Case history-5
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A 50 year old female has come to casualty with shortness of breath and swelling in lower limbs (pedal edema) since 4 days .
Patient complaints of decrease in urine output since 4 days.
PAST HISTORY :
Patient compliant of hypertension since 7 years.
No history of diabetes, asthma, Tuberculosis, coronary artery disease.
No history of blood transfusion and atherosclerosis.
PERSONAL HISTORY:
Appetite : normal
Diet : mixed.
Bowel and bladder movement: normal.
Addictions : patient takes alcohol regularly.
FAMILY HISTORY:
No history of diabetes, hypertension, asthma, tuberculosis in the family.
No history of heart diseases , stroke, cancer .
TREATMENT HISTORY:
Patient is not allergic to any known drugs.
Patient has not undergone any surgeries .
Patient doesn't use any antibiotics and not undergone any chemotherapy or radiation.
GENERAL PHYSICAL EXAMINATION:
Patient is cohorent , concious and cooperative and examined in well lit room.
Presence of pedal edema in lower limbs .
No pallor, cyanosis, icterus , clubbing.
No General lymphadenopathy.
VITALS:
Temperature: 98.6 degree Fahrenheit.
Respiratory rate:22/min.
Blood pressure:140/90mmHg
Pulse:84/min.
SpO2:94%
SYSTEMIC EXAMINATION:
Cardiovascular system:
No thrills and cardiac mummers .
S1 and S2 are heard .
Respiratory system:
No wheezing and dyspnoea.
Positioning of trachea is central and breath sounds are vesicular.
Abdomen:
Shape of abdomen: obsese.
No tenderness and no palpable mass is present.
No free fluid and bruits and liver and spleen are not palpable and bowel sounds are not heard .
Central nervous system:
Patient is conscious and speech is normal.No signs of meningeal irritation such as neck stiffness and kerning's sign.
Cerebral signs such as finger - nose in coordination and knee - heal incoordination are not present .
Sensory and motor system are normal and glass -gow scale show 15/15.
PROVISIONAL DIAGNOSIS:
CKD ( chronic kidney diseases) and MHD ( maintenance haemolysis).
INVESTIGATION:
ULTRASOUND:
HBsAg- RAPID
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