75 YEAR OLD FEMALE WITH C/0 FEVER , BURNING MICTURATION SINCE 4 DAYS
A 75 year old female came to the medicine opd with c/o fever and burning micturition since 4 days
Hopi : patient was apparently normal 4 days back then she developed fever which is of low grade , intermittent associated with chills and rigor not relieved by medication . Subsided now .
C/o burning micturition since 4 days
and c/o generalized weakness since 4 days
C/o swelling of both lower limbs 2 days back pitting type , extending up to knee joint , reduced now .c/o dryness of tongue , c/o pain in the lower abdomen .
No c/o decreased urine output ,SOB , chest pain , loose stools , orthopnea , PND , constipation.
Past history: N/K/C/O DM , HTN , asthma , epilepsy , cva , cad , thyroid disorders.
Personal history:-
Diet - Mixed
Appetite - Normal
Bowel and bladder - regular
Sleep - adequate
No addictions
No H/o food and drug allergies
Family history:-
Not significant
General examination:-
Patient Patient is conscious, coherent, cooperative ,moderately built and nourished
Pallor is present . No signs of icterus, cyanosis, clubbing, generalised lymphadenopathy
Oedema of both feet present
Temp-98.7
BP-160/100mmHg
PR- 108 bpm
RR - 20cpm
SpO2- 98%
GRBS - 177mg/dl
Systemic examination :
CVS- S1;S2 + , no murmors
RS- BAE+ NVBS heard
P/A- Soft non tender, no organomegaly
CNS :- Patient is arousable , no focal and neurological deficits
Provisional diagnosis: AKI secondary to UTI
Daily routine of patient :
6:00am -wakes up
6:00am -7:00am : fresh up
7:00am -9:00am : house work (dish washing , laundry etc..)
9:00am : Breakfast ( Rice and dal )
10:00am -12:00pm : sleep
12:00pm-1:00pm : walking
1:00pm : Lunch (Rice with curry and curd )
2:00pm-4:00pm : Hose work and watches tv)
5:00pm -6:00pm : walking and talks with neighbors
7:00pm : Dinner ( Rice or Roti with curry or dal )
7:00pm -9:00pm : watches tv
9:30pm : sleep
Investigations:
On 2/11/23
RBS - 154mg/dl
Chest X-ray PA View:
2.Inj.ceftriaxone 2gm/IV/BD
3.Inj.lasix 20mg/IV /BD
4.Inj.pan 40mg /IV /BD
5. Inj. Buscopan 1amp IM/sos
6.Inj Neomol 1gm/IV / SOS
7.syp.Citralka 10ml in 1 glass of water po /TID
Osce questions :
1. Is it bacterial or viral infection?
Ans : as the total counts are increased it is most likely to be bacterial . Total counts are 27,000
Usually in viral infection Total counts are not increased .
2. What are the differential diagnosis ?
Ans : pyelonephritis is one of the differentials which can explain her burning micturition, fever associated with chills , pain in the lower abdomen . Other differential is congestive heart failure, but patient 2d echo is normal which can rule out CHF .
3. Why does her Hb count decreased 10.7 to 9.0 g/dl?
Ans : Usually in the cases of pyelonephritis there is damage to the kidney which results in the decreased production of erythropoietin levels . Which can explain her drop in Hb count .
4. What is most common cause UTI ?
Ans : most common is the bacterial infection in which E.coli bacteria is most common cause .
5. List all the complaints of the patient with respect to the history and relevant clinical data and mention the treatment plan for each listed problem and mention treatment plan stating it's efficacy in relevance to patient relief and better outcome.
Ans : C/o burning micturition since 4 days and c/o fever which is now resolved.
and c/o generalized weakness since 4 days
C/o swelling of both lower limbs 2 days back pitting type , extending up to knee joint , reduced now .c/o dryness of tongue , c/o pain in the lower abdomen .
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