Skip to main content

25F REACTIVE ARTHRITIS

 


25 YR OLD FEMALE WORKS IN PETROL BUNK,RESIDENT OF DHAMARACHARLA CAME TO OPD WITHC/O DIFFICULTY IN WALKING SINCE 4 DAYS

PATIENT WAS APPARENTLY ASYMPTOMATIC UNTIL 10 DAYS AGO THEN HAD C/O FEVER WENT TO LOCAL HOSIPTAL AND TREATED ,AFTER TREATMENT PATIENT HAD C/O LOOSE STOOLS 4-5 EPISODES PER DAY MUCOID , GREENISH COLOUR , NON BLOOD STAINED , NON FOUL SMELLING , LARGE QUANTITY AGGRAVTED ON HAVING FOOD ,WENT TO LOCAL RMP AND GOT TREATED SYMPTOMS SUBSIDED .

SINCE 4 DAYS PATIENT HAD C/O BACK PAIN SUDDEN ONSET F/B NECK PAIN AT CERVICAL REGION , NON RADIATING F/B RIGHT KNEE PAIN AND SWELLING .RIGHT INDEX FINGER PAIN A/W SHOCK LIKE SENSATION .

N/K/C/O DM ,HTN, TB,CVA,CAD,ASTHMA,EPILEPSY,THYROID DISORDERS . GENERAL PHYSICAL EXAMINATION

PATIENT IS CONSCIOUS, COOHERENT, COOPERATIVE

TEMP-98.4F

PR-95BPM BP-110/70MMHG

SPO2 97%RA

GRBS -93

CVS-S1S2 +

RS BAE +, NVBS

P/A SOFT, NON TENDER

CNS E4V5M6

PUPILS - B/L PUPILS REACTIVE

TONE

LT UL- NORMAL LL NORMAL

RT ULNORMAL LT- NORMAL

POWER

LT UL-4/5 LL4/5

RT UL 4/5 LL 3/5

REFLEXES

BICEPS - RT +2, LT +2

TRICEPS RT - LEFT -

SUPINATOR RT+ LT +

KNEE RT +2 LT +2

ANKLE RT + LT +

PLANTARFLEXION RT FLEXION LT FLEXION CRANIAL NERVES -

1-NORMAL

2-NORMAL

3-NORMAL

4-NORMAL

5-NORMAL

6-NORMAL

7-NORMAL

8 -NORMAL

9-NORMAL

10-NORMAL

11-NORMAL

12-NORMAL





COURSE IN THE HOSPITAL

24 YEAR FEMALE CAME TO OPD WITH ABOVE MENTIONED COMPLAINTS, NECESSARY INVESTIGATIONS DONE AND DIAGNOSED WITH REACTIVE ARTHRITIS SECONDARY TO ENTERIC FEVER. ON DAY 2 OF ADMISSION PAINS SUBSIDED. ON DAY 3 OF ADMISSION PATIENT COMPLAINED OF RIGHT KNEE PAIN, AND 2 EPISODES OF LOOSE STOOLS WITH UNDIGESTED FOOD PARTICLES. ON DAY 4 OF ADMISSION PATIENT HAD BILATERAL KNEE PAINS, LOOSE STOOLS SUBSIDED. ON DAY 5 AND 6 PATIENT IS SYMPTOMATICALLY BETTER WITHOUT ANY FEVER SPIKES. PATIENT WAS CONSERVATIVELY MANAGED WITH IV ANTIBIOTICS AND NSAIDS. PATIENT IS HEMODYNAMICALLY BETTER AND PLANNED FOR DISCHARGE.

Investigation

Blood Urea 11 mg/dl 42-12 mg/dlSerum Creatinine 0.8 mg/dl 1.1-0.6 mg/dlSERUM ELECTROLYTES (Na, K, C l) 27-03-2024 12:55:PM

SODIUM 111 mmol/L 145-136 mmol/L POTASSIUM 3.3 mmol/L 5.1-3.5 mmol/L CHLORIDE 84 mmol/L 98-107 mmol/L

LIVER FUNCTION TEST (LFT) 27-03-2024 12:55:PM Total Bilurubin 0.99 mg/dl 1-0 mg/dl

Direct Bilurubin 0.28 mg/dl 0.2-0.0 mg/dl

SGOT(AST) 17 IU/L 31-0 IU/L

SGPT(ALT) 15 IU/L 34-0 IU/L

ALKALINE PHOSPHATASE 84 IU/L 98-42 IU/L

TOTAL PROTEINS 4.2 gm/dl 8.3-6.4 gm/dl

ALBUMIN 2.14 gm/dl 5.2-3.5 gm/dl

A/G RATIO 1.04

COMPLETE URINE EXAMINATION (CUE) 27-03-2024 12:55:PM COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN Nil

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 2-3

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent OTHERS Nil

HIV - NEGATIVE

HBsAg-RAPID 27-03-2024 12:55:PM Negative

Anti HCV Antibodies - RAPID 27-03-2024 12:55:PM Non Reactive

BLOOD UREA 27-03-2024 10:56:PM 16 mg/dl 42-12 mg/dl

SERUM CREATININE 27-03-2024 10:56:PM 0.8 mg/dl 1.1-0.6 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 27-03-2024 10:56:PM SODIUM 137 mmol/L 145-136 mmol/L

POTASSIUM 4.0 mmol/L 5.1-3.5 mmol/L

CHLORIDE 103 mmol/L 98-107 mmol/L

STOOL FOR OCCULT BLOOD 27-03-2024 10:56:PM Negative (-ve) CRP - + POSITIVE

ESR - 40MM

RBS - 78MG/DL

HEMOGRAM-27/3/24

HB-7.6GM/DL

TLC -9000 CELLS/CUMM

PLATELET COUNT - 2.8 LAKH/CUMM NORMOCYTIC NORMOCHROMIC ANEMIA. HEMOGRAM ON 28/3/24:

HB-9.4GM/DL

TLC -8,200CELLS/CUMM

PLATELET COUNT - 3.5 LAKH/CUMM NORMOCYTIC NORMOCHROMIC ANEMIA. HEMOGRAM ON 29/3/24:

HB-9.9GM/DL

TLC -12,400CELLS/CUMM

PLATELET COUNT - 4.5 LAKH/CUMM

NORMOCYTIC NORMOCHROMIC ANEMIA WITH LEUCOCYTOSIS PERIPHERAL SMEAR:

RBC : Normocytic normochromic few microcytes

WBC : With in normal limits

PLATELET : Adequate

IMP : Normocytic normochromic anemia

RECTIC COUNT:1.0%

SERUM LDH:130IU/L

SR.IRON:

USG ABDOMEN AND PELVIS -

NO SONOLOGICAL ABNORMALITY DETECTED Treatment Given(Enter only Generic Name) INJ.MONOCEF 1GM IV/BD X 4 DAYS INJ.NEOMOL 1G IV/SOS

TAB.NAPROXEN 250MG PO/TID 1-1-1 TAB.ULTRACET 1/2 TAB PO/QID 1/2-1/2-1/2-1/2 TAB.PAN 40 MG PO / OD 1-0-0 TAB.REJUNEX-CD3 PO/OD 0-1-0 TAB.SPOROLAC -DS PO/TID 1-1-1

DOROLAC - Z SACHET PO/BD 1-0-1

Advice at Discharge

TAB TAXIM 200MG PO/TID 1-1-1 X 2 DAYS

TAB INDOCAP SR 75MG PO/OD 1-0-0 X 2 DAYS TAB.NAPROXEN 250MG PO/TID 1-1-1 X 5DAYS TAB.PAN D PO / OD 1-0-0 X 5DAYS TAB.REJUNEX-C03 PO/OD 0-1-0 X 15DAYS

TAB SPORLAC DS 1TAB PO/TID 1-1-1 X 2 DAYS DOROLAC - 2 SACHET PO/BD 1-0-1 X 2 DAYS



Comments

Post a Comment

Popular posts from this blog

Participatory medicine

 Reflecting on my experiences as a patient advocate and a physician, I’ve seen both the strengths and the shortcomings of participatory medicine in action. Each patient’s journey has been unique, with moments of progress and empowerment, but also instances of struggle, especially when navigating issues like privacy, confidentiality, and security. The Good One of the most rewarding aspects of participatory medicine is seeing patients and their families become actively involved in care. For example, in the case of the 65-year-old man with chronic vomiting, there was a clear effort to include the patient in discussions about his symptoms and potential diagnoses. This active participation helped foster trust and engagement, even though the diagnostic journey was long. In chronic conditions like HFpEF and CKD, I’ve seen how educating patients about their disease helps them feel more in control. It’s encouraging to witness patients taking ownership of their health by asking questions and...
Post a Comment
Read more

PROJECT

TITLE:-   BIOPSYCHOSOCIAL FACTORS INFLUENCING OUTCOMES IN PATIENTS WITH ABDOMINAL OBESITY AND MULTISYSTEM COMORBIDITIES  By Dr. VEMULAPALLI HIMAJA (General Medicine PG) Team Members- Dr. Rakesh Biswas(MD General Medicine), Dr.Vishwak (MD PSYCHIATRY) INTRODUCTION Abdominal obesity may be defined as excess deposits of fat in the abdominal region. It is a common health condition seen in South Asians and is positively related to non-communicable diseases (NCDs). It is independent of body mass index and measured by raised waist circumference for men≥90 cm and women≥80 cm1 Waist circumference (WC) and waist-to-hip ratio (WHR) are widely used as indirect measures of abdominal or central adiposity in epidemiological studies. Although the definition of abdominal obesity remains in dispute, the cutoffs for WC (102 cm for men, 88 cm for women) and WHR (0.95 for men, 0.88 for women) were recommended by the American Heart Association and the US Department of Agriculture2 Abdominal obesity ...
Post a Comment
Read more

86M HTN DM CVA ORBITAL CELLULITIS SEPSIS

  86 year male born in a middle class family of 7 children, was an elder son, did not go to school and took upon family responsibility at a very young age and started fish business. He used to travel often inter country for his business. Can speak Hindi and Telugu.  Childhood was pleasant, married at young age and had five sons. His parents expired due to old age.  Patient started consuming alcohol (beer) during travelling occasionally and also started smoking. 16 years ago patient had complains of lower back pain and decreased urine output, went to Kamineni Hyderabad and was diagnosed as renal calculi and operated for same.  Two years later he returned home from work, had dinner and went to bed. Early in the morning he felt tiredness and struggled to wake up, later he observed he had right upper and lower limb weakness and slurring of speech. Patient went to local hospital and was diagnosed as right hemiparesis . At the same time he was also diagnosed with hypertens...
Post a Comment
Read more