A 60 Year Old Female With Fever and Backache and 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.

Ankur Kumar
Roll no 14

A 60 Year Old Female With Fever and Backache and Generalised Weakness Since 5 Days

CHIEF COMPLAINTS

Fever Since 5 Days
Backache since 5 Days
Generalised Weakness Since 5 Days

HOPI 
Patient was Apparently asymptomatic 5 days back and then developed sudden onset of high grade fever which is Continuous and with no diurnal variation and Not associated with Chills and Rigors.

She complained of Backache since 5 days which is insidious in onset ,gradually progressive, and is persistent.
She also Complained about Generalised Weakness Since 5 days.

She went to a Government Hospital with complaints of Fever and Generalised Weakness 4 Days ago Where She was Diagnosed With Hypotension and Low Platelet Count.

She was Put on Medication But as her Symptoms Were not relieving, She came to this Hospital for treatment.


PAST HISTORY

No history of Hypertension, Diabetes, Asthma, Epilepsy,TB

No history of prolonged hospital stay

No history of previous surgeries

PERSONAL HISTORY

DIET - Mixed
Appetite - Decreased
Sleep - Inadequate 
Bowel and Bladder - Regular
Addictions - Tobacco Smoking 2-3 times a Day since 40 years

DAILY ROUTINE

She wakes up at 5am and does her Morning chores.

Drinks Tea at 7am and eats her Breakfast - Rice and Vegetable curry at 9am
And then goes for work.
She works as labourer in the farm fields.
She eats her lunch by 1pm - Rice and vegetable curry
 She comes home by 5:30 pm and completes her daily chores and eat dinner by 8:30 pm - Rice and Vegetable curry and goes to sleep by 9 pm.



TREATMENT HISTORY - Unknown


FAMILY HISTORY - Not Relevant 


GENERAL EXAMINATION 

Patient was Conscious, Coherent and Cooperative

Moderately build and Moderately Nourished

Well oriented to Time ,Place and Person.


Pallor : No Pallor

Icterus: absent

Clubbing: absent

Cyanosis: absent

Lymphadenopathy: absent

Edema : absent




VITALS: 
Temp: Afebrile
BP: 80/60 mmHg in Supine position
PR- 90 bpm
RR- 30 CPM
 
SYSTEM EXAMINATION:-

Abdominal Examination- 

 INSPECTION :-

On Inspection Abdomen is Slightly Distended,

Umbilicus is central and Slit Like ,

No scars and Sinuses 
No Engorged Veins


PALPATION

All inspectory findings are Confirmed

Tenderness Present in the Right Hypochondrium Region
No Flank Fullness

Percussion 
- No Significant Findings

Auscultation
 - Bowel Sounds Heard

RESPIRATORY EXAMINATION 

Trachea central,

Bilateral Air Entry Present

Normal vesicular breath sounds.



CARDIOVASCULAR SYSTEM

S1 ,S2 heard ,

No murmurs



CNS EXAMINATION

No Focal Neurological Deficits


INVESTIGATIONS

FEVER CHART



PROVISIONAL DIAGNOSIS

Dengue Fever, With Thrombocytopenia









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