60 F with facial puffiness, pedal edema, b/l knee joints pain

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A 60 year old female who used to be to a farmer came with the complaints of b/l knee joint pain since 3 years, facial puffiness since 3 months, b/l pedal edema since 1 week

History of presenting illness 

Patient was apparently alright 3 years ago then she developed — b/l knee joint pain since 3 years

It is aggravated on walking and standing, relieved on taking medication and taking rest

She has been taking medication for pain frequently 3-4 days in a week both oral and injectables from local RMP

— facial puffiness since 3 months 

It is present mostly during the day and reduced in the night 

— b/l pedal edema since 1 week

Pedal edema is present until ankle, pitting type, it has reduced in the past 2 days

Daily routine 

3 years ago: She used to work as a farmer like sowing seeds, plucking up cotton in cotton fields 

Due to the b/l knee joint pain she stopped working as farmer

nowadays she does her house chores and takes rest

She wakes up at 5:30 am in the morning, does house chores like washing utensils, cooks food and eats it (rice+vegetables) in the morning at 9am and complete her remaining house chores and then she have lunch at 3 pm and takes rest, then prepares dinner and have it and sleeps at around 10pm

Most of the times she have only 2 meals a day 

She drinks tea in the morning and evening when she visits her sons place but not when she is at her house 

She smokes (chutta) 3 times a day, 1 chutta at a time and started smoking 2 years ago

She takes alcohol occasionally and she started taking alcohol 40 years ago


She is married at the age of 18 years

She has 5 children 

She attained menopause 

Not a k/c/o HTN, DM, Tuberculosis, Thyroid disorders, asthma, epilepsy, CVA, CAD

General examination 

No signs of pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy 

B/L pedal edema is present until ankles, pitting type 












Vitals

PR- 86 bpm

RR- 18 cpm

BP- 100/70mmHg

Spo2 - 99% on RA


RS-B/L air entry present 

       NVBS

CVS- S1S2 present, no murmurs heard


PA- Soft,non tender

CNS: NAD


Investigations:


Hb: 11.7 gm/dl

TLC: 10,700 cells/cumm

RBC: 4.33 millions/cumm

PLATELETS: 3.54 lakhs /cumm


Blood urea: 21 mg/dl

Serum creatinine: 0.9 mg/dl


Serum Na+:137 mEq/L

Serum K+:4.4 mEq/L

Serum Chloride:99 mEq/L


LFT:

Total bilirubin: 0.74

Direct bilirubin: 0.19

SGOT:14

SGPT:13

ALP: 223

Total proteins: 6.3

Albumin: 3.5

A/G Ratio: 1.32



USG Abdomen :








CUE

Albumin: Nil

Sugars: Nil

Epithelial cells: 2-3/ HPF

Pus cells: 2-3/HPF







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