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 67yr old male with fever since 20days


A 67 yr old male patient who was a daily wage labourer 5yrs back has come to the OPD with

CHIEF COMPLAINT: 

fever•.• 20days

Shortness of breath •.• 10days


HOPI

patient was apparently a symptomatic 5yrs ago then his daily rotuine was 

“Wakes up at 6am, complete his nature calls,brushes with neemstick, have’s his tea and takesbath , he takes rice as his breakfast and dinner,   skips his lunch most of the times .spend his rest of the time with neighbours and watching tv sleeps at around 9pm”


SOB was insidious in onset, gradually progressing from grade 1 to grade.2   , relieved on taking rest associated with cough since 10days

no h/o orthopnea, PND

 Fever was continuous type no aggravating factors and relieved on taking medications then he went to an hospital . He was there for 2days and the fever and cough subsided ,discharged and was at home for 2 days with decreased appetite so he was eating less or no ,later he developed fever and approched us 

-as told by the attender

yesterday they noticed a palpable swelling on his left buttock 


 PAST HISTORY 

He had an injury to the knee joint 5yrs back got surgically corrected then he was diagnosed with diabetes and hypertension . And was on regular medications .

Lifestyle modifications(?)

No h/o asthma ,TB, allergies,epilepsy


PERSONAL HISTORY 

appetite- decreased 

Diet-mixed

Sleep- not adequate 

Bladder -regular 

Bowel - no passage of stools •.•3days( since there is      no food intake)

Addictions- smoking( occasionally) stoped 5 yrs ago


FAMILY History 

Not significant 


 GENERAL EXAMINATION 

patient was conscious ,coherent ,cooperative and well oriented to time ,place ,person.

Poorly built and poorly nourshied 

Vitals

RR-20cpm

PR-92bpm

BP-120/80mmHg

Temperature-98*F

No pain




Pallor-present

Icterus-absent

Cyanosis absent 

Clubbing absent

No Generalized Lymphadenopathy 





LOCAL EXAMINATION 

 After taking informed consent patient was examined in sitting and supine posture in a well lit room exposing chest and abdominal area.


INSPECTION 

HANDS

pallor- present

No tophi, no tremors 

NAIL 

Left hand







Right hand




Skin


there is a swelling with discharging pus on medial side of the ankle joint since 6months 







Skin turgor 


ARMS 

No excoriation

No bruising 

No AV fistulas


MOUTH

was unhygenic

No gingival hypertrophy 

No uremic fetor

 Respitatosystem

Inspection: 

palpation-apex beat felt in 5 th intercoastal area


  Percussion.                   Rt                  Lt 

supra clavicular.           Resonant    Rltvly dull

 Infraclavicular.            Resonant               ”

                         

Mammary.                  R. Dull               Resonant

Inframammary.           R. Dull              Resonant



auscultation :              Rt                    Lt 

supra clavicular.           Normal               No

 Infraclavicular.             Normal                 No

Supramammary.          No.                    Wheezing 

Mammary.                   Decreased         Normal

Inframammary.           Crepitus             Normal


Supra scapular

Infrascapular

Interscapular



CVS EXAMINATION 

Palpation of apex beat - felt in 5th ICS in mid 

Auscultation of heartbeats - normal heart sounds heard in

Mitral valve area 

Tricuspid valve area 

Aortic valve area

Pulmonary valve area


ABDOMEN EXAMINATION 





INSPECTION 

No Scars

No Distention 

PALPATION

No pain on Light palpation over allquadrants 

Pain in right lumbar quadrant on Deep palpation 

PERCUSSION 

No shifting dullness

AUSCULTATION  

No vascular bruits heard

INVESTIGATIONS













Doppler



CT







ECG

USG






TREATMENT:

Day 1

Inj.. LASIX 40mg IV/BD

PAN 40mg

Nodisis 50mg

Orofer 

Inj HAI S/c

GRBS 4th hrly 

Nicardia 10mg po/bd


Day 2

 Agumentin 1.2g Iv/bd

Tab azithro 500mg po/od 

Inj lasix 40mgiv/bd

Tab atenolol 25mg po/od

Tab nodosis 500mg po/bd

Tab orofer po/bd

Tab shelcal ct po/od

Inj erythromycin 400iu s/c weekly once 

Inj iron sucrose 100mg / 5ml in 100ml Na/iv/over 1hr  during dialysis 

Neb with doulin/ budecort 8th hrly 


PROVISIONAL DIAGNOSIS: 


Diabetic nephropathy 

With HTN  and DM

with bronchiectesis 



 Reference:

https://geekymedics.com/renal-system-examination-osce-guide/









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