A 50 year old female c/o generalised weakness

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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 complaints: 

   -generalised weakness since 5 months 

   - loss of appetite since 5 months 

   - hematuria since 2 days 

   - dizziness since 5 months 

   - sob ( grade 2-3) since 5 months 

   - fever since 1 week 


History of presenting illness:


Patient was apparently asymptomatic 2 years back where she developed swelling of left lower limb first as with pain and then swelling progressed to whole body where she got admitted to Osmania and treated and swelling subsided and patient is doing fine .after 1 year of that event patient gradually developed generalised weakness, easy fatiguability, loss of appetite,weight loss, sob ( grade 2-3) not with cough, cold , palpitations, 


She has fever which is intermittent, low grade not associated with chills and rigors 


She also has Hematuria for which she went to local hospital where she found to have Anemia for which she was transfused 5 units of blood in a span of 20 days and was discharged. 

She was doing fine.


Since 5 months patient is experiencing similar complaints and went to hospital where she was found to have Anemia and got transfused 2 units of blood and came here as they were unsatisfied with the treatment there 


Past history: 

Not a known case of HTN, DM 2 , CVA, CAD, TB , EPILEPSY ETC 


She underwent hysterectomy surgery at the age 36 years after the third childbirth 


PERSONAL HISTORY: 

A 50 year old female ,mother of 3 children ( 2 sons and 1 daughter) 

Farmer by occupation

Diet - mixed 

Appetite- decreased since 1 year 

Bowel and bladder - regular 

Sleep- adequate 

Allergies - No


Menstrual history -


Menarche - 13 years age 

Past - A Regular cycle 5/30 

Present - hysterectomy done at the age of 36 yrs 


Daily routine 

She wakes up at 5 o clock and does her daily activities and then she prepares for breakfast and have her breakfast at 7 o clock and then goes for work and at 12 o clock she haves her lunch near the field and in the evening she goes to home at 7 o clock and prepares for dinner and eats dinner and then goes to bed at  9-10 pm 


After symptoms

She is not going to any work since 1 and half year she stays at home and takes rest .


General examination : 

Patient is concious , coherent and cooperative well oriented to time place and person 

Poorly built and poorly nourished 

Patient was examined in a well lit room and after taking consent with adequate exposure .


Pallor - present





Icterus - positive 

Cyanosis - negative

Kolinychia - negative 

Clubbing - negative 

Generalised lympadenopathy - negative 

Edema - negative 

VITALS - 
 
BP- 90/60mmhg 
PR- 84bpm 
RR- 16 cpm
Rs- BAE +ve , NVBS
CVS- S1 S2 heard , no murmurs 
CNS - NFND
P/A - spleenomegaly 
         Size- 17.5 * 15 cms
          Surface - smooth 
          Consistency - firm
          Borders- rounded borders










Spo2 - 98% at RA
Temp- afebrile 



Provisional diagnosis-
PANCYTOPENIA UNDER EVALUATION 
? AKI ( pre renal) 
Denovo HBSAG positive 



INVESTIGATIONS- 





















TREATMENT- 
Tab.dolo 650mg po/sos
Sup.aristozyme 10ml po/tid 
Tab.orofer XT po/OD 
Temp monitoring 4th hrly 
Vitals monitoring 4th hrly  


9/07/2023


S:
Stools passed
No fever spikes

O:
Pt is conscious,coherent and cooperative
No pallor,icterus,cyanosis,clubbing,
lymphadenopathy,edema

Bp-90/60mmHg
Pr-84bpm
Temperature - Afebrile
Rr-16 cpm  

CNS: NFND
CVS-S1,S2 heard ,no murmurs
RS- BAE present, NVBS Heard, no added sounds 
P/A- spleenomegaly 


A:
Pancytopenia under evaluation
?AKI ( Pre-renal)
DENOVO HBsAg +ve 

P:
- T.Dolo 650mg PO/SOS
- Syp. ARISTOZYME 10ml PO/TID
- Temperature monitoring 4th hourly
- Vitals monitoring 4th hourly


10/07/2023
Ward : WARD
Unit : 6
DOA : 8/7/23

Dr Nithin (pgy1)
Dr Nishitha (pgy2)
Dr Zain (SR)


S:
Stools passed
No fever spikes
No fresh complains 

O:
Pt is conscious,coherent and cooperative
No pallor,icterus,cyanosis,clubbing,
lymphadenopathy,edema

Bp-100/60mmHg
Pr-86bpm
Temperature - Afebrile
Rr-16 cpm  

CNS: NFND
CVS-S1,S2 heard ,no murmurs
RS- BAE present, NVBS Heard, no added sounds 
P/A- spleenomegaly 


A:
Pancytopenia under evaluation
?AKI ( Pre-renal)
DENOVO HBsAg +ve 

P:
- T.Dolo 650mg PO/SOS
- Syp. ARISTOZYME 10ml PO/TID
- Temperature monitoring 4th hourly
- Vitals monitoring 4th hourly


11/07/2023

Ward : WARD
Unit : 6
DOA : 8/7/23

Dr Govardhini(pgy1)
Dr Nishitha (pgy2)
Dr Zain (SR)


S:
Stools passed
No fever spikes
Tingling and numbness present

O:
Pt is conscious,coherent and cooperative
No pallor,icterus,cyanosis,clubbing,
lymphadenopathy,edema

Bp-100/60mmHg
Pr-84bpm
Temperature - Afebrile
Rr-16 cpm  

CNS: NFND
CVS-S1,S2 heard ,no murmurs
RS- BAE present, NVBS Heard, no added sounds 
P/A- spleenomegaly 


A:
Pancytopenia under evaluation
?AKI ( Pre-renal)
DENOVO HBsAg +ve 

P:
- T.Dolo 650mg PO/SOS
- Syp. ARISTOZYME 10ml PO/TID
-inj.vitcofol 1ml IM/OD
- Temperature monitoring 4th hourly
- Vitals monitoring 4th hourly




































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