General medicine: Internal examination

Internal examination

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39 year old male patient from West Bengal

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This is a case of a 39 year old bus driver who is a resident of West Bengal. CHIEF COMPLAINT : Abdominal distension since 2 months. Swelling in the leg since 2 months. Decreased appetite since 2 months. Decreased urine output since 1 month.   HISTORY OF PRESENT ILLNESS- Patient was apparently asymptomatic 2 months ago then he developed abdominal distension which was insidious in onset and gradually progressive, associated with decreased appetite. Later he developed bilateral pedal edema extending upto the knees which is of pitting type. After a month his urine output got decreased still he continued his work as a bus driver. His relatives started noticing that his abdomen is getting distended and his appetite is decreased. They suggested him to see a doctor following which he took a homeopathic treatment in West Bengal But there was no improvement. He also took some ayurvedic medication but nothing seemed to work out. Then he came to our hospital with complaints of abdominal disten...
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OSCE and Learning points

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OSCE AND LEARNING POINTS PREFINAL PRACTICAL EXAMS NAME : VAGISHA RANI ROLL NO: 138 DATE: 4 December '23 Blog link: https://vagisharani.blogspot.com/2023/12/48-year-old-male-patient-from-west.html QUESTIONS  1) West haven criteria clinical grade for hepatic encephalopathy. 2) Wilson's disease and cirrhosis of liver  Wilsons diease is an inborn errors of copper metabolism characterised by increased total body copper. Etiology: Molecular defect within the copper transporting ATPase encoded by gene ( ATP7B) located on chromosome 13 Pathology:  Copper enters the body through the digestive tract with the help of a transporter protein in the cells of the small bowel, copper membrane transporter 1 (Ctr1; SLC31A1).  In response to rising copper levels, an enzyme called ATP7A releases copper into the portal vein to the liver. Liver cells carry the CMT1 protein and metallothionein, and then ATOX1 binds it inside the cell. Once here, ATP7B links the copper to cerulop...
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59 year old female

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This is a case of a 59 year old professor who is a resident of West Bengal. CHIEF COMPLAINT : Case of  Rheumatoid arthritis under medication.   HISTORY OF PRESENT ILLNESS- Patient was apparently asymptomatic an year and half ago.  Then she felt pain in her left wrist joint which was insidious in onset and gradually progressive in nature. It slowly progressed to the hands and shoulder on both the sides with an increased intensity causing difficulty in daily activities and sleep. She used painkillers which provided relief for sometime.  She underwent a physiotherapy for a month. She also took steroid injections twice in a local hospital in West Bengal but the pain reappeared later. There is no history of swellings, morning stiffness, malaise, musculoskeletal pain, weight loss,fever or rash. On February 2022, she went to a specialist in Hyderabad, who suggested her some medications but there was no improvement. Later she went to an OPD in Nalgonda and she got relieved f...
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