82 yr female with fever, knee pain and swellings In both legs below knee

June 21, 2023

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82 year old female patient came with C/O weakness of lower limb, Neck and shoulder pain since along with pedal oedema and fever since 10 days.

HOPI-

Patient was apparently asymptomatic 10 days back then she developed weakness of the lower limbs, sudden in onset, non-progressive.

Also, C/O fever since 10 days low-grade not associated with chills and rigours, continuous, relieved on medication. C/O pedal oedema since 10 days, pitting type, from ankle to knee.

No C/o chest pain, palpitations, cough, cold, LOC

PAST HISTORY-

K/c/o of HTN since 10 years(On medication- Telma 40mg)

Not a k/c/o DM, Epilepsy, Seizures, CVA, Asthama, TB.

PERSONAL HISTORY-

Addictions- Nil.

Appetite- Normal

Diet: Vegetarian

Sleep: Adequate

Bowel and bladder movements: Regular

Family History:

Not significant.

General Examination -

Patient is examined in a well lit room with adequate exposure, after taking the consent of the patient.

She is conscious, coherent and cooperative.

Built & nourishment-Moderate

Icterus - Present

Pallor +

No cyanosis

No clubbing

No edema

No lymphadenopathy.

Vitals:

Temp: 98.2 F

Bp: 100/60 mmHg

PR: 102 bpm

RR: 18 cpm

SpO2: 98% on RA

Systemic Examination -

CVS : S1 S2 present

No murmurs

RESPIRATORY SYSTEM;

B/l symmetrical chest

Trachea - Central

B/l air entry present

NVBS heard

ABDOMEN:

Shape of abdomen: Scaphoid

Soft, non tender.

No rigidity or guarding.

BS+

CNS :

NFND, HMF intact

GCS- 15/15

Provisional Diagnosis-

Anemia under evaluation

Treatment-

1) Tab. Ultracet PO/SOS

2) Tab. Telma-AM PO/OD

Complaints:

Bilateral knee pain (rt > lt) since 26-5-23.

Fever since 1 week (increased temperature spikes since 3 days.

No c/o chest pain, cough, cold.

HOPI:

The patient was apparently asymptomatic 3 weeks ago, when in the morning after waking up ,the patient was unable to lift both her legs from the bed due to weakness and felt the heaviness of the legs. She recalls dragging herself to the bathroom.

3 days later, the patient developed swelling and pain in both lower limbs at and below the knee joint, right more than left. The pain was sudden in onset, pricking in nature, continuous, aggravated with walking, relieved on taking rest, and did not radiate to any other site. It was associated with redness and increased warmth of the overlying skin. The patient also complained of high-grade fever, that was continuous and not associated with chills and rigor, associated with generalized body pain.

The patient visited a doctor and was prescribed medication, after which her symptoms were reduced.

1 week ago the patient presented to our Hospital as her fever, swelling, and pain aggravated, medication was given and symptoms were reduced.

2 days ago, the patient presented back to the hospital with fever, bilateral knee joint pain, and swelling, more in the right leg than the left.

The patient also complains of pain in the joints of both hands since 15 days.

The patient also complains of bilateral knee joint pain while climbing stairs , that is relieved on rest .

Past illness :

K/c/o hypertension since 10 years, on tab TELMA AM 40 5mg PO/OD

Personal history:

APPETITE NORMAL

DIET Vegetarian

BOWELS & BLADDER REGULAR

SLEEP ADEQUATE