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1. DPT OF INTERNAL MEDICINE MORNINIG SESSION  

2. IDENTIFICATION DATE OF ADMISSION 29/12/2016 Age 59yrs SEX F MRN Address Admission Diagnosis P1: DissTB (lung, liver and spleen) P2: Newly diagnosed RVI HU CHMS SOM Dpt of Internal medicine 2 9/5/2024

3. Subjective Evidence HPI This is a 59yrs old female patient presented with sputum productive intermittent cough of three months duration. Associated with this she has history of night sweat, weight loss and appitite loss of three months duration. She has also history of low grade intermittent fever, easy fatigability and SOB on excertion of 2months duration. She has history of similar illness and treated for PTB at this hospital two years ago. Otherwise, she has no ABM and LOC - No orthopenia and PND - No body swelling - No hx DM and HNT - No hx of hemopytesis HU CHMS SOM Dpt of Internamedicine 3

4. Objective Evidence HU CHMS SOM Dpt of Internal medicine 4 PHY EXAM HEENT LGS PC and nonicteric sclera No SLAP ABD GUS Iss MSS Flat and moves with respiration there is hepatomegaly w/c is 3cm BRCM along MCL No signs of fluid collection. No suprapubic and CVAT. No edema CNS COPPT GA CSL Vital signs BP 95/58 PR 87 R/S CVS Coarse crepitation over right posterior lower lung and decreased air entry over area S1and S2 well heard No murmur and gallop RR 30 T PSO2 36.7 67% Off O2 90% w 3L of O2 ABD ISS No rash MSS 9/5/2024

5. OFT CBC Cr= 0.41 WBC=7.2K Urea 12.3 AST=45 NEUT=56.2% Serum electrolyte ALT=15 LYPH=27.2% Na 130 ALP Hgb K 3.99 ESR =60 Hct =38.8 Cl 99.5 MCV=89.4 Genexpert = not detected Viral marker = negative HBSAG and HC Ab PLT=363k 9/5/2024 HU CHMS SOM Dpt of Internal medicine 5

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8. What was done IN O2 3L/MIN Ceftriaxone 1gm iv bid Azithromycin 500mg po /day3days Follow v/s 8 9/5/2024

9. PLAN Urine LAM, VIRAL LOAD, DC4, Repeat genexpert 9/5/2024 HU CHMS SOM Dpt of Internal medicine 9