SURYAVAMSHI UMAKANTH ROLL NO 155

45 year  old male came to the OPD with Chief complaints   of: Bilateral pedal edema since 12days Shortness of breath since 5days  HOPI : Patient was apparently asymptomatic 12days back then he developed bilateral pedal edema which was gradual in progression, extended upto knee and is of pitting type. He also developed Shortness of breath which was initially grade 1 and progressed to grade 2 (nyha) Associated with orthopnea H/o loss of appetite since one week and nausea and vomitings three days back (3 episodes) non billious No H/o- fever,burning micturation, diarrhoea decreased urine output  No H/o cough, hemoptysis,fever, No h/o chest pain,giddiness , palpitations, decreased urine output, syncopal attacks, No h/o abdominal distension, jaundice  vomitings Past history: Not a K/C/o Diabetes Mellitus,Asthma,TB,epilepsy,leprosy,CAD Treatment history  Not significant  Personal history: Diet:Mixed  Appetite:Decreased  Sleep-adequate Bowel movements-regular Bladder movements- normal urinary

COMPLAINTS AND DURATION: A 77 y/o male was brought with c/o cough since 1 & half month ,  difficulty in swallowing  since one month Fever since 10 days C/o altered sensorium since 3 days HOPI  Patient is a known case of cva with left hemiplegia, DM type 2 , Hypertension, hypothyroidism   Patient was apparently asymptomatic one and half month back when he developed cough insidious in onset and gradually progressive. PRODUCTIVE but patient is not able to spit it out. Difficulty in swallowing.  H/o cough on intake of liquids.  H/o change of voice since 20 days, insidious, hoarse in character and   SLURRING OF SPEECH +present  Fever since 10 days -high grade associated with Chills and rigors  H/O WEAKNESS in LEFT upper and lower limb since 7 years aggrevated since 4 days. No history head trauma  No history of loss of consciousness No history of transient loss of vision No history of involuntary movements No history of pain in calf muscles No history of chest pain and loose stools PAST