A 54year old woman with c/o Shortness of breath and generalised weakness

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 A 54 year old female patient, housewife from Munugodu came with complaints of Shortness of breath and generalised weakness from 2days

History of presenting illness

Patient was apparently asymptomatic 3yrs back then she had joint pains and went to a local hospital and was found to have hyperthyroidism and was kept on medication(Carbimazole). In December 2021, she had fever, generalised weakness and shortness of breath and she went to a local hospital and was found to have Hb 3gm% and was transfused 1unit of blood and then Hb increased to 8gm%. On July 5,2022 she has complaints of Shortness of breath and went to a hospital, then her Hb was 3gm% and was again transfused 2units of blood and Hb raised to 7gm%

She has recurrent episodes of low grade fever since Dec,2021 and reduces with medication(Dolo)

She also has dry cough from 12days

Past history 

She has history of surgery for correction of cleft lip at the of 3yrs

She had underwent hysterectomy 26yrs back

She had history of Tuberculosis 6years back and was under ATT for 6months 

N/k/c of Diabetes, Hypertension, asthma, epilepsy, CAD

Personal history 

Appetite: normal 

Diet: mixed

Bowel and bladder movements: regular 

Sleep:adequate

Family history: not significant 


General examination

Patient is conscious, coherent and cooperative 

She is ill built and poorly nourished 

Pallor is present 







No icterus, cyanosis, clubbing, lymphadenopathy and edema



Fine tremors

https://youtu.be/2LJlqJJYEws

Vitals 

Temperature:98.6F

Pulse rate: 70bpm

Blood pressure:120/70mmHg

Respiratory rate:20cpm

GRBS:106gm%

Systemic examination

Respiratory examination 

Inspection: shape of chest is normal 

Chest movements are bilaterally symmetrical on breathing 

Palpation:

Inspectory findings are confirmed 

No palpable sounds are felt

Percussion:Resonant in all areas 

Auscultation:normal vesicular breath sounds 

Cardiovascular system examination

S1 S2 heart sounds heard, no murmurs 

Raised JVP

https://youtube.com/shorts/Z92CV3ZV3YM?feature=share

Central nervous system examination

HMF intact

Cranial nerves intact 

No focal neurological defecits 

Per abdomen


Inspection: scaphoid, no distension 

Palpation: soft, nontender

No hepatomegaly

No splenomegaly 

Auscultation:bowel sounds heard 

Provisional diagnosis: Anemia due to chronic inflammation with Renal failure 

Investigations 

On 1/08/2022







On 02/08/2022 (after blood transfusion)












Treatment 
Tab. OROFER XT OD
IV NS@30ml/hr
Inj. VITAMIN B12 im OD
1pack PRBC transfusion








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