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Top differential - Infective carditis secondary to prosthetic valve, with concern about impact on cardiac function due to SOB on exertion and fatigue. Ddx to consider: Lymphoproliferative disorder HIV, TB or abscess, early menopause (primary ovarian failure) but there wouldn't be an actual fever & periods still present.

Thanks dr punekar I like his clear and confident conversations I wish I could work with him

Great hx taking..It would be relevant to ask any lumps or bumps(lymphoma) , medication allergy (because of the long treatment duration) and any recent procedure e.g tooth extraction

Thankyou sir

That’s really helpful. Thank you Dr. Punekar.

D/D Lympoham TB Infective Endocarditis Spleenic Infection

Did this new history taking stations now started in overseas centers

I think adrenal hemorrhage dt warfarin also fit

Dr Punekar never smiles

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