Patient Case Clerkship

 Essay regarding Patient Case Clerkship




Circumstance 5

Congestive Cardiac Failure

Nephrotic Problem

Community-Acquired pneumonia

Siti Hasmah Bt Mohd Suffian



Name: MAMGender: Male

Era: 24 years old Race: Malay

Weight: 138 kgBMI: 55 (morbidly obese)

Height: 159cmDOA: 21st Mar 2010


Chief complaint:

•bilateral reduced limb swelling for the past a couple weeks.

•scrotal puffiness for the past three or more days nevertheless noted upon DOA experienced progressively elevated in size. •complained of throwing up for your five days, throws up about 3-4 times each day •so much had vomited once inside the afternoon together 2 symptoms of diarrhea on DOA

History of present illness:

•had noted excoriation of the scrotal skin which includes amount of clear liquid discharge •has been having difficulties in starting micturation as morning of DOA •claimed that urinary habits were normal ahead of this

•history of periodic SOB within the past 2 weeks

•orthopnea for 2 weeks

•had lowered effort threshold for the past 30 days

•diarrhea for the past 3 days

•has abs distension within the past 1 month

•associated with abdominal pain and infrequent bouts of vomiting •had seen the physician and was treated intended for gastritis

•had one event of fever last friday

•had epigastric discomfort since DOA

•loss of appetite for the past 1 month

•Had on and off coughing for go 2 months, whitish sputum

Family history and ancestors:

•father passed away due to esophageal cancer

•mother provides hypertension and diabetes mellitus

Social background:

•smoker within the past 8 years (14 supports per day) but quitted 2 a few months ago

Past medical and medication history:

•Have been acquiring T. Piroxicam (Roxim) for his discomfort management •History of peptic ulcer 3-4 months ago


Review of program:

•BP = 127/54 mmHg

•PR = 115 bpm (regular great volume)

•T = 37oC

Laboratory values in day of admission:

Person's valueNormal Principles

Full blood vessels countTWBC25. 6x 109/L 4-11 x 109/L

Hb12. 6 g/dL 14-17. a few g/dL

RBC5. 03 x 106/L 4. 5-6. 5 x 106/L

Hct39. zero % 40-54 %

Platelet353 x 109/L 150-400 times 109/L

Renal profileBUN 12. your five mmol/L 1 . 8-8. several mmol/L

Na 131. 7 mmol/L 135-152 mmol/L

T 4. doze mmol/L three or more. 5-5. 4 mmol/L

Craigslist 95. 6th mmol/L 98-106 mmol/L

Scr 275 Umol/L 0-126 Umol/L

CrCl (using BSA)40. 5 mL/min 97-137 mL/min

Coagulation profilePT 33. five sec11-16 sec

APTT 36 sec23-40 sec

INR 3. 16

Random bloodstream sugar7. 81 mmol/L four. 4-8 mmol/L

Albumin25 g/L 43-50 g/L

Ward Medications:

Particular date





22/3IV Amoxicillin Clavulanate 1 ) 2 g stat then OD

4 Azithromycin 500 mg stat then ODInfection/Community-acquired pneumonia 22/323/3IV Omeprazole 20 mg statEpigastric pain next Azithromycin administration 23/3

23/3IV Amoxicillin Clavulanate 1 . two g Z

IV Azithromycin 500 mg ODInfection/Community-acquired pneumonia 21/3





29/3IV Furosemide forty five mg stat then TDS

IV Furosemide 40 mg BD

4 Furosemide eighty mg TDS

IV Furosemide 40 mg TDSDehydration


Pulmonary hypertension

Nephritic syndrome

21/323/3IV Ranitidine 40 mg stat then TDSEpigastric pain

25/3T Meloxicam 7. 5mg ODNSAID for joint pain

26/3Miconazole creamAntifungal to get skin excoriation on scrotal skin 27/328/3SC Fondaparinux 2 . 5mg ODDVT prophylaxis

Full blood depend:


TWBC (4-11 times 109/L)23. 025. 315. 315. 017. a few

RBC (4. 5-6. a few x 106/L)5. 035. 035. 054. 915. 15

Plt (150-400 back button 109/L)374353386469440

Ht (40-54 %)41. 439. 041. 442. 244. 4

Hb (14-17. your five g/dL)13. 312. 612. 712. 412. on the lookout for

Renal account:


BUN (1. 8-8. 3 mmol/L)4. 512. 513. 16. 04. 54. 8

Cl (98-106 mmol/L)101. 395. 699. 9101. 099. 596. 2

Cr (0-126 Umol/L)138. 0275. 0197. 0104. 088-

K (3. 5-5. 4 mmol/L)3. 904. 123. 983. 673. 973. 80

Mhh (135-152 mmol/L)135. 8131. 7131. 2136. 2140. 0131. you

Liver function test:

Particular date...

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