Final practical long case

June 7, 2022

A 45 year old female with chief complaints of abdominal distension and facial puffiness since 1 year

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 .


Name : manaswini
1701006020



 40/F Came with complaints of 

Abdominal Distension since 1 year 

Facial puffiness since 1 year 

Itching all over the body since 1 year and developed multiple plaques on hips, buttocks, abdomen and dorsal of feet.

Sob since 5 days

pedal edema since 5 days which is of pitting type



H/O PRESENT ILLNESS

Patient was apparently asymptomatic 1 years back then she developed abdominal distension, facial puffiness,itching all over the body and 5 days ago she developed pedal edema and SOB grade 3.
she had an episode of vomiting two days back which was non projectile and non bilious contained food
 particles. It was relieved on medications

PAST HISTORY 

she developed  B/L Knee pain - since 3years,  onset - insidious, gradually progressing, type- pricking, more at the night, aggravated on walking, relieved on sitting n sleeping, no radiation and is under medication( demisone 0.5 mg and acelogic SR) 
She developed abdominal distension and facial puffiness one year back.
 She also developed itching and skin lesions and was diagnosed as tinea and was given medications. 


Not a K/C/O DM/HTN/ asthma / Ischemic heart disease / epilepsy / TB



FAMILY HISTORY 

NO SIGNIFICANT FAMILY HISTORY



PERSONAL HISTORY:

OCCUPATION Daily wage worker

DIET  MIXED

APPETITE decreased 

SLEEP NORMAL

BOWEL AND BLADDER HABITS : decreased urine output 

ADDICTIONS: NO





GENERAL EXAMINATION 

Patient is concious coherent and coperative, well oriented to time palce and person



VITALS 

BP 110/80 measured in supine position in both arms

PR 90bpm   Regular
                       Normal volume
                       Normal character of vessel wall
                       No radio radial delay
                       No radio femoral delay 
                       All peripheral arterial pulses are present 

TEMP 98.5degrees F

SPO2 98 @ RA

GRBS 106





NO PALLOR, ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY ,



SYSTEMIC EXAMINATION



CVS-S1 S2+ heard , no murmurs 



P/A-SOFT, NON TENDER, NO ORGANOMEGALY



RS - BAE + , normal vesicular breath sounds

Clinical pictures:










2d echo



Lipid profile



Random blood sugar


Liver function tests


Complete blood picture 


Renal function test



provisional diagnosis : itrogenic cushings syndrome 

Treatment: 

4-06-2022
Inj. Pantop
Inj lasix
Inj optineuron 
Tab. Ultracet
Tab.aldactone
Tab. Atarax
Tab . Zofer
Luliconazole
Syp aristozyme


5-06-2022
Ultracet
Luliconazole ointment
Rantac
Syp aristozyme 


6-06-2022
Spironolactone 
Ultracet
Luliconazole ointment
Rantac
T defloz 6mg
Syp. Aristozyme 


07-06-2022
TAB deflazacort
Tab Ultracet
Rantac
Luliconazole ointment
Syp. Aristozyme



































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