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45/F with b/l knee pains

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"


A 45 year old female who is a daily wage labor by occupation
Came with the complaints of both leg pains since 1 year 

HOPI:
Patient was apparently a symptomatic one-year back then she developed bilateral lower limb pains, 
dragging type of pain insidious in onset gradually progressive radiating from hip to foot, accompanied with tingling sensation while walking since one year 
Bilateral knee pain, with crepitus dragging type of pain, non radiating insidious in Onset associated with morning stiffness no complaints of burning micturition urinary urgency or hesitancy history of usage of NSAIDs.

PAST HISTORY:

Not a known case of hypertension diabetes, thyroid disorders, CAD epilepsy 

PERSONAL HISTORY:
Married, daily wage laborer by occupation
diet mixed
 Appetite lost since 10 days.
Bowels regular difficulty in passing stools hard stools.
Bladder: normal
No known allergies.
Toddy drinker one glass per day 
Betel leaf chewing 4-5 per day.

MENSTRUAL HISTORY:
Age at menarche 11 years 
Menstrual cycle 3/ 30
LMP one year ago
Age at marriage 13 years 
Age at first childbirth 13 years 

FAMILY HISTORY:
Not significant

General examination.
Patient is conscious coherent, cooperative.
No pallor, icterus, cyanosis clubbing lymphadenopathy or edema of foot
Temperature afebrile.
Pulse rate 92 bpm.
Respiratory rate 16 cycles per minute
BP 130:80 mm hg 
GRBS 133 mg%

Systemic examination.
CVS S1S2 heard
RS bilateral air entry present, NVBS 

CNS: 
She is conscious, coherent, cooperative
GCS E4V5M6. 
Motor power:.    UL.         LL
   R                      5/5         5/5
   L                      5/5         5/5

Tone normal in all 4 limbs.

Reflexes:.     
           B     T     S     A    K     P
    R.   2+   2+   2+  2+   2+   Extensor
    L.   2+   2+   2+  2+   2+   Mute

 



Cerebellar signs:
Finger nose in coordination: yes 
Knee heel in coordination: yes



















Provisional diagnosis: 
?OSTEOARTHRITIS B/L KNEE
? LUMBAR RADICULOPATHY 
?DENOVO HTN

Treatment: 

(1)T. HIFENAC MR PO BO

(2) T. SHELCAL 500 mG y - 0

(3) T. ELIDEL CAMOTRYPTILLINE) 10mg Po/.   od 30 minutes before dinner

(4)T. A -z PO OD

(5)PHYSIOTHERAPY KNGE ROM SSE
     IFT- LOWER BACK

(6)T.TELMA 40mG Po/od









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