Exam

A 60yr female who was farmer by occupation came with the complaints of Shortness of breath since 1o clock in the night .. HOPI: pt was apparently asymptomatic since 1  o clock in the night ..then started developing sudden onset breathlessness in the night which was grade 4 , progressive .pt was taken to the local RMP ,found to have high BP levels and took some medication and came to KIMS for further evaluation. Past history: K/C/O DM and HTN  since 10 years . Persoal history: PICKLE : negative.   General examination : Pt conscious but irritable . Vitals : BP : 180/90 mmHg             PR: 140bpm             CVS: S1S2 +              RS: BAE + , Coarse crepts in all areas.             P/A: Soft.            GRBS: 256mg/dl Investigations: Diagnosis: INFERIOR WALL NSTEMI with CARDIAC ASTHMA COURSE IN HOSPITAL : 1)Inj.LASIX 40MG IV / STAT FOLLOWED BY LASIX 40MG IV AFTER 2MIN  2) INJ.NITROGLYCERINE ( 1AMP= 4ml =20mg) ..1ml has 5mg and 1ml diluted with 4ml NS

a)  Problem representation : 26yr old female with k/c/o SLE Polyarthritis with head ache since 8 days and fever, vomtings since 4 days and altered sensorium since 2 days with Euvolemic hyponatremia under evaluation. Anatomical localization: Brain. b) etiology: CVA , TB Meningitis , SLE vasculitis ,SIADH secondary to infection.   Initially the first on-call team thought it was Hyponatremia that is secondary to SIADH which is causing altered sensorium.. and also MRI was done which showed stroke the second on call team with further work up decided to do LP which showed the CSF positive for CBNAAT...thus came to the diagnosis of TB Meningitis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357611/( Bisphosphonate prophylaxis). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970554/(proton pump for corticosteroid ulcers) https://pubmed.ncbi.nlm.nih.gov/10067053/ ( TB Meningitis in SLE pts) C) Bisphosphonates were given to prevent osteoporotic fracture risk associated with using lon