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40M PRESENTED WITH PEDAL EDEMA AND FACIAL PUFFINESS

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

40 yr old male presented with chief complaints of pedal edema since 10 days B/L pitting type upto knee
-facial puffiness since 2 days 
-SOB grade 2 since 10 days
-Palpitations+
-Post prandial chest pain since 1 week 

HOPI
Pt was apparently asymptomatic 10 days ago then he developed b/l pitting type of pedal edema and sob grade 2 with Palpitations 
No decreased urine output,no groin pain, facial puffiness present 
Post prandial chest pain since 1 week non radiating type

PAST HISTORY
H/o hemorrhoids 5-6 yrs back(passage of blood in stools intermittent)
N/k/c/o DM, CVA, TB, EPILEPSY, HTN

Personal history
Diet-mixed 
Appetite-normal
Bowel and bladder -regular

GENERAL PHYSICAL EXAMINATION
On examination, patient is conscious, coherent, cooperative
patient is moderately built and moderately nourished
No pallor,icterus, cyanosis, clubbing, lymphadenopathy, edema
VITALS 
temp-afebrile
Bp-120/80
PR-82
Rr-18

SYSTEMIC EXAMINATION:

Abdominal examination:
Inspection-
Umbilicus inverted , No abdominal distention,no visible pulsations,scars and swelling.
Palpation-
Soft, non tender, no organo megaly.
Auscultation-
Bowel sounds Heard
Cardio vascular examination:
No visible pulsations, scars, engorged veins. No rise in jvp 
Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.
S1 S2 heard . No murmurs.
Respiratory system :
-Shape of chest is elliptical, b/l symmetrical.
-Trachea is central. Expansion of chest is symmetrical
-Bilateral Airway Entry - positive
-Normal vesicular breath sounds
CNS examination: 
-No neurological deficit found.
-HMF Intact 

Provisional diagnosis 
Wet Beri beri 

Investigations
Blood urea
Serum creatinine 
LFT 
CUE
PLBS 
PERIPHERAL SMEAR






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