1701006089 CASE PRESENTATIONS
LONG CASE:
This is case of 48year old male who is farmer and construction worker by occupational hailing from chityal who came with chief complaints of shortness of breath since since3days, Decreased urinary output since 2days .
HOPI:
Patient was apparently asymptomatic 4yrs back then he developed bilatera pedal edema( on and off ) for which he went to local hospital and was on conservative management. Since then, he was diagnosed with hypertension using tab. Telmisartan 40 mg since 4year.
Since yesterday night patient is having is having sob grade 3 which is sudden in onset and gradually progressed to grade4now ,aggravated on lying down,relieving on sitting position . He also complaining of cough since 2 days which is insidious in onset ,non productive cough with no aggravating and relieving factors
not associated with chest pain or sweating.
No c/o fever, vomitings or loose motions.
PAST HISTORY
PERSONAL HISTORY
FAMILY HISTORY
CLINICAL EXAMINATION:
There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy
B/l pedal edema present, pitting type extending up to the knee
VITALS
Temp- 98. 6F
PR-86 Bpm
RR- 20 cpm
Bp- 110/80 MMHG
Spo2- 46% on RA
Grbs- 101 mg%
SYSTEMIC EXAMINATION
CVS- jugular venous pulse normal S1, S2 Present, no murmurs
RS-on inspection
Shape of chest-bilaterally symmetrical and Elliptical BAE Present,
b/l wheeze present in infraaxillary, mammary, inframammary
Normal vesicular breath sounds present
Crepts present in b/l inframammary areas
P/A examination - soft, nontender,no organomegaly,no abnormal distension
CNS EXAMINATION - normal
INVESTIGATION
Chest X-ray
Hemogram
Complete urine examination
RENAL FUNCTION TEST
Arterial blood gas
2d echo
PROVISIONAL DIAGNOSIS:
Chronic renal failure with type 1 respiratory failure with severe metabolic acidosis.
Treatment -
Inj. Lasix 40 mg iv stat
Inj. Sodium Bicarbonate 150 meq iv stat
Nebulisation with duolin and budecort stat
Hemodialysis
30 years old female homemaker by occupation came to the General Medicine OPD with the
Cheif complaints:
- bilateral joint pains in both legs
HOPI: Patient was apparently asymptomatic 12 months ago.
Then she developed symmetrical b/l joint pains in the knees which was insidious in onset, gradually progressive which aggravates on standing and relieving on taking rest and medication.
Around the same time she developed itching over neck and back region .
She also complains of generalised body pain.
C/O Difficulty in walking.
C/O proximal muscle weakness manifested in the form of : difficulty in getting up from squatting position, getting objects present at a height.
On examination:
Past h/o: Not a k/c/o DM, HTN, BA, epilepsy, Asthma, CVA, CAD
Family h/o: No similar complaints in the familyy
Personal h/o:
Diet- Mixed
Appetite- Normal
Sleep- Inadequate since 12 months. WAKES AT 2 AM -3AM BECAUSE OF PAIN IN LEGS.
Bowel and bladder-regular
No addictions
No known drug allergies
General physical examination: The patient is conscious, coherent, cooperative
No pallor
No icterus, cyanosis, clubbing, lymphadenopathy.No pedal edema
Vitals:
Temperature- Afebrile
BP- 130/80mm Hg
PR- 114bpm
RR- 18cpm
SpO2- 98% @ RA
SYSTEMIC EXAMINATION:
CVS- S1, S2 sounds heard. No murmurs
RS- BAE+, NVBS heard
CNS- NAD
P/A- Soft, non tender, Bowel sounds heard
INVESTIGATION:
Provisional diagnosis:
DERMATOMYOSITIS
