A 63 yr old female

 A 63year old female with c/o neck pain and b/l knee pain since 1 year. C/O decreases urine output since 1 year

History of presenting illness: 


Patient was apparently asymptomatic 1year back then developed neckpain,insidious ,gradually progressive, aggravated on bending forward and relieved with medication.


C/O b/l knee pain since 1 year insidious in onset and gradually progressive relieved with medication. 


C/o decreased urine output since 1 year, no burning micturition , no frequency/urgency /hesitancy.


No pedal edema, no SOB, no palpitations, orthopnea,PND 


C/o belching,burning sensation in epigatrium .


Past history:


K/c/o hypothyroidism since 2years and is on medication. 


Not known case of DM ,HTN ,epilepsy, asthma, TB 


Personal history: 


Diet: mixed


Appetite: normal


Sleep: adequate 


Bowel and bladder : regular


Addictions: none 



Daily rotinue: she wakes up by 6am in the morning freshens up and goes for a walk.  She has breakfast by 8am and watches TV.  Talks to neighbour's and rests.


She has her lunch by 1pm and sleeps for a while . Has dinner around 8pm and sleeps by 9pm. 



General examination: 


Patient is c/c/c 


Pallor : absent 


Icterus :absent 


Cyanosis: absent 


Clubbing:absent


Lymphadenopathy: absent 


Edema: absent 



Vitals:


BP:120/80mm Hg


Temperature:99.2F


Respiratory rate: 16cpm


Heart rate:82bpm



Systemic examination:


CVS: S1 S2 +


CNS: NFND


RS: BAE+ NVBS


P/A : Soft and non tender , no organomegaly 



Provisional diagnosis : 


? Cervical spondylosis


? Osteoarthritis 


Acid peptic disease with k/c/o hypothyroidism since 2 years . Left eye immature cataract.


 


Investigations: 











Treatment:

Tab THYRONORM 25mcg po/od 

Tab PANTOP 40mg po/od 

Tab MVT po/od 

E/D LUBREX 4times/day


















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