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Title: grand round 4

1
HUBERT KAIRUKI MEMORIAL UNIVERSITY.

GRAND ROUND PRESENTATION.
PRESENTERS- EDWIN
MNGONGO-HK/MD/19/2382
RAMADHAN
MLUNZA-HK/MD/20/2541
MWAJUMA
MNEDAH-HK/MD/20/2621
ISABELLA
MNYITAFU-HK/MD/21/2951
GIFT MNYINGI-HK/MD/19/2474
FACILITATOR-DR. SARAH AND DR. CONSOLATHA.

2
PATIENT PARTICULARS

Name Hawa Siwa Rashid.
Age 20 years old.
Sex Female.
Address Kigogo Mwisho.
Tribe Mrangi.
Religion Muslim.
Informant Herself.
Date of Admission 17/11/2023.
Date of Clerkship 21/11/2023.
Duration of stay at the hospital 5 days.

3
CHIEF COMPLAINT

Left sided body weakness for 1/7

4
HISTORY OF PRESENTING ILLNESS.

The patient was apparently well until 1 day prior
admission
She started experiencing left sided body
weakness.
of sudden onset
with no specific periodicity
non progressive
It is associated with
Slurred speech for 1 day which was sudden
on onset and difficulty in swallowing for both
solid and liquids for 1 day not associated with
vomiting, diarrhoea, constipation, loss of
consciousness, headache, numbness, convulsion,
muscle pain , joint pain.

5
REVIEW OF THE OTHER SYSTEMS

Genital-urinary System
No Genital discharge
No Genital itching
No Genital rash
Painful urination associated with abdominal pain
more marked below the umbilicus sudden on onset,
sharp pain in nature and also associated with
urine mixed with blood.
No change in urinary frequency
Respiratory System
Cough that was productive with yellowish sputum
associated with chest pain.
No difficulty in breathing.
No hemoptysis.

6
REVIEW OF THE OTHER SYSTEM

Cardiovascular System
No awareness of heartbeats.
No lower limb swelling.
No breathlessness when lying flat.
Endocrine System
No excessive thirsty.
No heat intolerance.
No cold intolerance.
No neck enlargement.
No loss of libido.

7
REVIEW OF THE OTHER SYSTEM

Hemopoetic system.
No easy bruising.
No bleeding tendency.
Integumentary system.
No skin itch.
No skin rashes.
No skin swelling.

8
REVIEW OF THE OTHER SYSTEM

Ear,Nose, Throat.
No abnormal ear discharge.
No abnormal nasal discharge.
No difficulty in swallowing.

9
PAST MEDICAL HISTORY

This is her first admission , no past admissions.
No history of Blood Transfusion.
No history of trauma/surgery.
She has no allergy to drugs.
She is a known patient with HIV/AIDS since birth
on regular Tenofovir ,Lamivudine ,Dolutegravir
medication OD.

10
FAMILY HISTORY

She is a third born out of 4 children , 3 of them
are alive, well and have no history of HIV/AIDS.
Her mother is alive and a known HIV/AIDS patient.
Her father is alive and has no history of
HIV/AIDS.
No history of sudden death.
Negative family history for other chronic illness
such as Hypertension, Diabetes Mellitus.

11
SOCIAL HISTORY

She is a student with certificate level.
She is single with no extra marital affairs.
She has no child.
No history of smoking.
No history of alcohol use.
No history of illicit drug use and abuse.

12
DIETERY HISTORY

She takes three meals per day.
Morning she takes tea and maandazi.
Afternoon she takes cooked rice with meat or
beans or vegetables.
Evening she takes cooked rice with either meat or
beans or vegetables.
She takes fruits such as water melon or banana.
she drinks reasonable amount of water gt1000ml per
day.
She takes a balanced diet.

13
SUMMARY 1.

Female patient, 20 yrs Old from Kigogo Mwisho
Known patient with HIV/AIDS since birth on
Tenofovir, Lamivudine and Dolutegravir with Chief
Complaint of left sided body weakness for one
day associated with slurred speech and dysphagia.
Also reported abdominal pain associated with
hematuria and dysuria. Patient had a productive
cough, yellowish in nature which was associated
with chest pain.She has no history of chronic
illness such as hypertension,Diabetes Mellitus.

14
CLINICAL DIAGNOSIS BASED ON HISTORY.

1. STROKE.
Reason for
Left sided body weakness.
loss of power in left arm.
Immunocompromised patient.

Differential Diagnosis
1. Space Occupying Lesions.
Reasons for
Left sided body weakness
Hemiplegic gait.
Reasons against
No vomiting.
No headaches.
No behavioural changes.

Other Diagnosis.
1. Pulmonary Tuberculosis
Reasons for
Productive cough.
Immunocompromised.
Reasons against
No night sweats.
No fever.
Sudden onset.
No hemoptysis.

2.Urinary Tract Infection.
Reasons for
Haematuria.
Painful urination.
Abdominal pain.
Reasons against
No history of fever.
3. Community Acquired Pneumonia.
Reasons for
Chest pain.
Productive cough yellow in nature.
Reasons against
No fever.

18
PHYSICAL EXAMINATION.

GENERAL EXAMINATION.
Ill looking,wasted with blue cannula on her right
hand and she was catheterized.
She had black coloured hair well distributed with
normal texture.
Face is symmetrical.
Pale eyes ,not jaundiced and cyanosed.
No Xanthelasma,No cornea arcus.
Normal ear set position with no abnormal
discharges.
No nasal blockade , no nasal discharge.
No oral thrush no any palpable lymph nodes.
No finger clubbing , no koilonychias, no
leokonychia , no splinter hemorrhage.
Normal capillary refill of less than 2 seconds,
no palmar erythema.

19
VITALS.

Temperature 37.5 0C. (normal)
Blood pressure 105/68 mmHg.(normal)
Respiratory Rate 20 bpm. (normal)
Pulse Rate 108 bpm. (tachycardia)
SpO2 92 on room air. (normal)

20
SYSTEMIC EXAMINATION.

NERVOUS SYSTEM EXAMINATION.
Higher Center.
Patient was alert,fully conscious with GCS 15/15.
Oriented to person,place and time.
Long term memory and short term memory were
intact.
Normal intelligence, concentration and slurred
speech.

Cranial Nerves.
CN 1 (Olfactory)
She has normal sense of smell
CN 2 (Optic)
Normal visual acuity
Normal visual field
Normal colour vision
CN 3,4 6 (Occulomotor,Trochlea,Abducent )
Normal eye ball movement

CN 5 (Trigeminal)
Normal sensory function
Normal jaw opening and closing
CN 7 (Facial)
Normal facial expressions.
CN 8 (Vestibulocochlea)
Positive Rinnes test
Positive Webers test
CN 9 (Glossopharyngeal)
Normal gag reflex

CN 10 (Vagus)
Patient had dysphagia for both solid and liquid
hence vagus nerve was not intact
CN 11 (Accessory)
Patient can normally turn her head against
resistance
Patient can shrug her right shoulder but not the
left shoulder
CN 12 (Hypoglossal)
Patient could not articulate words well (slurred
speech)

PERIPHERAL NERVOUS SYSTEM.
Motor system examination.
The muscle bulkiness was normal .
There was no any involuntary movement.
There was normal tone for 3 limbs , No tone on
the left arm.
She had hemiplegic gait with normal
coordination.
Power was reduced to 1 , trace of contraction was
seen.
Biceps,triceps,patellar and Achilles tendon
reflexes was normal on the 3 limbs , No biceps
and triceps reflexes on the left arm.
Sensory system examination.
On sensory system there was normal sensation to
sharp touch,light touch,vibration sense, joint
position sense.

ON RESPIRATORY EXAMINATION
On inspection
The chest was symmetrical in morphology, there
was no any therapeutic or surgical scars ,the
chest movement was symmetrical with respiratory
rate of 20 beats per minute.
There was no use of accessory muscles in
breathing.
On palpation
No tenderness and superficial palpable lymph
nodes, the trachea was placed in the midline and
the cardiac apex beat was felt on the left 5th
intercostal space mid clavicular line,no
superficial palpable mass.There was normal
tactile vocal fremitus and symmetrical chest
expansion on both sides of the lungs.
On percussion Both the lung fields were
resonant on percussion.

On auscultation
Normal vesicular sounds were heard with fine
crackles on the right mid infra scapular.
ON CARDIOVASCULAR EXAMINATION.
The Radial pulse was 98 beats/minute,regular ,
strong with normal character and synchronous with
contralateral pulses with blood pressure
105/68mmHg at supine lying position heard at 1st
and 5th Korotkoff phase.The Jugular venous
pressure was increased with no hepatojugular
reflux.
On precordial examination
On inspection There was no precordial
hyperactivity or any bulging,there was no
surgical or traditional scar
On palaption The cardiac apex beat felt at the
5th intercostal space mid clavicular line with
normal character.There was no palpable thrills or
parasternal heaves.
On percussionThere was dull percussion note
heard over the area of the heart.
On auscultation Normal S1 and S2 were
heard.There were no any added sounds and no extra
sounds were heard.Fine crackles were heard at the
base of the lungs.

ON GASTRO INTESTINAL SYSTEM EXAMINATION
Per abdomen
On Inspection
There was normal abdominal contour and
symmetrical in shape with normally inverted
umbilicus , there was no any surgical or
traditional scars.
On palpation
On superficial palpation there was no tenderness
or any palpable mass.
On deep palpation there was abdominal tenderness
below the umbilicus.
On percussion
There was a tympanic note heard on the
abdomen.
On auscultation
There were normal bowel sounds.

28
SUMMARY 2.

Female patient , 20yrs Old from Kigogo Mwisho
known patient with IDS since birth on Tenofovir,
Lamivudine and Dolutegravir with chief complaint
of
Left sided body weakness for 1/7.
On examination revealed
Slurred speech , loss of tone and reflexes on
the left arm, No shrug of the left shoulder,
abdominal pain below the umbilicus.She had no
numbness on her left arm hemiplegic gait and
dysphagia for both solid and liquid