General medicine 1st internal

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39M with ASCITES AND PEDAL ODEMA SINCE 2 MONTHS

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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 distensi...
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learning points and OSCE

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Learning points  I have gained understanding of how chronic liver disease due to chronic alcoholism made a way to complications like ascites ,portal hypertension  & pedal edema  i have learned how to check for apraxia which is a symptom indicating that patient is developed hepatic encephalopathy  i have learnt how important it is to listen to patients complains carefully and doing a proper head to toe clinical examination before sending to  investigations to come to a diagnosis    And i have learnt how essential it is to build communication with the patient and gain his confidence for treating the patient  -i have learnt  that how important it is to take a brief history and know the daily routine of the patient to know exactly the root cause( i.e,deviation from the routine ) which lead into an acute episode  - I have learnt how important it is to do a proper clinical examination before sending for investigations I have learnt how to ...
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48 yr old male with problem in left knee joint

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This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've 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 a diagnosis and treatment plan A 48 yr old male resident of west Bengal presented with  Chief complaints: Difficulty in walking on the left lower limb since 2weeks  History of presenting illness: Patient was apparently as...
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