GULAGATTU PRIYARSHA ROLLNO 52

 48 year old Male came to the medicine OPD with chief complaints of  Difficulty in breathing since 5 days  Decreased urinary output since 3 days Swelling of lower limbs since 1 year HISTORY OF PRESENTING ILLNESS Patient was apparently asymptomatic 1 year back then he developed bilateral pedal edema which is insidious in onset gradually progressive, from knee to ankle region, and was on conservative treatment. He went to local hospital for swelling of limbs and was diagnosed with hypertension and started using medication (drug-Telmisartan dosage-40mg)since 1 year. 5 days before at night the patient developed shortness of breath which is sudden in onset and gradually progressive which is of class 3, associated with orthopnea and paroxysmal nocturnal dyspnea   Decreased urinary output and it is of streamlined urine since 3 days  History of intermittent fever not associated with chills and rigor  not associated with chest pain , palpitations , sweating  No history of burning micturition No

 A 21 yr old female resident of Ismailpalli who is a student by occupation came to casuality with chief complaints of  *  Fever since 5 days  *  Body pains, Vomitings since 5 days *History of Cough since 5 days which is non productive •  History of Presenting Illness  *A 21 yr old female had fever which is insidious in onset,high grade,continuos ,which is associated with chills and rigors and body pains since 5 days  *History of Vomitings 6 episodes per day, which is non bilious,non projectile ,which consists of food particles and water as content which is associated with abdominal pain since 5 days. *History of headache in frontal region  *There is no history of cold, burning micturition, ear ache, tinnitus shortness of breath,chest pain, palpitations, diarrhoea,eye pain. *There is history of intake of junk food 2 days before onset of symptoms  •Daily routine:- • Normally wakes up at 7am in the morning and do her regular activities and goes to the college and attend her clinicals (B.s