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80F with HFrEF secondary to CAD

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 80 year old female came with the chief complaints of sob since 3 days, pedal edema since 1 month and decreased urine output HOPI Patient was apparently asymptomatic 3 days back, then she had SOB which is grade II insidious in onset, gradually progressive and progressed to grade IV today morning. orthopnea + , no PND, pedal edema + which is pitting type fever + low grade yesterday which is relieved by medication. PAST ILLNESS known case of CKD, hypertension and DM II since 15 years known case of CAD 1 month back. Advised PTCA but was not done TREATMENT HISTORY Linagliptin 5mg OD Amlodipine 5mg OD On cefpodoxime 200mg BD PERSONAL HISTORY Married Housewife Normak appetite Vegetarian diet Rrgular bowel movement  Decreased micturition Teetotaler GENERAL EXAMINATION no signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy Oedema of feet +  Vitals: Temperature : 98.2 PR : 116/ min RR : 20/ min BP : 130/70 mmHg Spo2 : 83% at room air Grbs : 144mg% SYSTEMIC EXAMINATION CVS : S1 S2 + ,
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Swapna

27 YEAR OLD P3L3A1 TUBECTOMISED CAME WITH COMPLAINTS OF WHITE DISCHARGE SINCE 7 YEARS LMP- 10/9/23 HISTORY OF PRESENTING ILLNESS- PATIENT WAS APPARENTLY ASYMPTOMATIC 7YEARS BACK THEN DEVELOPED WHITE DISCHARGE WHICH IS THICK, MUCOID, WHITE IN COLOUR, PROFUSE IN QUANTITY, NOT ASSOCIATED WITH ITCHING IT FOUL SMELLING. HISTORY OF ABDOMINAL PAIN, SUDDEN IN ONSET, NON PROGRESSIVE IN THE EPIGASTRIC REGION, PRICKING TYPE OF PAIN, INTERMITTENT, AGGRAVATED ON EXERTION AND RELIEVED ON REST.  NO HISTORY OF BACK PAIN.   HISTORY OF DYSPAREUNIA SINCE 4 YEARS NO HISTORY OF POST COITAL BLEEDING. NO HISTORY OF MENSTRUAL IRREGULARITIES OR COGNITIVE DYSMENORRHOEA. HISTORY OF BURNING MICTURITION SINCE 4-5 YEARS, USED MEDICATIONS.  NO HISTORY OF URGENCY, FREQUENCY OR SUPRAPUBIC PAIN. HISTORY OF SIMILAR COMPLAINTS IN THE PAST AND USED MEDICATIONS (INJECTIBLE ANTIBIOTICS AS TOLD BY THE PATIENT. DOCUMENTS NOT AVAILABLE) SYMPTOMS SUBSIDED ON USING MEDICATIONS AND RETURNED AFTER STOPPAGE OF MEDICATION.  HISTORY
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Chandramma

  35 YEARS OLD P3L2D1 TUBECTOMISED WITH COMPLAINTS OF LOWER ABDOMINAL PAIN, WHITE DISCHARGE AND BURNING MICTURITION SINCE 1 WEEK. HISTORY OF PRESENTING ILLNESS- PATIENT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK THEN SHE DEVELOPED PAIN IN THE LOWER ABDOMEN / DIFFUSE ABDOMINAL PAIN / LOWER - SUPRAPUBIC REGION, CONTINUOUS, NON PROGRESSIVE, PRICKING TYPE, NON RADIATING, NO AGGRAVATING OR RELIEVING FACTORS ASSOCIATED WITH NAUSEA AND BURNING MICTURITION. NOT ASSOCIATED WITH LOOSE STOOLS, VOMITINGS, CONSTIPATION, FEVER.  NO HISTORY OF OUTSIDE FOOD INTAKE. PATIENT HAD VISITED PRIVATE HOSPITAL IN MIRYALGUDA FOR SIMILAR COMPLAINTS. BUT PATIENT DID NOT GET TREATED THEN AND CAME TO KIMS NARKETPALLY. HISTORY OF WHITE DISCHARGE SINCE 1 WEEK (CURDY WHITE) AS TOLD BY THE PATIENT AND ASSOCIATED WITH FOUL SMELL. NOT ASSOCIATED WITH ITCHING. COMPLAINTS OF BACK PAIN SINCE 1 WEEK, DRAGGING TYPE, NO AGGRAVATING / RELIEVING FACTORS. HISTORY OF BURNING MICTURITION SINCE 1 WEEK. NO DYSURIA, NO INCREASED FREQUENC
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Radha

  POD - 3 UNDERWENT EMERGENCY EXPLORATORY LAPAROTOMY WITH LEFT OOPHORECTOMY IN VIEW OF 35 YEAR OLD P3L3 POST HYSTERECTOMISED WITH SPONTANEOUS RUPTURED LEFT OVARIAN CYST   35    YEARS OLD P3L3 POST HYSTERECTOMISED WITH 3 PREVIOUS LSCS WITH COMPLAINTS OF PAIN IN THE LEFT ILIAC FOSSA SINCE TODAY (12/9/23) MORNING 7 AM HISTORY OF PRESENTING ILLNESS- PATIENT WAS APPARENTLY ASYMPTOMATIC TILL YESTERDAY MORNING AFTER THAT SHE DEVELOPED SUDDEN PAIN IN LEFT ILIAC FOSSA, CONTINUOUS DRAGGING TYPE RADIATING TO GROIN. NO AGGRAVATING AND RELIEVING FACTORS. HISTORY OF BURNING MICTURITON WITH INCREASED FREQUENCY SINCE YESTERDAY AFTERNOON WHILE PASSING URINE FOR WHICH PATIENT WENT TO LOCAL DOCTOR WITH SIMILAR COMPLAINTS. TOOK INJECTION AROUND 7 PM ON 11/9/23. PAIN GOT SUBSIDED (NO DOCUMENTATION AVAILABLE) NO HISTORY OF VOMITING HISTORY OF 3 EPISODES OF STOOLS WITH NORMAL CONSISTENCY HISTORY OF FEVER 10 DAYS BACK FOR WHICH SHE TOOK TREATMENT IN KIMS NARKETPALLY PAST HISTORY PATIENT HAD SIMILAR COMPLAINTS
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