1701006043 CASE PRESENTATION
LONG CASE
A 40 year old female came to OPD with
CHIEF COMPLAINTS OF :
ECG
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 9 days
pedal edema since 9 days pitting type
H/O OF PRESENTING 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 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
MENSTRUAL HISTORY
menarche - 13 years
Regular monthly cycles
No of pads - 2
No clots
Menopause - 35 years
PERSONAL HISTORY:
OCCUPATION Daily wage worker , stopped going to work since 3 months
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
Renal function tests
Random blood sugar
Liver function tests
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
8-06-2022
Ultracet
Rantac
Tab.Deflazacort
Syp.Aristozyme
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SHORT CASE
A 71 year old male patient came to opd with
CHIEF COMPLAINTS OF
Breathlessness and
cough since 20 days
HISTORY OF PRESENTING ILLNESS
Patient is apparently asymptomatic 20 days back then he developed cough and shortness of breath.
COUGH
cough is associated with sputum
color of sputum - whitish( Mucoid)
Blood tinged sputum ( 2 to 3 episodes)
not associated with odour
DYSPNEA
insidious in onset
grade III dyspnea
breathlessness after walking for some distance.(100 yards)
Associated with right sided chest pain
which is of dragging type.
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
Weight 37 kgs
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 sunuses
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)
Chest diameters
Transverse :- 27 cm
Anteroposterior :-20 cm
Movements of chest with respiration are reduced on right side
chest expansion 1cm
vocal fremitus - increased on right side
Right left
• Supra clavicular normal normal
• Clavicular Increased normal
• Infra clavicular Increased normal
• Mammary Increased normal • Axillary Increased normal
• infra axillary Increased normal
• Supra scapular. Increased normal
• infra scapular Normal normal
PERCUSSION
supraclavicular, infraclavicular, mammary, axillary, infra axillary, suprascapular, infrascapular areas are percussed
Dull note was noted in Right infraclavicular and suprascapular areas
All other areas were 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
Soft and
NO HEPATOSPLENOMEGALY
CENTRAL NERVOUS SYSTEM
Higher mental functions are normal
Sensory and motor examinations are normal
No signs of meningeal irritation
INVESTIGATIONS
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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