26 year old female with lower back pain and fever
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CASE
26 year old female who is a resident of nalgonda and housewife came with the complaints of
▪ Lower back ache since 15 days
▪ Fever since 10 days
HISTORY OF PRESENTING ILLNESS
▪Patient was apparent asymptomatic 15 days back then she developed severe lower back adhe which was insidious in onset and gradually progressive and continuous type which was squeezing in character and not a radiating type of pain and it gets relieved by medication and the injection given by local doctor there are no associated symptoms
▪ Then she developed fever 10 days back which was insidious in onset which started as chills then developed fever which was gradually progressive and associated with chills and rigors more during night times
▪ She had vomitings on 2nd( 1 episode) and 3rd June ( 5 to 6 episodes) with food as content and non bilious and not projectile and there are no associated symptoms such as abdominal pain and got relieved with medication given on 4th june
▪ She had noticed red coloured urine on 1st and 2nd june not associated with pain or difficulty in passing urine, no oliguria or increased frequency of urination, no urge to pass urine, there is a feeling of incomplete voiding of urkne
▪ she had puffiness of face and abdominal distension on 6th june and got subsided
▪ There is no history of chest pain , difficulty in breathing, cough, indigestion or heart burn, pain or stiffness or swelling in the joints
PAST HISTORY
▪ no similar complaints in the past
▪ Patient had history of rheumatic heart disease at 10 years for which she was on medication for it but not subsided so surgery was done( CABG , MITRAL VALVE REPLACEMENT) then she was on prophylaxis for 2 years then she discontinued then she had c section done 7 months back as baby is weak she consulted doctor from then she again started the penicillin prophylaxis
▪ She has a history of PCOS for which she is on medication
▪ not a known case of diabetes, Hypertension, asthma, tuberculosis
MARITAL HISTORY
3rd degree consangious marriage , 6 years back and had 7 months old baby
FAMILY HISTORY
not significant
PERSONAL HISTORY
Diet - mixed
Appetite- normal
Sleep - decreased because of pain
Bowel and bladder movements - regular
no addictions
no allergies
MENSTRUAL HISTORY
menarche - 13 years
regular periods
5/ 28 - moderate flow
not associated with pains
GENERAL EXAMINATION
Patient is conscious coherent cooperative well oriented to time , place , person moderately built and moderately nourished
Pallor- present
Icterus- absent
Cyanosis- absent
Clubbing - absent
Lymphadenopathy - absent
Edema- absent
VITALS
Pulse- 70 bpm
Respiratory rate- 34 per min
Blood pressure- 120/ 70 mm hg
Temperature - afebrile
SYSTEMIC EXAMINATION
Per abdomen
INSPECTION
shape of abdomen- normal
c section scar is seen and stria gravidarum
no abdominal swellings seen
no dilated veins are seen
no visible peristalsis
all quadrants are moving equally with respiration
PALPATION
No local rise of temperature and no tenderness
no palpable mass
no hepatomegaly and no spleenomegaly
Kidney - ballatoble
PERCUSSION
resonant sound heard
ASCULTATION
Bowel sounds heard
CVS
INSPECTION
midline scar is seen
shape of chest - normal
no precordial bulge seen
JVP not raised
no visible pulsations
PALPATION-
Apex beat felt at left 5th intercoastal space 2.5 cms lateral to mid clavicular line
Ausculatation -
S1 , S2 heards
no murmurs
click sound heard ( without stethescope)
INVESTIGATIONS
on day 1
Hemoglobin- 9.8
Total leukocyte count- 21900
neutrophils- 83
lymphocyte- 07
basophils- 02
monocytes- 08
Platelets- 2.1 lakh
Normocytic mormochromic anemia
LIVER FUNCTION TEST
Appt- 51secs
Pt -25 secs
INR- 1.8
Random blood sugar- 101 mg/ dl
Urea- 26
Electrolytes
Serum creatinine- 1.4
Sodium- 141meq
Pottasium- 3.4
chloride- 106
day 4th
Hemoglobin- 10.1
Urea- 18
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