65M with filariasis and multiple blisters on right leg

 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 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 inputs on the 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



65 yr old male resident of nalgonda weaver by occupation came to OPD with 

Chief complaints
Swelling in the right lower limb and scortum since 5 days 
Multiple blisters on the leg since 5 days
Fever since 5 days 

History of presenting illness 
He was apparently asymptomatic 5 days ago then he developed swelling in right lower limb upto thigh (gradually progressive from foot to thigh)along with scortum which is associated with pain - sudden in onset , gradually progressive , pricking type, aggravated on walking , releived on rest 
Multiple blisters on right leg, associated with local rise of temperature, moderate fever(102°f),skin changes, pigmentation 
Not associated with burning micturation, urinary incontinence

Past history 
Known case of filariasis since 15 yrs and on medication ( Diethylcarbamazine)
Not a k/c/o HTN,DM , epilepsy,TB,CAD,CVD,asthma

Personal history
Diet :mixed
Appetite : decreased 
Sleep: adequate
Bladder and bowel movements : normal and regular 
Addictions : consumes alcohol occasionally
No allergies

Treatment history 
Diethylcarbamazine since 15yrs (takes medicine only after noticable swelling)
Chymoral forte -takes when there is pain 

Family history
Non significant

General examination 
Patient is conscious,coherent and cooperative
Well oriented to time place and person
Moderately built and nourished
No pallor,icterus, cynosis, clubbing, koilonychia,
Lymphadenopathy:enlarged inguinal and popliteal lymph nodes
Pedal oedema -pitting type ,from foot upto thigh

Vitals 
Bp:100/60 mm hg 
Temp:98 
RR:21cpm
PR:78bpm

























Systemic examination
CVS:S1,S2 heard ,no murmurs
CNS: no focal neurological deficit
Resp: Bilateral air entry present,normal vesicular breath sounds heard 
Per abdomen: soft and non tender 


Investigations

















Treatment history
 1)IV fluids (normal saline 75ml/hr)

2) Inj.PAN 40 mg OD

3)Tab.Dolo 650 mg 

4) Inj. NEOLOL 1gm 

5) Inj.PIPTAZ 4.5gm 











Comments

Post a Comment

Popular posts from this blog

A 60F with megaloblastic anemia

Image
DOA - 27/11/2023 CHIEF COMPLAINTS Fever since 1 week Palpitations since 1 week  Generalised weakness since 4 days  Chest pain and tightness since 4 days HISTORY OF PRESENTING ILLNESS  The patient was apparently asymptomatic 1 week ago and then she developed fever which is sudden in onset, high grade, associated with chills and rigors, relieved temporarily on medication.  Palpitations are present since 1 week which are regular and associated with chest discomfort. There is H/o shortness of breath on exertion which is progressive (grade 2 to grade 3). No orthopnea, or PND. There is associated generalised weakness since 4 days and blood in stools since 3 days.  There is no h/o vomitings, loose stools, pain abdomen, giddiness. PAST HISTORY N/k/c/o DM, HTN, Asthma, TB, Epilepsy, CAD, CVA There is h/o tubectomy  PERSONAL HISTORY  Diet mixed  Appetite normal Sleep adequate Bowel and Bladder-regular  Addictions - None GENERAL EXAMINATION  Pt is conscious, coherent and cooperative and well orie
Read more

General Medicine Assignment-October

  Bimonthly blended assessment - October 2021 25 october 2021 Name:P.Jahnavi Roll no.- 183 Batch: 2019 (3rd sem)   I have been given the following assignment to analyze , and review, in an attempt to understand the topic of 'Patient clinical  data analysis' to develop my competency in reading and to comprehending clinical data including history, clinical findings, investigations and diagnosis. This is the link of questions asked in the bimonthly assignment: https://medicinedepartment.blogspot.com/2021/10/oct-2021-formative-bimonthly-blended.html?m=1 QUESTION 1 Critical Appraisal - GASTROENTEROLOGY - https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html - The case discussed is of Chronic liver failure and kidney disease. - The case is very well explained. - The main abnormalities of patient are highlighted which are easy to grasp.  - There is a video link kept which is very clear about ascitic tap. CNS -  http://keelasreevalli.blogspot.com/2021
Read more