GENERAL MEDICINE
CHIEF COMPLAINTS - 
 • Fever since 3 months 
• Loss of appetite since 3 months 
• cough since 3 months 
• Shortness of breath since 2 months 
• Decreased urine output since 15 days 
HISTORY OF PRESENT ILLNESS - 
• Patient was apperantly assymptomatic 15 days , then he developed fever which is continuous on and off and subsiding on medication .
• Loss of appetite since 3 months 
• cough since 3 months Dry cough on and off and subsided by medication .
• Shortness of breath Grade 2 on exertion 
• Decreased urine output since 15 days 
HISTORY OF PAST ILLNESS 
IN 2016
• Patient was diagnosed with Dengue admitted in a private hospital where he was treated symptomatically & other investigations showed increased levels of Creatinine and uric acid .
• Patient had severe joint pains  ( PIP & DIP )  and swelling due to accumulation of Uric acid and on medication (? Unknown ).
IN JUNE 2022
• Patient had severe itching all over body , Fever , joint pains , for which he was taken to Hospital where
Investigations showed - 
Creatinine - 6.2 mg/dl 
Blood urea - 145  mg/dl 
Uric acid - 9 mg/dl 
and he was diagnosed with CKD .
2 sessions of Hemodialysis was done .
IN DECEMBER 2022
• Patient had complaints of Fever which is continuous and subsiding on medication  and Shortness of breath (Grade III ) for which he was brought to our hospital 
• He is a k/c/o Hypertension since 7 years and on medication ( T.Metoprolol 25mg OD )
• Not k/c/o DM 
• No H/o Bronchial asthma
• No H/o CVA , CAD 
• No H/o Epilepsy
PERSONAL HISTORY
Diet - Mixed 
Appetite - Decreased
Sleep - Inadequate 
Bladder - Decreased urine output 
Bowel movements - Regular 
Alcoholic occasionally 
FAMILY HISTORY
• Not significant
SURGICAL HISTORY 
Cataract surgery to left eye 6 months ago 
GENERAL EXAMINATION
Patient is concious , coherent , co-operative 
Well oriented to Time place person 
Thin build and moderately nourished 
• Pallor - Present 
• Icterus - Present 
• Clubbing - Absent 
• Koilonychia - Absent 
• Lymphedenopathy - Absent 
• Pedal oedema + Grade 1 Pitting type ( upto ankle)
• JVP - Normal 
VITALS
• Temperature - 102°F 
• Pulse rate - 110 bpm
• Respiratory rate - 24 cpm
• BP -  130/90 mmHg
• SPO2 - 98% on room air 
• GRBS - 157 mg/dl 
CLINICAL IMAGES 
SYSTEMIC EXAMINATION 
RESPIRATORY SYSTEM 
INSPECTION 
• Chest is elliptical , bilaterally symmetrical shape.
• Trachea is in central 
• Movements are bilaterally  equal 
• JVP - Normal 
• No visible scars and sinuses .
PALPATION 
• All the inspectory findings are confirmed , 
• Trachea is in centre 
• Movements  are bilaterally equal
• Apex beat felt in Left 5 th ICS , 1 cm lateral to the midclavicular line 
• Vocal fremitus decreased
PURCUSSION 
• Dull note heard in all areas of lung 
AUSCULTATION 
• Decreased air entry bilaterally +
• Normal vesicular breath sounds + 
• Breath sounds decreased bilaterally.
CARDIOVASCULAR SYSTEM 
INSPECTION 
• Chest is Elliptical and bilaterally Symmetrical
• Trachea - Centre 
• JVP - Normal 
• Transverse diameter > Anterio posterior diameter.
• No scars and sinuses 
PALPATION 
• All the inspectory findings are confirmed , 
• Trachea is in centre 
• Movements are equal bilaterally. 
• Apex beat felt in Left 5 th ICS , 1 cm lateral to the midclavicular line .
AUSCULTATION 
• S1S2 Heard 
• No Murmurs 
PER ABDOMEN 
• Scaphoid 
• No engorged veins , sinuses , scars 
• No visible epigastric pulsations 
• Soft and NonTender
• No organomegaly 
• Tympanic note heard all over abdomen 
• Bowel sounds +
CNS 
• HMF - Intact 
• Speech - Normal
• No signs of Meningeal irritation
• No Focal neural deficit  
• Sensory and motor system - Normal 
• Cranial nerve - Intact 
• Reflexes - Normal 
• Gait - Normal 
• Cerebellum - Normal 
• GCS 15/15
PROVISIONAL DIAGNOSIS
? AKI on CKD 
? Pulmonary TB
? Heart failure 
? Massive pleural effusion 
INVESTIGATIONS 
Hemogram 
                                     RFT 
Serum electrolytes 
ABG 
Dengue NS1 
Bleeding and clotting time 
HBsAg
HIV
LDH
Serum osmolality
APTT
XRay 
15/12/2022 
16/12/2022
18/12/2022 
Final Diagnosis
CKD on MHD 
2° NSAID abuse 
 
   
   
   
   
   
  

 
   
   
   
   
   
   
   
  

 
   
   
   
   
  
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