case of sob and dysphagia

50 yrs old female patient came with
Chief complaints: sob from 20 days and difficulty in swallowing to solids and liquids from 3 days
And not able to open mouth from 1 day
History of present illness: pt apparently asymptomatic 20 days back and developed sob of grade 2  not associated with orthopnea, pnd ,pedal edema,chest pain, palpitations
From 3 days pt having difficulty in swallowing to solids and liquids  and  from  1 day not able to open mouth
It is because of reddish discoloration of tongue and pain 
History of past illness: 
2 months back pt had complaints of cough and expectoration 
Pain in chest region went to hospital diagnosed clinically as pulmonary military Tb and started on ATT. 
After 1 month she developed redness itching all over body it is ATT induced erythoderma
She stopped ATT (1/2/2022) for 20 days and agin started 1 month back
Know case of 
                 DM 3 months no medication
                  HTN  10 yrs on medication
                  TB     on ATT.  3 tab per day 
She is a know n case of rheumatoid arthritis and hypothyroidism

Personal history
 Appetite   : normal
 diet.          : Mixed
 Bowel and bladder. Regular
 No allergies and no habits

General examination conscious , coherent , cooperative
Pallor present but no
      Icterus
      Cyanosis
       Clubing
       Lymphadenopathy
Vitals
         BP 130/80mmhg
         PR 110 BPM
         RR 27
         Spo2 95 
 
Systemic examination
CVS
       No thrills 
       S1 S2  heard
     No cardiac murmurs
  
Respiratory examination 
     Dyspnea present and no wheeze
     Position of trachea central 
     Breath sound s  vesicular sounds
     Crepts heard at rt infraclavicular area
Abdomen 
  Soft and non tender
  No palpable masses
  Liver and spleen not palpable
  Bowel sounds heard
   No fluid thrills
CNS examination
Higher motor and sensory system were normal
Provisional diagnosis. 
   Miliary Tb with Att induced erythoderma. 
  With  heart failure  . with nutritional anemia

  Investigations
                    
              USG
                    1)left mild hydronephrosis
                    2) mild hepatomegaly with grade 2 fatty liver

ECG.      
X rays 
Color Doppler 2D echo
      TR and AR
       Moderate LV dysfunction 
       RWMA. +ve with diastolic dysfunction







Popular posts from this blog

65 yr old female with involuntary movements of Lt upper limb

Image
February  ,2023 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. Name : SANTOSH KUMAR .K ( Intern )  Roll Number : 62 I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.  Chief compliants A 65 yr old female patient came to casualty with complaints of lt upper limb  since 1 day  Cough since 4 days...
Read more

pre final case

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs". This E log book also reflects my patient-centred online learning portfolio and your valuable comments on comment box is welcome.  I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. Name K Santosh Kumar Roll no 52 CASE DETAILS  An 80yr old male patient hailing from rural nalgonda a known case of CHRONIC KIDNEY DISEASE ON DIALYSIS  has presented with complaints...
Read more

Online Blended Bimonthly Assignment MAY 2021 Roll no. 52.

Image
I have been given the following cases to solve in an attempt to understand the topic of 'patient clinical data analysis 'to develop my competency in reading and comprehending clinical data including history ,clinical findings, investigation and diagnosis and come up with the treatmentplan.                 PULMONOLOGY Case 1 https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html 1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem? Ans) 1st episode of sob - 20 yr back 2nd episode of sob - 12 yr back From then she has been having yearly episodes for the past 12 yrs  Diagnosed with diabetis - 8yrs back Anemia and took iron injections - 5yr ago Generalised weakness - 1 month back  Diagnosed with hypertension - 20 days back HRCT showed Signs of - 20 ...
Read more