1701006155 CASE PRESENTATION
LONG CASE :
A 75 year old female, who is a resident of miryalguda was brought to the OPD with chief complaints of
- Vomiting since 1 day
- Giddiness since 1 day
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 4 years back and was able to perform her regular work as an agricultural worker when she developed gradual diminision of vision (in both eyes) along with generalised weakness and headache for which she was taken to a nearby hospital and underwent bilateral cataract surgery. At the same time she was diagnosed with Type 2 Diabetes Mellitus and Hypertension for which she started regular medication ever since.
4 days back she visited her daughters house and forgot to take her medication for Diabetes Mellitus and Hypertension subsequent to which she developed giddiness and vomiting which was sudden in onset, non projectile, non bilious and non foul smelling containing food particles as content.
Not associated with fever, abdominal pain, loose stools or rapid breathing with fruity odour.
On taking her to hospital 1 she was found to have a GRBS of 394 mg/dl and urinary ketones was found to be positive for which she was referred to hospital 2 and admitted.
No H/O chest pain , palpitations , syncopal attacks.
No H/O shortness of breath , burning micturition
PAST HISTORY-
No similar compliants in the past.
Not a known case of TB, Asthma, Epilepsy or CAD.
SURGICAL HISTORY
Underwent bilateral cataract surgery 4 years back.
PERSONAL HISTORY
Diet- mixed
Appetite- normal
Sleep- adequate
Bowel and bladder- regular
Addictions- smoked chutta for 10 years; 3 Chuttas per day; stopped 4 years back
FAMILY HISTORY
Not significant
No h/o TB, asthma, epilepsy
GENERAL EXAMINATION
Patient is conscious, coherent and cooperative.
She is well oriented to time, place and person.
Moderately built and nourished.
Patient was examined in supine position in a well lighted room after taking consent.
Pallor - absent
Icterus - absent
Cyanosis - absent
Clubbing - absent
Lymphadenopathy - absent
Edema - absent
Temperature - afebrile
Pulse rate - 90 beats per minute; regular rate and rhythm
All Superficial pulses- intact
Respiratory rate - 20 cycles per minute
Blood pressure - 230/110mmHg at the time of presentation(around 7pm) on 09/06/2022
On day 10/06/22- Blood pressure - 150/100mmHg
On day 11/06/22- Blood pressure - 180/100 mm Hg
GRBS - 394mg/dl ( at presentation) Day 1
On day 2 - 226mg/dl
On day 3- 204mg/dl
SYSTEMIC EXAMINATION
CENTRAL NERVOUS SYSTEM EXAMINATION
Level of consciousness- conscious/ alert
Higher mental functions- normal
Speech- Normal
Cranial nerve functions - Intact.
Sensory system-
R. L
pain N. N.
Temperature N. N.
Superficial touch N. N.
vibration N. N.
Proprioception N. N.
Motor system -
Right Left
Power- UL 5/5 5/5
LL 5/5 5/5
Neck Normal
Trunk muscles Normal
Tone- UL Normal Normal
LL Normal Normal
Reflexes-
Superficial reflexes - Intact
Plantar Reflex- R- flexion L- flexion
Deep tendon reflexes -
Biceps ++ ++
Triceps ++ ++
Supinator ++ ++
Knee ++ ++
Ankle ++ ++
Gait- Normal
Cerebellar system - intact
GIT
Inspection
Abdomen - distended
Umbilicus - transverse slit like
Movements - all quadrants are equally moving with respiration
No scars and sinuses
No visible peristalsis
No engorged veins.
Palpation-
No local rise in temperature and no tenderness in all quadrants
LIVER: no hepatomegly
SPLEEN- not enlarged
KIDNEYS - bimanually palpable kidneys
Percussion-
no shifting dullness
Auscultation-
Bowel sounds are heard and are normal
No bruit.
Respiratory system
Inspection
No tracheal deviation
Chest bilaterally symmetrical
Type of respiration: thoraco abdominal.
No dilated veins,pulsations,scars, sinuses.
Palpation:
No tracheal deviation
Apex beat- 5th intercoastal space,medial to midclavicular line.
Tenderness over chestwall- absent.
Vocal fremitus- normal on both sides.
Percussion:
Right side and left side- resonant
Auscultation:
Normal Vesicular breath sounds
Bilateral Airway entry - present.
Cardiovascular system
Inspection
no visible pulsation , no visible apex beat , no visible scars.
Palpation
all pulses felt
apex beat felt.
Percussion
heart borders normal
Auscultation
Mitral area, tricuspid area, pulmonary area, aortic area- S1,S2 heard.
INVESTIGATIONS
Investigations prior to admission at hospital 2-
Urinary Ketones- Postive
GRBS - 394 gm/dl
Investigations on admission to Hospital 2
GRBS CHARTING-
On day 09/06/22- at presentation- 394 mg/dl
On Day 10/06/22- 226 mg/dl
On day 11/06/22- 214 mg/dl
On day 12/06/22- 199 mg/dl
On day 13/06/22-200mg/dl
A 12 year old boy ,who is a 7th standard student, resident of miryalaguda ,stays in the hostel ,he is taken to the hospital by his father with chief complaints of
itching all over body but more in the web spaces of fingers of hands since 10days.
History of Presenting Illness
he was apparently asymptomatic 10 days ago ,then he noticed itching involving all over the body . itching is insidious in onset , gradually progressive and more during night time.
No h/o fever, vomiting and diarrhea
No h/o cough and cold
PAST HISTORY;
No similar complaints in the past
No h/ o asthma, TB, epilepsy
No h/o drug intake
FAMILY HISTORY:
No similar complaints in the family
But his roomate is having similar complaints in the hostel.
PERSONAL HISTORY;
Diet ;mixed
Appetite;normal
Bowel and bladder: regular
Sleep : disturbed due to itching since 4 days
No known drug allergies
GENERAL EXAMINATION;
He is examined in a well lit room and after adequate exposure.
He is conscious, coherent, cooperative and well oriented to time ,place and person.
He is moderately built and moderately nourished.
VITALS :
Temperature: Afebrile
Pulse rate- 95bpm
RR-18 CPM
BP:110/80mmhg ,measured in sitting position in left upper arm
SYSTEMIC EXAMINATION;
Respiratory system: BAE - present,no added sounds
CVS;S1,S2 heard,no murmurs
PER ABDOMEN:soft and non tender,No organomegaly.
CNS: Intact
CUTANEOUS EXAMINATION;
ON Examination,there are papules and excoriated lesions over finger web spaces and periumbilical region.
PROVISIONAL DIAGNOSIS;
SCABIES.
Investigations-
Hemogram
•Hb-12g%
•Total Count -normal
•Platelets -normal
KOH mount-
Shows eggs and adult mites.
Treatment;
*Tab.levocet-for 15 days OD at night time
*Permethrin 5%lotion ,apply all over the body below neck before going to bed and keep it for atleast 12 hours and repeat it after one week.
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