sridevi’s e-log

September 12, 2020

Hello everyone..! I am SrideviTripuraneni,an intern posted in medicine department and one of the most important terms of getting internship completion is to complete mu log book with my online log of what I learn during the course of my duties.

Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve these patient’s clinical problems with collective current best evidence based inputs.

This e-log also reflects my patient-centered online learning protfolio and your valuable inputs on comment box is welcomed.

Here is the case i have seen:

A 45 year old male came to the hospital with the chief complaints of pain in the left foot 2nd toe since 4 days , fever since 4 days

C/o burning feet since 2 months

C/o burning micturition since 2 months

History of present illness:

Pt was apparently asymptotic 10 days back then had a history of trauma to left 2nd toe where there was a bleb formation and got ruptured.Pt noticed discolouration of toe assosciated with pain which is gradually progressive ,aggrevating type not relieved by lying down .After 4 days he developed fever ,gradual in onset ,intermittent type ,present throughout the day ,not associated with night sweats , nausea and vomitings

C/o burning feet since 2 months ,throughout the day

No complaints of chest pain, palpitated,sob, constipation,diarrhoea,weight loss

Past history:

K/C/O diabetes since 4 years on irregular medication (glimipiride 2 mg, metformin 500mg)

Not a K/C/O hypertension,asthma , tb , copd

Personal history:

Pt has mixed diet with normal appetite,sleep adequate ,regular bowel amd bladder movements

Alcoholic since 15yrs

Non smoker

General Examination:

Pt is conscious, coherent,cooperative

Moderately built and nourished

Vitals: temperature: afebrile

Bp:110/70

Pr:80bpm

Rr:18cpm

Grbs:226mg/dl

Local examination left foot:

Local rise of temperature +

Tenderness +

Dry shribbled mummified 2nd toe with line of demarcation with surrounding edema +

Pustular discharge from 2nd toe +

Fluctuation +

Peripheral pulses +

Per abdomen:

Soft ,mild tenderness in epigastric region,no rise in temperature,no guarding,no rigidity,no organomegy,hernial orifices are free,bowel sounds present

CVS-

S1 S2 heard, no murmurs

RS-

Shape-normal,NVBS heard,trachea midline, no wheeze,no added sounds

CNS-

Higher mental functions:normal

Motor system:intact

Sensory system:intact

Cranial nerve examination:normal

—Investigations