SYED SADATH HUSSAINI ROLL NO : 156

  37 year old female came with c/o b/l knee pain since 10 days , b/l pedal edema since 10 days  HOPI- pt was apparently asymptomatic 2 yrs ago then she started RT knee pain since 10 days b/l knee pain has aggravated H/o claudication pain in both legs initially relieved on rest and now progressed to pain at rest H/o b/l pedal edema present Facial puffiness since 5 days  No C/o decreased urine output  Past history Not a k/c/o htn,dm,tb, epilepsy,cad Personal history Diet mixed  Appetite normal Bowel and bladder -regular GENERAL PHYSICAL EXAMINATION On examination, patient is conscious, coherent, cooperative patient is moderately built and moderately nourished No pallor,icterus, cyanosis, clubbing, lymphadenopathy, edema Vital  Bp 140/90 Pr 72 Rr 18 Grbs 142 SYSTEMIC EXAMINATION: Abdominal examination: Inspection  Umbilicus inverted , No abdominal distention,no visible pulsations,scars and swelling. Palpation   Soft, non tender, no organo megaly. Auscultation  Bowel sounds Heard Cardio va

  PT CAME WITH  C/O FEVER SINCE 4 DAYS  ASSOCIATED WITH CHILLS AND RIGORS EVENING RISE OF TEMP PRESENT  DECREASED URINE OUTPUT SINCE 4 DAYS C/O ABDOMINAL DISTENSION PRESENT  SOB SINCE YESTERDAY EVENING  C/O PEDAL EDEMA AND FACIAL PUFFINESS  HOPI: PATIENT WAS APPARANTLY ASSYMPTOMATIC 4 DAYS BACK THEN SHE HAD FEVER FOR 1 DAY WHICH IS HIGH GRADE, SUDDEN ONSET, ASSOCIATED WITH CHILLS AND RIGORS RELIEVED BY TAKING MEDICATION. SOB(GRADE-2) SINCE YESTERDAY WHICH IS GRADUALLY PROGRESSIVE AND PROGRESSED TO GRADE-4 . NO ORTHOPNEA, NO PND C/O PEDAL EDEMA WHICH IS PITTING TYPE C/O ITCHY SCALY LESIONS ON DORSUM OF FOOT SINCE 1 YEAR H/O DECREASED URINE OUTPUT NO COUGH, COLD, NO CHEST PAIN, PALPITATIONS, NO ABDOMINAL PAIN, NO NAUSEA, VOMITING, LOOSE STOOLS PAST HISTORY: K/C/O HTN SINCE 4 YEARS NOT A K/C/O DM-II, TB, EPILEPSY, CVA, CAD PERSONAL HISTORY: MIXED DIET SLEEP ADEQUATE APPETITE NORMAL BOWEL AND BLADDER MOVEMENTS NORMAL ADDICTIONS- ALCHOHOL- DRINKS WHISKY 90ML DAILY, STOPPED 10 DAYS BACK FAMI