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 A 65 year old female patient came to casualty with complaints of Involuntary movements of tongue, involuntary micturition and defecation since 2 days. History of presenting illness: Patient was asymptomatic 1 month ago. Then, she developed involuntary movement of tongue. She had history of neck pain with back ache since 5 days. H/O vomitings since 2 days associated with nausea sensation, which was non bilious and non projectile. Past History: History of HTN AND DM present. General physical examination: Temp: afebrile PR 90/min RR 22 cpm BP 130/70mmHg SpO2 98% Systemic examination: CVS: S1 S2 + RS: BAE+, NVBS + CNS: Patient is conscious, slurred speech    Motor examination:                                        RIGHT                 LEFT Tone : UL                    incr                  incr LL.                   incr.                 incr Power:              UL.                       4/5.              4/5 LL.                       4/5.               4/5 Reflexes: Biceps             

 Unit 2 admission: 32 year old male lorry driver by occupation came to casualty with chief complaints of pain in abdomen since one day. Patient was apparently asymptomatic 1 day ago. Patient had alcohol intake today morning (14/09/21), and had food in the afternoon.  Then he developed pain in abdomen at umbilical region, throbbing type, non radiating, aggravated after food intake, not associated with nausea, vomiting , constipation and loose stools, No History of fever and burning micturition. Not a known case of hypertension diabetes epilepsy tuberculosis asthma. O/E: vitals: temperature AFEBRILE, pulse rate 88 BPM, respiratory rate 16 CPM , BP 130/80 mm Hg, spo2 98% at Room air. CVS : S1 S2 heard RS: BAE+ NVBS + PA: obese abdomen, tenderness in gastric and hypochondrial region, bowel sounds present. Provisional diagnosis: Acute pancreatitis? Secondary to alcohol dependence Investigations  Amylase - 45 IU/L Lipase - 23 IU/L Ultrasound -  altered echotexture of body of pancreas

 Unit 2 admission: INTRODUCTION: A 65 year old male came to casualty with complaints of vomitings and pain abdomen since one day. CHIEF COMPLAINTS: Patient was apparently asymptomatic one day ago and he had before day food, followed by vomitings of 10 episodes bilious non projectile, food as content. He developed Pain abdomen around umbilicus squeezing type radiating to lower abdomen no aggravating or no relieving factors. HISTORY OF PAST ILLNESS: COVID 19 PNEUMONIA, No covid vaccine taken. Patient attender started observing pedal edema and abdominal distension since one month , not associated with chest pain palpitations ,shortness of breath and increased urine output.  PERSONAL HISTORY: known case of alcohol since 20 years O/E:  VITALS:  TEMPERATURE AFEBRILE  Pulse rate: 96 BPM Respiratory rate: 14 CPM  BP :200/90 mm Hg,  Spo2 98% at Room air.  Grbs 190mg % CVS S1 S2 HEARD RS BAE + PA: DISTENDED ABDOMEN , TENDERNESS AROUND UMBILICUS EPIGASTRIC AND RIGHT HYPOCHONDRIAC REGION , B

                  ELOG BASED STUDY A 25 year old male patient mason by occupation, came to casualty with the complaints of SOB since 1 day and fever since 10 days. Patient was apparently asymptomatic one month ago. He took vaccine one month ago for COVID 19, then he developed swelling of Left lower limb ( upto knee) since 20 days. He developed fever 10 days back which was high grade associated with chills,  subsided with medication and cough with expectoration since 5 days , which was non blood tinged, non foul smelling. His father in law died two days ago and he didn't take food after that incident , and developed generalised weakness and he SOB since today evening ( 7/9/21). Not a K/C/O of DM, HTN. Patient is conscious/ coherent/ cooperative. BP : 140/90mm Hg PR : 78 BPM RR : 18cpm CVS : S1 S2 HEARD RS: BAE+ ,  decreased breath sounds in lower( basal ) areas of  left lung. CNS : NFND  Investigations: 1)HEMOGRAM: Hb : 14.4 TLC: 3,800 PC : 1.76 2) ESR : 40 3) LFT:  TB 1.00 DB 0.25

      ELOG BASED CASE STUDY Date: 31/08/21 A 19r old male patient came with chief complaints of fever since 5 days. Patient was apparently asymptomatic 5 days back then he developed high grade fever, which was intermittent , decreased on medication. He developed abdominal discomfort since three days, vomitings 4-5 episodes which was non bilious and non projectile with food particles as a content. Loss of appetite since three days and constipation since three days. No C/O cough, cold, SOB No H/O giddiness/ blurring of vision No h/o HTN, DM, CVA, CAD,TB, epilepsy. Personal history: Decreased appetite Bowel movements  - decreased ( constipation) and bladder movements are normal Known alcoholic - beer since one year ( occassionally) General examination: The patient is conscious coherent and cooperative Moderately built and moderately nourished.  Vitals: PR:102pm BP:90/60 mmHg RR:16cpm Spo2:98% at RA P/A:  Shape of abdomen: scaphoid Non tender Liver and spleen - not palpable Bowel sounds ar