B12 deficiency
A young male patient aged 28 years presented with progressively increasing dyspnoea on exertion.
On examination:pt.was very pale,respiratory rate increased,blood pressure normal.Pt.was obese.
I advised some investigations based on syspicion:
The result:HB 4.5,rbs-146,Iron-230,B12: 99
A young male patient aged 28 years presented with progressively increasing dyspnoea on exertion.
On examination:pt.was very pale,respiratory rate increased,blood pressure normal.Pt.was obese.
I advised some investigations based on syspicion:
The result:HB 4.5,rbs-146,Iron-230,B12: 99
ESR 45 and 95
Having some doubts due to high ESR ,p.was send to hematologist for opinion.He also asked for some tests to confirm:
It pays to be watchful
A 42 year old presented with lump in axillary region.
>On Examination there mild tenderness over lump
>Mobile lump
>No fever.
Was given a course of antibiotics and anti inflammatory for 5 days.
On follow up lump mildly regressed in size.
>Surgical reference was done.
>Asked for ultrasound s/o absecss
>Surgeon decided to do excision biopsy:Result Intraductal Carcinoma of breast.
Pt.was then referred to Onco Surgeon:Extensive oncology work was done:
Findings:Positive nodes in axilla,rest of the reports are normal
Surgery:Modified Radical Mastectomy done.
Total time from first visit to surgery is 20 days.
I know I have done nothing great,but wants convey message that one has to be watchful for big things in routine cough and cold opd.
NEW CASE
(OPEN FOR DISCUSSION)
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1.Painless Haematuria:Please do not Ignore.
Hb 4.7,>tc 4500,>plt 106000,>RDW-Cv 26,>Retic count:0.2
S.crea:0.78,>sgpt 102,>S.LDH 17030
Ferritin:551,TSH 3.8
S.crea:0.78,>sgpt 102,>S.LDH 17030
Ferritin:551,TSH 3.8
The pt.was primarily diagnosed as B12 defi with option of Bone marrow examination if not improved.
New reports are not done yet,but patient has improved a lot symptomatically.
It pays to be watchful
A 42 year old presented with lump in axillary region.
>On Examination there mild tenderness over lump
>Mobile lump
>No fever.
Was given a course of antibiotics and anti inflammatory for 5 days.
On follow up lump mildly regressed in size.
>Surgical reference was done.
>Asked for ultrasound s/o absecss
>Surgeon decided to do excision biopsy:Result Intraductal Carcinoma of breast.
Pt.was then referred to Onco Surgeon:Extensive oncology work was done:
Findings:Positive nodes in axilla,rest of the reports are normal
Surgery:Modified Radical Mastectomy done.
Total time from first visit to surgery is 20 days.
I know I have done nothing great,but wants convey message that one has to be watchful for big things in routine cough and cold opd.
NEW CASE
(OPEN FOR DISCUSSION)
A male patient aged 31 years approached me with complain of tingling in legs,weakness,excessive thirst.
Age:31 yrs.
Family history:DM on maternal side.no dm in first degree relatives.
Profession:Executive life
On suspicion blood sugar done;Random sugar 396.Pt was not ready to accept so advised to get in done rechecked and confirmed from a lab.
Lab results:FBS-291,u/s 2+,ppbs 296,u/s 4+
Now the patient got impatient and wants immediate treatment.So i had to start anti diabetics.I Started with Glimepride 1 mg in morning before breakfast and metformin 1gm before dinner.
Now the case is open for discussion,your suggestions and comments are welcome for further management of this patient.
Please send comments on pragneshmv@gmail.com
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1.Painless Haematuria:Please do not Ignore.
Patient profile:
Sex: Male
Age: 50 years
Past History: Hypertension
Presenting Complain: Haematuria (Blood in urine)
On one fine Sunday morning on a holiday, male patients aged 50 years presented to me with complain of blood in urine since last night. There was no pain while urination. He was properly examined his vitals were normal. Pulse, blood pressure all the things were normal.
On abdominal examination nothing particular was found and there was no tenderness in any area.
He was not taking any drugs which could be cause of this bleeding. The first and foremost possibility in this kind of cases is stone disease. The only against this was there was no pain.
He was immediately subjected to ultrasound of kidneys. The result was more then expected. He was having tumor in his right kidney. He was immediately referred to a urologist and diagnosed to have renal cell carcinoma.
He was operated upon and now doing fine.
2.Altered Behavior: Unusual Presentation of Intra cranial Bleed.
Patient Profile
Sex:Female
Age:62 years
Past History:CKD and Diabetes
Early in the wee hours of morning there a was a house call.Presenting complain was strange.The patient started to cook in the mid night.She was conscious and mildly disoriented.She could recognize me.Responded well to all the queries.Seems to be disturbed.
Findings:
Blood Sugar -245
Blood Pressure:140/90mm Hg.
As she was a patient of CKD some disturbances in electrolytes and kidney function was suspected.Tests were advised for the same.The test result were not remarkable.She was referred to a physician,who could find anything special.A neurosurgeon was involved suspecting something wrong with CNS.CT scan brain was advised.That has clinched the diagnosis.There was subdural Hematoma. Burr Hole surgery was done and patient improved.
doing fine today.
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