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K Vinila Bhavani

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 65 yr old female patient , who is a daily wage labourer came to casualty in altered state  with complaints of : Episodes of slurring of speech since 1 day  Profuse sweating that resolved on having food. Patient was asymptomatic till yesterday 4 pm . patient was brought to casualty in uncounsious state   HISTORY OF PRESENT ILLNESS : Patient has no involuntary movements . Patient has history of sweating and snoring . HISTORY OF PAST ILLNESS : In 2014 patient was discovered with GIST - gastrointestinal stromal tumour on histopathological examination.  In 2016 patient was found to be Mets+ve and was treated with anticancer drugs . In 2019 he was again found to have Mets 16mm in liver . Eye movements1, verbal1, motor4  PERSONAL HISTORY : Diet - mixed  Apetite - normal Bowel movements - regular  Micturition - normal Patient use to drink alcohol occasionally . THERE IS NO RELEVANT FAMILY HISTORY . Patient was having diabetes . VITALS  Pallor - yes  Cyanosis - no  Icterus - yes ( mild )  Lymp
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OSCE and LEARNING POINTS

 http://vinilabhavani.blogspot.com/2023/12/k-vinila-bhavani-case-of-63-yr-old-male.html  OSCE QUESTIONS 1. The sensitivity of diagnosing BPH or prostatomegaly by ultrasound? BPH appears in TRUS as an echogenic and non-mobile mass. TRUS is mainly used to assess prostate volume, which is crucial for therapeutic strategies. Prostate volume can be estimated by serial planimetry, orthogonal plane, rotational body (single plane, ellipsoid) and three-dimensional methods. Staging sensitivities in studies using grey-scale TRUS varied between 30% and 50% with specificities between 77% and 96%. Three-dimensional TRUS aided in the assessment of extracapsular extension and seminal vesicle invasion. 2. How does hypothyroidism affect urine retention?   In hypothyroidism there is loss of medullary hypertonicity impairing urinary concentration ability of kidneys . In hypothyroidism there is a reversible increase in vasopresssin sensitivity causing increased water reabsorbption  3. What are the  causes
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CHIEF COMPLAINTS: A 54yrs old female who is a housewife from Nalgonda came to opd with chief complaints of SOB since 2days and generalised weakness. HOPI: Patient was apparently asymptomatic  8 months ago then she developed SOB which is insidious in onset and continuous in nature which aggravates on walking and also on lying down.It gets relieved on sitting position [grade 3 SOB].It is also associated with dry cough.She also has genearalised weakness and also fever since 8months which is intermittent in nature. She consulted a local doctor in Nalgonda from where she got to know that she has low Hb levels for which she underwent blood transfusion and again back in July her Hb levels were found low[5.0g/dl] and again she underwent blood transfusion[2units] after which her Hb levels increased from 5.0 -8.0g/dl.She again developed SOB and generalised weakness since 2days for which she again consulted a local doctor in Nalgonda and got her tests done. Now her Hb levels have got down within
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