This is a case of a 45 year old female,resident of Nalgonda, technician by occupation came to the op with the chief complaints of
HOPI AND PAST HISTORY
30 YEARS BACK(15 yrs of age)- Got married in 10th class (Non consanguinous marriage) Her partner was a jobless alcoholic
AT 18 YEARS- She gave birth to a healthy baby boy through LSCS
AT 20 YEARS- Gave birth to a healthy baby girl through LSCS
22 YEARS BACK - She was a homemaker then.
Due to her husband’s aggressive behaviour, she ingested pesticide which was seen by her sister.
She gave her saltwater,induced vomitings and shifted her to Osmania hospital where she was admitted for 2 days
20 YEARS BACK (JAN 2003)-She joined as a technician in this hospital and also worked as a tailor
17 YEARS BACK(2006)-
C/o left ankle swelling and left leg edema which initially resolved overnight but later didn’t seem to resolve
Later she c/o bilateral lower limb edema about which she neglected due to her work stress
She also c/o pain in the large joints (ankle,knee,wrist,elbow,shoulder) and also neckpain
There was no h/o small joint involvement
She used homeopathy medication but the pain didn’t seem to resolve
7 YEARS BACK (2016)
Visited this hospital due to severe pain in the joints and diagnosed to be having RHEUMATOID ARTHRITIS
CCP +ve, ANA -ve
She was started on Intralesiona triamcelone and NSAIDs
During one of her routine checkups, she c/o increase in her weight for which Thyroid profile is done and she was having HYPOTHYROIDISM. She was kept on Tab.Thyronorm 25mcg PO/OD
5 YEARS BACK (2018)
She was also kept on Tab.Wysalone 5mg PO/OD(used it for 3 years) and Tab.Methotreaxate (15mg) PO/OD
4 YEARS BACK(2017)
She was also kept on Hydrochloroquine (used it till 2022)
Also on Tab.Sulphasalazine 1000mg
2 YEARS BACK
Due to medication she c/o Recurrent gastritis and ulceration
AUGUST 2022
During one of her routine investigations she was diagnosed to be having Type2 Diabetes Melkite’s for which she was kept on Tab.Metformin 500mg Po/OD
PERSONAL HISTORY
DIET- Mixed
APETITE- Good
BOWEL AND BLADDER MOVEMENTS -Regular
SLEEP -Adequate
ADDICTIONS -none
MENSTRUAL HISTORY -
Age of Menarche -13 yrs
Periods -regular 5/28
No of pads-3/ days
Pain and clots absent
FAMILY HISTORY -Non significant
GENERAL EXAMINATION
The patient is conscious, coherent,cooperative, well oriented to time place and person
She is moderately built and nourished
Ht-155cm
Wt-74 kgs
Pallor - absent
Icterus - absent
Cyanosis - absent
Clubbing - absent
Edema - absent
Lymphadenopathy - absent
SYSTEMIC EXAMINATION
CVS- S1S2 present
RS- no abnormal breath sounds heard
CNS- Higher mental functions intact
LOCAL EXAMINATION
1)Neck
Flexion
Extension
2) Shoulder
Abduction -
RIGHT Left
Supraspinatus .
Deltoid .
Infraspinatus .
Lattismus dorsi .
Serratus anterior .
Pectoralis major .
Rhomboid. .
3) Elbow
Biceps .
Triceps .
Brachiradialis .
4) Wrist
Flexor carpi radialis .
Flexor carpi ulnaris .
Extensor carpi radialis longus .
Extensor carpi ulnaris longus .
Extensor digitorum .
5)Handgrip
Abductor pollicis longus
Abductor pollicis brevis
Extensor pollicis longus
Extensor pollicis brevis
Oppenens pollicis longus
Opponens pollicis brevis . .
Adductor brevis . .
Dorsal interossei . .
Palmar interossei . .
6) Trunk Abdomen
Able to roll but unable to get up from the bed on her own
7) Hips
RIGHT LEFT
iliopsoas 4-/5 4-/5
Adductor femoris 4-/5 4-/5
Abductor femoris 4-/5 4-/5
Gluteus maximus 4-/5 4-/5
Gluteus medius 4-/5 4-/5
8)KNEE
Internal rotators . 4-/5 4-/5
External rotators 4-/5 4-/5
Extension 4-/5 4-/5
Flexion 4-/5 4-/5
9)Ankle
Dorsiflexion . 4+/5 .4+/5
Plantar Flexion. . 4+/5 . 4+/5
External rotation . 4+/5 . 4+/5
Internal rotation . 4+/5 . 4+/5
Vibration 5.3 seconds 8seconds
Ankle. 6 seconds. 6seconds
Medial malleolus. 6seconds. 6seconds
TibiaL tuberosity. 6seconds. 06 seconds
Elbow 7seconds. 07 seconds
Crude touch Normal. Normal
Temperature able to perceive heat and cold
Fine touch. Normal normal.
Romberg sign.
Proprioception. Decreased 3-4/10 9/10
Stereognosis good good
Tactile localisation. Normal normal.
Two point discrimination present present
DIAGNOSIS
INVESTIGATIONS
CBP
Hb-9.8
TLC-8600
N/L/E/M/B-68/25/2/5/0
Platlets -4.5
MICROCYTIC HYPOCHROMIC ANAEMIA
FBS-106
PLBS-241
HbA1c-7.0
THYROID PROFILE
T3-1.06
T4-12.03
TSH-4.15
LIPID PROFILE
Total cholesterol-190
Triglycerides-238
HDL-39
LDL-118
VLDL-47.6
RFT
Urea-24
Creatinine -0.7
Uric acid-2.2
Calcium-9.3
Phosphorus -3.1
Sodium-135
Potassium-4.6
Chloride-101
LFT
Total bilirubin-0.60
Direct bilirubin -0-15
SGOT-22
SGPT-17
ALP-173
Total proteins-5.8
Albumin -3.5
A/G ratio-1.58
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