Dr.Keerthi Madireddy

  A 50YEAR OLD FEMALE PATIENT RESIDENT OF NALGONDA PRESENTED TO OPD WITH COMPLAINTS OF C/O FEVER SINCE1 MONTH GENERALISED BODY PAINS SINCE 10 DAYS B/L LOWER LIMB EDEMA SINCE 3 DAYS VOMITINGS SINCE 3 DAYS SHORTNESS OF BREATH SINCE 2 DAYS ABDOMINA PAIN SINCE 1 DAY HISTORY OF PRESENTING ILLNESS:  PATIENT WAS APPARANTLY ASYMPTOMATIC 1 MONTH AGO, THEN DEVELOPED FEVER, HIGH GRADE ASSOCIATED WITH CHILLS, INTERMITTENT TYPE, RELIEVED WITH MEDICATION, NO DIURNAL VARIATION, GENERALISED BODYPAINS SINCE 10 DAYS SHORTNESS OF BREATH SINCE 2 DAYS, INSIDIUOS IN ONSET AND GRADUALLY PROGRESSIVE FROM GRADE 2 TO GRADE 3 NO ORTHOPNEA, NO PND VOMITINGS SINCE 3 DAYS, CONTENT FOOD MATERIAL, NON BILIOUS, NON PROJECTILE ABDOMINAL PAIN, DIFFUSE, NON RADIATING B/L LOWER LIMB PEDAL EDEMA, PITTING TYPE EXTENDING UPTO KNEE. DIDNOT PASS STOOLS SINCE 5 DAYS. NO H/O LOOSE STOOLS, CHESTPAIN. HISTORY OF PAST ILLNESS : K/C/O HTN, SINCE 2 ?AKI ON CKD S/P 4 SESSIONS HD DONE 1 YEAR AGO [STOPPED MEDICATION 10 DAYS AGO] N/K/C/O

CHIEF COMPLAINTS  50/F HOUSEWIFE BY OCCUPATION CAME TO ORTHOPAEDICS OPD WITH COMPLAINTS OF  LOWER BACK PAIN SINCE 2 MONTHS RADIATING TO RIGHT LOWER LIMB HISTORY OF  PRESENT ILLNESS: PATIENT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS BACK THEN HE DEVELOPED LOWER BACK PAIN WHICH WAS INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE, DRAGGING TYPE, AGGREVATED BY BENDING AND SITTING .RADIATING TO RIGHT LOWER LIMB. TINGLING, NUMBNESS + IN RIGHT LOWER LIMB H/O TRAUMA 16 DAYS BACK BUT NO H/O LOC, ENT BLEED, HEAD INJURY LATER PATIENT WAS TAKEN TO NIMS FOR PET CT, AFTER ADVICING IN VIEW OF TUMOUR OF UNKNOWN ETIOLOGY WHICH SHOWED METOBOLICALLY ACTIVE CAVITATORY LESIONS IN BOTH THE LUNGS, MULTIPLE PULMONARY NODULES, NODAL DISEASE AND SKELETAL LESION.RENAL PARAMETERS WAS DERRANGED. NO H/O FEVER H/O NEUROLOGICAL CLAUDICATION PRESENT BOWEL &BLADDER REGULAR NON ALCOHOLIC NON SMOKER  APPETITE REDUCED  PAST HISTORY N/K/C/O HTN, DM, TB, BA, EPILEPSY, CVA, CAD, ASTHMA  GENERAL EXAMNATION : PATIENT I