45F with b/l Pedal Edema

202403311 laxmamma
Case History and Clinical Findings PATIENT CAME WITH C/O BILATERAL PEDAL EDEMA SINCE 1 MONTH ,DECREASED URINE OUTPUT SINCE 1 MONTH,FEVER SINCE 1 MONTH. DIFFICULTY IN BREATHING SINCE 1 MONTH, SWELLING OVER CHEEKS SINCE 3 MONTHS 

HOPI 
PATIENT WAS APPARENTLY NORMAL 3 MONTHS BACK AND THEN DEVELOPED BILATERAL PEDAL EDEMA THAT WAS INSIDIOUSON ONSET, GRADUALLY PROGRESSIVE AND ASSOCIATED WITH DECREASED URINE OUTPUT. FEVER IS LOW GRADE, GRADUAL IN ONSET, PERIODIC, NO ASSOCIATED CHILLS AND RIGORS. DIFFICULTY IN BREATHING IS ASSOCIATED WTH EXERTION. NO PND NO ORTHOPNEA , NO H/O VOMITINGS, DIARRHOEA, COUGH, COLD, BURNING MICTURITION 

Past h/o
NOT A K/C/O DM, HTN TB, ASTHMA , EPILEPSY, CAD 
H/O HYPERTENSION SINCE 1 MONTH.


 SURGERY REFERRAL DONE ON 23-1-24 I/V/O PLEOMORPHIC ADENOMA ADVICE : USG OVER SWELLING, FNAC OVER PAROTID GLAND, OPG OPHTHAL REFERRAL WAS DONE ON 24/1/24 SPECTACLE CORRECTION DONE, USAGE OF SPECTACLES ADVICED FOR LEFT EYE.

Investigations
USG WAS DONE ON 24/1/24 E/O 30X32 MM WELL DEFINED LESIONS WITH CYSTIC AND SOLID COMPONENT MEASURING 22 X 21 MM WITH FAINT INTERNAL VASCULARITY NOTED RISING FROM SUPERFIICIAL LOBE OF PAROTID GLAND AT THE SITE OF SWELLING IN THE RIGHT PAROTID REGION. DD:PLEOMORPHIC ADENOMA, PLEOMORPHIC ADENOMA EX CARCINOMA , LOW GRADE CARCINOMA, THYROID GLAND APPEARS NORMAL, S/E WITH NORMAL VASCULARITY, E/O 14 X 10 MM ISOECHOIC SOLID, CYSTIC LESION, WIDER THAN TALLER WITH INTERNAL AND PERIPHERAL VASCULARITY NOTED IN LEFT LOBE OF THYROID TIRADS 2 LESION FEW PROMINENT LN NOTED B/L B/L CAROTID, JUGULAR VESSELS APPEAR NORMAL B/L SUBMANDIBULAR GLANDS APPEARS NORMAL LEFT PAROTID GLAND APPEARS NORMAL 







Diagnosis 
CHRONIC KIDNEY DISEASE ANEMIA OF CHRONIC DISEASE PLEOMORPHIC ADENOMA HYPERTENSIVE URGENCY (RESOLVED ) K/C/O HTN SINCE 1 MONTH
TREATMENT GIVEN
FLUID RESTRICTION <1.5 L/DAY SALT RESTRICTION <2GM / DAY INJ LASIX 40 MG IV BD TAB NICARDIA 10 MG TID INJ KCL 40 MCG IN 150 ML NS OVER 5 HOURS 2 EGG WHITES/ DAY BP MONITORING HOURLY 
Advice at Discharge 
FLUID RESTRICTION <1.5 L/DAY SALT RESTRICTION <2GM / DAY TAB FUROSEMIDE 40 MG PO BD TAB NICARDIA 10 MG TID 2 EGG WHITES/ DAY

Comments

Post a Comment

Popular posts from this blog

K. Rithika 59

Image
Greetings to one and all who are currently reading my blog. This is Rithika, 8th semester medical student.                                               This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's 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.  Note : This is an on-going case and will be updated as and when I receive any information.  CHIEF COMPLAINTS Patient came with chief complaint of cough since  7 Days, Fever since 7 days, with difficulty in breathing since 7 days HOPI Fever since 15-days high grade-not associated with chills and rigor, evening rise + Associated with sweating Cough since 7- days associated with less amount of sputum, mucoid. blood tinged aggravated on changing position from l
Read more

PREFINAL EXAMINATION OSCE LEARNING POINTS

My case for today was a case of acute cervical dystonia. Was a quite interesting case which I saw in the recent times.               Different diagnosis were considered for it like   Tetanus   Focal seizures   Drug induced dystonia     Now my learning points were:     - With so many differentials in mind, how to land up in a particular diagnosis    - Why drugs cause dystonia in a few and doesn't in the other?        Let's dig deep to know how🙂 Focal dystonia Focal dystonia is limited to one area of the body and can affect the neck (cervical dystonia or spasmodic torticollis), eyes (blepharospasm), jaw/mouth/lower face (oromandibular dystonia), vocal cords (laryngeal dystonia) or arms/legs (limb dystonia). Other less common types of focal dystonias can cause unusual stretching, bending or twisting of the trunk (truncal dystonia) or sustained contractions and involuntary, writhing movements of the abdominal wall (abdominal wall dystonia). Symptoms Dystonia affects different peop
Read more

59 K. Rithika Vasantha

Image
Greetings!! I'm Rithika, a third semeter medical student. This blog aims at providing a wide array of information of cases evaluated to the best of my understanding. This blog paces up with spectrum of patient centered active learning under the guidance of my experienced seniors.  A 65 YEAR OLD FEMALE WITH HYPOGLYCEMIA  SECONDARY TO THE PRESENCE OF CANCER Date of admission: On 5.7.21 Note : The following blog aims at discussing our patient's deidentified health data shared after taking the guardian's signed consent.  This blog is prepared under the guidance of Dr. Siddharth.  A 65 year old female came to the casuality in altered state at 3 am.  CHIEF COMPLAINTS : • Slurring of speech and profuse sweating since a day before (4. 7.21) , (from evening).  • And at around 3 am, was brought to casuality in unconscious state, responding to deep stimulation and LOC + HISTORY OF PRESENT ILLNESS : • Pt was apparently asymptomatic since yesterday evening 4 pm.  • Pt had episodes of sl
Read more