LOSS OF APPTITE ,AND DIFFICULTY BREATHING SINCE 15 DAYS .  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 30 YEAR THEN SHE DEVELOPED DOV WHICH WAS PAINLESS AND GRADUAL PROGRESSIVE . 10YEARS YEARS BACK DEVELOPED JOINT PAINS ASSOCIATED WITH MORNING STIFFNESS.2YEARS BACK PATIENT HAS LOST HER VISION . PATIENT WAS ADMITTED 1MONTH BACK AND EVALUATED .ANA PROFILE SHOWS f/s/o / ? SJOGRENS SYNDROME . NOW SINCE 15 DAYS PATIENT HAD NAUSEA ,LOSS OF APPETITE .NO VOMITINGS ,NO PAIN ABDOMEN .  PAST HISTORY : NOT K/C/O DM/HTN . PERSONAL HISTROY DIET MIXED , SLEEP ADEQUDATE MICTURITION NORMAL BOWEL REGULAR  NON ALCOHOLIC , NON SMOKER .  O/E  PT IS C/C/C AFEBRILE  PR 78 BPM BP 100 /70 MMHG .  CVS S1S2 PRESENT PNS NO ACTIVE DISEASE  Investigation  2D ECHO - NO RWMA EF 58 % NO AS /MS GOOD LV SYSTLIC FUNC

  60 YEAR OLD FEMALE WITH PSYCHOGENIC HYPERVENTILATION & RIGHT RENAL CYST : ** This is an ongoing case. I am in the process of updating and editing this E LOG as and when required. Note: This is an online E Log book recorded to discuss and comprehend our patient's de-identified health data shared, AFTER taking his/her/guardian's signed informed consent. Here, in this series of blogs, we discuss our various patients' problems through series of inputs from available global online community of experts with an aim to solve those patients' clinical problems, with collective current best evidence based inputs. This E-log book also reflects my patient - centered online learning portfolio and of course, your valuable inputs and feedbacks are most welcome through the comments box provided at the very end. I have been given the following case to solve, in an attempt to understand the concept of "Patient clinical analysis data" to develop my own competence in reading