Osce

This blog aims at providing cutting edge and wide array of information over the distinguished cases evaluated to the best of my understanding. This was done under the guidance of  our seniors
 
https://mvineelarollno90.blogspot.com/2023/11/65-y-female-with-co-fever-since-4-days.html

Here I will state the question I was unable to answer and my learning based on them
First off a brief history
65 Y Old female came to casualty with C/O fever since 4 days,Shortness of breath since 2 days,pedal edema since 2 days.

Patient was apparently asymptomatic 2days ago then she developed SOB of grade 3 of insidious onset,gradually progressive associated with fever of high grade associated with chills and rigors. 
No H/O cough,sore throat.
Pedal edema present ,ulceration over right foot associated with pain and swelling present .
No C/O abdominal pain,loose stools,vomitings nausea.

And hence after a series of investigations

Diagnosis-Type 2 DM,K/C/O  CAD S/P CABG I 2020,K/C/O HTN,AKI on CKD ,Diabetic foot ulcer ,candidial intertrigo +frictional dermatits

Question 1
Diabetic neuropathy

https://www.ncbi.nlm.nih.gov/books/NBK279175/

First let us learn about basic nerve fibers


Types

How to diagnosis? 


Question 2
Ivc compression
The 30 left-lateral tilt position most consistently reduced inferior vena cava compression by the gravid uterus compared with the supine position.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=ivc+compression+and+left+lateral+tilt&btnG=#d=gs_qabs&t=1701434524690&u=%23p%3D237iIxYDU94J





Question 3
Reason for dialysis in this patient
1) Metabolic acidosis 

2) Consequent rise of serum creatinine to 5 for first 2 days 

3) Biochemical derangement 

4) Oliguria 


Question 4
Concerns and priority list




Question 5
What can we do

1) Ulcer
Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=diabetic+ulcer+treatment&oq=diabetic+ulcer+treat#d=gs_qabs&t=1701435590002&u=%23p%3DESRuhIGfuDwJ

2) bed sores

Adhesive elastic plasters
Dakins solution application
Hypertonic saline solution
Solughing off of bed sores

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2209288/?page=2

3) diabetic neuropathy
Pergabalin
Gabapentin

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=diabetic+neuropathy+treatment&oq=diabetic+neuropathy+#d=gs_qabs&t=1701435971308&u=%23p%3DzUodm9dJD74J

4) copd

Bronchodialators 
Corticosteroid

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=copd+treatment&btnG=#d=gs_qabs&t=1701436033520&u=%23p%3DVDlDyTUEMyoJ




Question 7
Diagnostic gaps

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