1701006005 CASE PRESENTATION

 LONG CASE 

40/F Came with complaints of 

Abdominal Distension since 1 year 

Facial puffiness since 1 year 

Itching all over the body since 1 year and developed multiple plaques on abdomen and Lower limbs 

Sob since 5 days

pedal edema since 5 days pitting type

H/O PRESENT ILLNESS

Patient was apparently asymptomatic 1 year back then she developed abdominal distension, facial puffiness,itching all over the body and 5 days ago she developed pedal edema and SOB grade 3.

she had an episode of vomiting two days back which was non projectile and non bilious contained food particles. It was relieved on medication. 

PAST HISTORY 

she developed  B/L Knee pain - since 3years,  onset - insidious, gradually progressing, type- pricking, more at the night, aggravated on walking, relieved on sitting n sleeping, no radiation and is under medication( demisone 0.5 mg and acelogic SR) 

She developed abdominal distension and facial puffiness one year back.

 She also developed itching and skin lesions and was diagnosed as tinea and was given medications. 

Not a K/C/O DM/HTN/ asthma / Ischemic heart disease / epilepsy / TB



FAMILY HISTORY 

NO SIGNIFICANT FAMILY HISTORY



PERSONAL HISTORY:

OCCUPATION Daily wage worker

DIET MIXED

APPETITE decreased 

SLEEP NORMAL

BOWEL AND BLADDER HABITS : decreased urine output 

ADDICTIONS: NO





GENERAL EXAMINATION 

Patient is concious coherent and coperative, well oriented to time palce and person



VITALS 

BP 110/80

PR 90bpm

TEMP 98.5degrees F

SPO2 98 @ RA

GRBS 106





NO PALLOR, ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY ,



SYSTEMIC EXAMINATION



CVS-

Inspection :

Apex beat 5th intercostal space 

Palpation 

Apical impulse - medial to mid clavicular line at 5th ics 

Auscultation 

Mitral area

Aortic area

Pulmonary area

S1 S2+ heard , no murmurs, or any added sounds 

P/A-

Inspection:

Abdomen is distended

Umbilicus is inverted

Movements :- gentle rise in abdominal wall in inspiration and fall during expiration. 

No visible gastric peristalsis 

palpation : SOFT, NON TENDER, NO ORGANOMEGALY


RS - BAE + , normal vesicular breath sounds

Random Blood sugar

Renal function test

Liver function test

Complete blood picture

Lipid profile 

Ultrasound:

X-ray

Provisional diagnosis : cushings syndrome 

Treatment: 

4-06-2022

Inj. Pantop

Inj lasix

Inj optineuron 

Tab. Ultracet

Tab.aldactone

Tab. Atarax

Tab . Zofer

Luliconazole

Syp aristozyme

5-06-2022

Ultracet

Luliconazole ointment

Rantac

Syp aristozyme 

6-06-2022

Spironolactone 

Ultracet

Luliconazole ointment

Rantac

T defloz 6mg

Syp. Aristozyme 

7-06-2022

Tab.Deflazacort

Ultracet

Luliconazole ointment

Rantac

Syp. Aristozyme

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SHORT CASE 

Chief complaints-

A 71 year old male ,Mason by occupation came to the general medicine OPD  on 1st June,2022 with chief complaints of

. breathlessness since 20 days

.cough since 20 days

.fever since 4 days

Daily routine-

He is Mason by occupation since 25 years.Daily he used to wake up at 7 am and goes to work by 9 am and return home at 5 pm.He doesn't wear mask while working.He sleeps at 10pm 

History of present illness-

Patient was apparently asymptomatic 2 months back,then he developped breathlessness which is insidious in onset, gradually progressive(MMRC grade-1) and dry cough.

=>2 months back, he visited near by government hospital where he was given medication.The symptoms were on and off with medication.

=>20 days back breathlessness was progresses to MMRC grade-2 to 3

.Associated with wheeze

.Aggrevated on cold exposure, exertion

.Relieved on rest

.No orthopnea and PND

=>20 days back,he developped cough with expectoration

.Mucoid in consistency

.Non foul smelling

.Non blood stained

.Aggrevated at night

=>4 days back,he developped fever,which is continuous and low grade 

.Evening rise of temperature is present

.Relieved on medication

.Not associated with chills and rigors

General examination-

Patient is conscious, coherent , cooperative.well oriented to time, place and person

He is thin built and moderately nourished.

.Temperature-99°F

.Pulse rate-83 beats per minute

.Respiratory rate-20 cycles per minute

.BP-120/80 mm of hg

.SpO2-95%at room air

.Pallor- absent

.Icterus-absent

.cyanosis- absent

.Clubbing- absent

.Lymphadenopathy- absent

.Edema- absent

Systemic examination-

Respiratory system-

Inspection-

.Shape of chest-bilaterally symmetrical,elliptical

.Trachea- shift to right side

.Chest movements-decreased on right side

.No kyphosis and scoliosis

.No crowding of ribs

.No scars,sinuses,visible pulsations,engorged veins

.No usage of accessory muscles

Palpation-

.All inspectors findings are confirmed

.No local rise of temperature and tenderness

.Trachea-shift to right side

.Chest movements- decreased on right side

.Chest expansion-decreased on right side

.AP diameter-

.Transverse diameter-

Percussion-

.Dull note heard on right upper part of chest

.vocal fremitus-equal on both sides

Auscultation-

.Normal vesicular breathsounds heard

.Decreased breath sounds on right upper lobe 

.crepitations present on right mid axillary area

CVS-

.S1 and S2 heard

.No murmurs

Per abdominal examination-

.Shape of the abdomen- scaphoid

.Hernial orifices- normal

.Soft,non tender,no organomegaly

.Bowel sounds- heard

Provisional diagnosis-

Right lung upperlobe consolidation

Investigation

CBP 

CUE 

Lft

HRCt

Treatment 

1).Inj.augmentin-1.2 gm IV TID

2).Inj.pantop-40 mg OD

3).Tab.paracetomol-650 mg BD

4).syp.Ascoril-2 Tbsp

5).Nebulization with .budecort-BD

                                       .Duolin-TID

                                       .Mucomol-TID

6).oxygen inhalation with Nasal prongs@2.4 lit/ min

7).Tab.Azee-500 mg OD.