A 40/F Came with chief complaints of ,
Abdominal Distension since 1 year
Associated with abdominal discomfort-diffuse abdominal pain, aggravated after eating, relieved on sleeping , sitting and after defecation.
Dizziness and headache -9 days back
Facial puffiness since 1 year
Itching all over the body since 1 year and developed multiple plaques on abdomen and Lower limbs.
Sob since 9 days
pedal edema since 9 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 9 days ago she developed pedal edema- pitting type.
She has developed SOB of 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 has bilateral knee pain since 3 years.
Onset- insidious
Duration- 3 years
Gradually progressing
Type- pricking
Non radiating
More at the night
Aggravated on walking
Relieved on sitting ,sleeping and medication.
No history of trauma
No history of fever , swelling in the knees during the pain.
She is diagnosed with Tinea corporis infection since 1 year and she is put on medications for it.
Medical history -
She is under medication( demisone 0.5 mg and acelogic SR) since 3years.
Not a K/C/O DM/HTN/ asthma / Ischemic heart disease
FAMILY HISTORY
NO SIGNIFICANT FAMILY HISTORY
PERSONAL HISTORY:
OCCUPATION - worker in a glass factory
DIET -MIXED
APPETITE- decreased
SLEEP -NORMAL
BOWEL AND BLADDER HABITS : decreased urine output
ADDICTIONS: NO
MENSTRUAL HISTORY:
Menarche -13 years
Regular monthly cycles
No.of pads per day -2
No clots
Menopause -35 years
GENERAL EXAMINATION
Patient is concious ,coherent and coperative
built - obese , moderately nourished.
VITALS
BP 110/80
PR 90bpm
TEMP 98.5degrees F
SPO2 98 @ RA
GRBS 106
NO PALLOR, ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY
SYSTEMIC EXAMINATION
CVS EXAMINATION
Inspection-
The chest wall is bilaterally symmetrical
No raised JVP.
Palpation-
Apical impulse is felt in the left 5th intercostal space, medial to the midclavicular line
• No parasternal heave felt.
Percussion- no pericardial effusion
Auscultation-
S1 and S2 heard, no added thrills and murmurs are heard
PER ABDOMINAL EXAMINATION :-
Soft and non tender .
No visible peristalsis.
Normal bowel sounds.
NO HEPATOSPLENOMEGALY elicited
Umbilicus - inverted umbilicus.
RESPIRATORY SYSTEM EXAMINATION :-
Inspection-
Upper respiratory tract - Normal
Shape of chest - elliptical & Bilaterally symmetrical
Trachea- in midline
no scars and sinuses
no visible pulsations
no engorged veins
no usage of accessory respiratory muscles
Palpation-
No local rise of temperature
No tenderness
All the inspectory findings are confirmed
Apical Impulse :- 5th intercostal space 1 cm medial to mid clavicular line
Trachea is in normal position.
chest expansion - normal.
Movements of chest with respiration are normal.
vocal fremitus - normal.
Ausclutation-
Bilateral air entry - present.
Normal vesicular breathsounds are heard.
No advantitious sounds heard.
INVESTIGATIONS DONE ON 31-5-22 :
Blood sugar- random:
Renal function tests:
Liver function tests:
Complete urine examinatiom:
Complete blood examination.
X-ray :
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
8-06-2022
Ultracet
Rantac
Tab.Deflazacort
Syp.Aristozyme
PROVISIONAL DIAGNOSIS: steroid-induced cushings
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SHORT CASE
CHIEF COMPLAINTS
A 71 year old male patient came to opd with chief complaints of breathlessness and cough since 20 days
Fever since 4 days
HISTORY OF PRESENTING ILLNESS
Patient is apparently asymptomatic 20 days back then he developed cough and shortness of breath.
cough- is associated with sputum
color of sputum - whitish( Mucoid)
Blood tinged sputum ( 2 to 3 episodes)
Non foul smelling
Shortness of breath - insidious in onset,
grade III dyspnea
breathlessness after walking for some distance.(100 yards)
Associated with wheeze.
Aggravated on excertion and exposure to cold
Relieved on rest.
Associated with right sided chest pain
which is of dragging type.
Fever - low grade
There is evening raise of temperature
Not associated with chills or rigors.
Relieved on medication.
PAST HISTORY
No history of similar complaints in the past
no history of covid 19 in the past
No history of Diabetes,Hypertension,Asthma Tuberculosis,epilepsy, Thyroid abnormalities
PERSONAL HISTORY
Appetite :- Decreased
Diet :-mixed
Bowel and bladder :- regular
Sleep :- adequate
Addictions :- smokes 3-4 beedis per day since 50 years. Drinks alcohol occasionally.
He used to work as a construction worker ,later he worked as a security gaurd , recently he worked as a farmer but stopped working 5 days before admitting in Hospital
FAMILY HISTORY
No history of similar complaints in family
GENERAL EXAMINATION
Patient is conscious, coherent and cooperative
Thin built and moderately nourished
Pallor :- Present
Icterus :- Absent
Cyanosis :- Absent
clubbing :- present (Grade II - Parrot beak appearance )
Lymphadenopathy :- Absent
Pedal Edema :-Absent
VITAL SIGNS
Temperature :- afebrile
Respiratory Rate :- 22 cycles per minute (tachypnea)
Pulse:-79 beats per minute
Blood pressure :- 120/80 mmHg
taken from Left arm ,measured in sitting position
DAY 1
BP- 110/80 mm hg
pulse- 88 bpm
respiratory rate -28 cpm
spo2 -96%
DAY 2
BP -120/80 mm hg
pulse -89 bpm
respiratory rate -26 cpm
spo2 -96%
DAY 3
BP -120/80 mm hg
PULSE -94 bpm
RR-14 cpm
SPO2 -92% (on room air )
96% ( with 2 lits of oxygen)
GRB 108mg /dl
DAY 4
BP -120/80 mm hg
PULSE -90 bpm
RR-24cpm
SPO2 -96% (on room air )
DAY 5
BP -120/80 mm hg
PULSE -88 bpm
RR-22cpm
SPO2 -98% (on room air )
DAY 6
BP -120/80 mm hg
PULSE -92 bpm
RR-24cpm
SPO2 -91% (on room air )
97% (with 2 lits of oxygen)
SYSTEMIC EXAMINATION
The patient was examined in a well lit room with adequate exposure after taking informed consent
INSPECTION
Upper respiratory tract - Normal
Shape of chest - elliptical & Bilaterally symmetrical
Trachea - deviated to right side
Movements - reduced on right side
no crowding of ribs
no scars and sinuses
no visible pulsations
no engorged veins
wasting of muscles is present
no usage of accessory respiratory muscles
PALPATION
No local rise of temperature
No tenderness
All the inspectory findings are confirmed
Apical Impulse :- 5th intercostal space 2 cm medial to mid clavicular line
Trachea is deviated towards right side (3 finger test )
chest expansion 1cm ( Inspiration circumference - expiration circumference)
Movements of chest with respiration are reduced on right side
chest expansion 1cm
vocal fremitus - increased on right side
PERCUSSION
supraclavicular, infraclavicular, mammary, axillary, infra axillary, suprascapular, infrascapular areas are percussed
Dull note was noted in Right infraclavicular and suprascapular areas
Remaining all areas are resonant
AUSCULTATION
Normal vesicular breath sounds are heard
decreased breath sounds in Right infraclavicular area and Right Suprascapular area
No added sounds
CVS EXAMINATION
Inspection-
The chest wall is bilaterally symmetrical
Palpation-
Apical impulse is felt in the fifth intercostal space, 1 cm medial to the midclavicular line
• No parasternal heave felt
Percussion-
Right and left borders of the heart are percussed
Auscultation-
S1 and S2 heard, no added thrills and murmurs are heard
PER ABDOMINAL EXAMINATION :-
Shape - scaphoid
Soft and
NO HEPATOSPLENOMEGALY
CENTRAL NERVOUS SYSTEM
Higher mental functions are normal
Sensory and motor examinations are normal
No signs of meningeal irritation
INVESTIGATIONS
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PROVISIONAL DIAGNOSIS
Right upper lobe consolidation or fibrosis.
TREATMENT
DAY 1
injection Augmentin 1.2 gms IV TID
injection PAN 40mg IV OD (before breakfast)
Tab paracetamol 650 mg BD
Nebulization with Budecort BD ,DUOLIN TID
oxygen inhalation with nasal prongs at the rate of 2 - 4 lits per minute
Tablet AZEE 500 mg OD
DAY 2
injection Augmentin 1.2 gms IV TID
injection PAN 40mg IV OD (before breakfast)
Tab paracetamol 650 mg BD
Nebulization with Budecort BD ,DUOLIN TID
oxygen inhalation with nasal prongs at the rate of 2 - 4 lits per minute
Tablet AZEE 500 mg OD
DAY 3
injection Augmentin 1.2 gms IV TID
injection PAN 40mg IV OD (before breakfast)
Tab paracetamol 650 mg BD
Nebulization with Budecort BD ,DUOLIN TID
oxygen inhalation with nasal prongs at the rate of 2 - 4 lits per minute
Tablet AZEE 500 mg OD
DAY 4
injection Augmentin 1.2 gms IV TID
injection PAN 40mg IV OD (before breakfast)
Tab paracetamol 650 mg BD
Nebulization with Budecort BD ,DUOLIN TID
oxygen inhalation with nasal prongs at the rate of 2 - 4 lits per minute
Tablet AZEE 500 mg OD
injection optineuron 100ml OD
Syrup Ascoril 2 tspns TID
DAY 5
injection Augmentin 1.2 gms IV TID
injection PAN 40mg IV OD (before breakfast)
Tab paracetamol 650 mg BD
Nebulization with Budecort BD ,DUOLIN TID
oxygen inhalation with nasal prongs at the rate of 2 - 4 lits per minute
Tablet AZEE 500 mg OD
syrup cremaffin 10 ml (per oral )
DAY 6
injection Augmentin 1.2 gms IV TID
injection PAN 40mg IV OD (before breakfast)
Tab paracetamol 650 mg BD
Nebulization with Budecort BD ,DUOLIN TID
oxygen inhalation with nasal prongs at the rate of 2 - 4 lits per minute
Tablet AZEE 500 mg OD
syrup cremaffin 10 ml (per oral )
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