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OSCE & LEARNING POINTS

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OSCE  • Which is the better afterload reducing drug? One of the classes of drugs commonly used to reduce afterload is vasodilators. Afterload refers to the resistance the heart has to overcome to eject blood into the systemic circulation. Vasodilators help dilate blood vessels, reducing this resistance and making it easier for the heart to pump blood. Several types of vasodilators are used for this purpose: 1. **Angiotensin-Converting Enzyme (ACE) Inhibitors:**    - **Examples:** Enalapril, Lisinopril, Ramipril.    - **Mechanism:** Inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to vasodilation and reduced afterload. 2. **Angiotensin II Receptor Blockers (ARBs):**    - **Examples:** Losartan, Valsartan, Irbesartan.    - **Mechanism:** Block the action of angiotensin II on its receptors, resulting in vasodilation and decreased afterload. 3. **Calcium Channel Blockers:**    - **Examples:** Amlodipine, Nifedipine, Diltiazem.    - **Mechanism
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PREFINAL PRACTICAL EXAM

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40 YEAR MALE WITH PAIN AND DISTENSION OF ABDOMEN , DECREASED URINE OUTPUT SINCE 2 DAYS  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 • A 40 year old male pt , farmer by occupation resident of Nalgonda came with  Chief complaints  Pain abdomen 2 days  Vomit
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29 year old male patient . Daily labour by occupation , resident of Bhongir came with  Chief complaints  Pain abdomen 10 days  Vomitings 10 days  Involuntary movements of left upper limb  1 week  History of present illness    Patient was apparently asymptomatic 10 days ago then he developed pain abdomen 10 days ago which was sudden onset in epigastric region , sharp which is radiating towards back , aggrevating on taking foods. • H/o 2 episodes of vomiting which is non bilious non blood tinged , non projectile water as content . • H/o seizure , involuntary movemnt of the left upper limb a/w Deviation of mouth to right side  uprolling of eyes , drooling of saliva  H/o Loss of conciousness for almost 15 mins and regained his conciousness. H/o Slurring of speech  H/o Memory loss  No H/o Trauma , No H/o Neck stiffness ,  No H/o Fever , No H/o weakness No H/o Loose stools involuntary micturation or defecation  History of past illness  Patient had pain abdomen and 2 episodes of vomiting for
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60 year old male , R/o Nakrekal , Farmer by occupation came with the Chief complaints  Decreased urine output since 20 days Abdomen distension since 1 week Shortness of breath since 1 week  History of present illness  Patient was apparently asymptomatic 20 days ago the developed high grade fever , continuous , assosiated with chills and rigors for which he was admitted to local hospital medications and they put foleys catheter and patient symptoms were  relieved . • Patient complaining of decreased urine output since 20 days  • Abdomen distension not a/w pain or tenderness  • SOB since 1 week  Grade 3 proggresses to Grade 4 .  H/o Orthopnea  H/o Burning micturation  No H/o PND  No H/o Vomitings , Loose stools  History of past illness  Patient had a trauma over right bigtoe which was not healing  for which toe was amputated 3 years ago Patient also had a trauma over right lateral aspect of leg . And healed 1 month ago 1 month ago before comming to our hospital . Pt was admitted in a loc
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48 F SOB 7 days & Pedal oedema 5 days

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Im presenting a case of 48 year Female House wife ,  resident of Narketpally  came to opd with  CHIEF COMPLAINTS  Shortness of breath 7 days  Pedal oedema 5 days  HISTORY OF PRESENT ILLNESS  Patient was apparently asymptomatic 1 week ago then she developed shortness of breath which was sudden onset Grade 3 and progressed to Grade 4 ( NYHA CLASS 4 )  Patient also complaining of pedal oedema B/L pitting type , which is extending upto ankle. Grade 3  Patient also complaining of cough ,insidous onset  non productive , not associated with sputum , no diurnal variation . H/o Orthopnea  No H/o PND  N/o H/o Chest pain , palpitations  History of past illness 4 years ago  Patient had admitted with  the similar complaints of pedal oedema & noticed deranged renal  parameters & diagnosed CKD  for which they treated symptomatically with medications  2 years ago  Pedal oedema & treated symtomatically with medications  3 months ago  Similar complaints pedal oedema & sob for which patie
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