GENERAL MEDICINE
Hello all , I’m an intern of 2015 batch , this is a case history of one of our patients who got admitted . This is to complete my log book as a part of internship duties .i have seen a case of 43 year old female who presented with 

Case Report 
C/o rt sides hypochondrial pain , stabbing type , non radiating.increasd with inspiration and on lying down on rt side ,
c/o low grade fever ,intermittent since 10 days , 
H/0 medication used for 4 days from 24 rth . Amikacan , sulbactum + ceftriaxone 
From 28/ 5/ 20 Piptaz , levoflox for 4 days 
No h/0 wt loss , cough , evening rise of temperature, decreased micturation , burning mituration .
PAST HISTORY 
c/o fever for which she went to hospital 20 years back for which she used medication for 3 moths ? Pulmonary TB
No h/o DM , HTN , CKD , BA ,Thyroid

ON EXAMINATION 
Pt c/ c
Temperature 98.6  F 
Pule 85 bpm
RR 20 cpm
BP 160/ 80mmhg 
Spo2 99%
Cvs :S1 S2 heard ,no murmurs 
p/ A : soft , non tender 
CNS : HMF intact
           Speech normal
           Sensory system N
           Motor system N 
Respiratory system examination:
inspection- shape of the chest: elliptical
symmetry:b/l symmetry
position of trachea: central
apex beat: seen in 5th intercostal space midclavicular line
Rr-18 cpm
rhythm-regular
type- thoracoabdominal
old scar in left neck region.
no accessory or intercostal muscles usage .
no dilated veins/pulsations
no obvious spine abnormality
PALPATION- all inspectory findings are confirmed.
position of trachea- central
apex beat- felt ( 5th intercostal space midclavicular li



































movements.      rt.                      lt
upper thorax.     --.                      N
anterior.              --.                      N
posterior.           decreased.      N
chest expansion - felt
inspection - patient can't take deep breath due to pain
No subcutaneous emphysema
chest expansion.          lt.          rt
supraclavicular.             N.         N
infraclavicular.               N.         N
mammary.                      N.         decreased
axillary.                            N.         decreased
infraaxillary.                    N.         decreased
suprascapular.               N.         N
interscapular                  N.         decreased
infrascapular                  N.         decreased
VOCAL FREMITUS.       lt.          rt
supraclavicular.             N.         N
infraclavicular.               N.         N
mammary.                      N.         decreased
axillary.                            N.         decreased
infraaxillary.                    N.         decreased
suprascapular.               N.         N
interscapular                  N.         decreased
infrascapular                  N.         decreased
PERCUSSION                 lt.                 rt
supraclavicular.             resonant        resonant
infraclavicular.               resonant.       resonant
mammary.                      resonant.       dull
axillary.                            resonant.       dull
infraaxillary.                    resonant.       dull
suprascapular.               resonant        dull
interscapular                  resonant.       dull
infrascapular                  resonant.       dull
 tidal percussion - normal
AUSCULTATION.              lt.         rt
supraclavicular.            nvbs.     nvbs
infraclavicular.              nvbs      absent/reduced
mammary.                     nvbs       reduced
axillary.                           nvbs.      absent
infraaxillary.                   nvbs.      absent
suprascapular.              nvbs.       reduced
interscapular                 nvbs.       absent
infrascapular                 nvbs.       absent
 no added sounds
no wheeze/crepts/rub

INVESTIGATIONS
Haemogram
Hb :9.5 gm/ dl 
TLC :16000 cells / cumm
Lymphocytes:15%
RBC : 4.12 
Plt- 7.7 lakhs cells /cumm
Smear :

Normocytic hypochromic with neutophelia and thrombocytosis 
LFT:
TB - 0.6 mg/ dl 
DB - 0.2 mg/ dl 
SGOT - 16
SGPT- 27
Alp - 239
TP-6.8
Albumin -2.9
A/G- 0.74

Pleural fluid analysis 
Pleural tap was done following all the aseptic measures, on right side 6 th posterior intercostal space, white viscous fluid was taken out and sent for analysis.
Protein 4.3 gm/ dl
Sugar 34 mg / dl 
LDH 319 IU/ lit 
Cytology Report 
Smears showed rich cellularity composed of degenerating neutrophils only against eosinophilic proteniacious background 
Impression: cytology suggestive of acute inflammatory condition.


Creatinine-0.7

Provisional diagnosis: right sided pleural effusion ? Empyema 
PROCEDURE LEARNT 
I have seen a 2d echo of a 30 year old ccf patient.
TOPIC LEARNT 
op poisoning 
-Most common poisoning seen , because of its wide availability 
-Is used as a sucidal poisoning 
-it causes 
   Cholinergic chrisis
   Intermediate syndrome 
   Op poison induced delayed poky neuropathy 
Treatment 
Atropine
Pralidoxime 










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