37 F RIGHT KNEE PAIN

 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 vascular examination:


No visible pulsations, scars, engorged veins. No rise in jvp 


Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.


 S1 S2 heard . No murmurs.


Respiratory system :


Shape of chest is elliptical, b/l symmetrical.


Trachea is central. Expansion of chest is symmetrical


 Bilateral Airway Entry - positive


Normal vesicular breath sounds


CNS examination: 


No neurological deficit found.


HMF Intact 


PROVISIONAL DIAGNOSIS


INVESTIGATIONS

HEMOGRAM 


CUE


S.CR


BLOOD UREA


SERUM ELECTROLYTES


TFT



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