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A 65yr old M with Hypoglycemia,Hypotension

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 A 65 yr old male patient, resident of miryalguda came with chief complaints of  Hypoglycemia. Pt came with  Hypoglycemia with Grbs 30mg/dl. Pt came to the surgery department with c/o multiple ulcers over lt leg since 6 months. Pt was apparently asymptomatic 6 months back then he developed 4 small ulcers of size 1x 1 cm initially, which was gradually increasing to attain present size.H/o fever which was on and off. Then he suddenly developed Hypoglycemic symptoms and became unconscious  and transferred to medicine department.No H/o trauma  H/o Fracture at left elbow joint which was ill treated - Non union of Fracture 30 yrs back. Pt is a K/C/O of DM and is on regular medication - T. Glimestarmil PO/OD Had H/o pulmonary cox 2 yrs ago. N/K/C/O HTN,Asthma,Epilepsy.  Married He worked as a Sarpanch in his village. Have Normal appetite with mixed diet and regular bowel and bladder movements.  No significant family history  General examination  Pt is c/c/c .  No pallor,Icterus, Clubbing,Cyan
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1801006077 SHORT CASE

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 A 40 year old female patient ,hotel owner, resident of Narketpally came with chief complaints of Increased heartbeat since 6 months Breathlessness since 6 months HISTORY OF PRESENT ILLNESS : Patient was apparently asymptomatic 6 months back then she developed palpitations which were sudden in  onset, gradually progressive and develops under stress, heavy work. It lasts for 2 to 3 min and relives on rest . Since the last 2 to 3 months she complains of increased frequency and intensity of palpitations. She also complains of breathlessness ( shortness of breath) since 6 months and it was gradually progressive from grade 1 (6 months back)to 3 (presently)and it relieves on rest. Patient also has fainting attacks , headache when there is delay in food intake or prolonged standing and it gets relieved on taking rest or food. PAST HISTORY Not a known case of Diabetes, Hypertension, Asthma, Tuberculosis,Epilepsy, Thyroid disorders. Has acidity from past 15 years. She develops burning sensation
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Sle

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  A 13 year old female student from suryapet came to the OPD with chief complaints of Vomitings on Monday night at 10 pm breathlessness since 1 day  History of present illness: Patient was apparently asymptomatic before 2020 that is till the age of 11 years,then she noticed swellings in the neck bilaterally,no pain, firm in consistency. She also had fever which was insidious in onset , intermittent, no night rise of temperature, relieved with medication  dolo 3 tid She also had Non productive cough , no hemoptysis ,relieved with medication. These symptoms was continued for 2-3 months. After consulting rmp they started att as her mother has tuberculosis. Eventually swellings size decreased and symptoms got relieved. But the fever was not subsiding,so they  stopped taking medication. As rmp suggested , they went to hospital in Hyderabad and got her  tested for tuberculosis: -fnac -cancer tests - tb tests -mantoux -sputum culture -cbnaat because her mother is a known ca
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