A 65 year old female with bilateral knee pain,low back ache and Pedal edema
Hello everyone .I am Sanya ,an intern posted in Medicine department and of the important terms of getting internship completion is to complete my log book with my online log of what I learn during the course of my duties
Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients 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 is welcome
CASE HISTORY:
A 65 yr old female patient who was farmer by occupation was apparently asymptomatic 2 years back ( She was able to perform all her activities , she used to go for labour work in addition to agriculture,and home based works with out any problem) .Exactly 2 years back she noticed pain in the left knee joint, which was pricking type, which aggravated with standing, with and even without work.also.Increased during night time.. The pt had many sleepless nights because of pain.Even she used to cry at night because of her severity in pain, but the patient did not visited orthopedician,The reason for not visiting could nt be properly explained by the pt.After 3 months the patient developed pain in the rt knee joint also.. Associated with bilateral pedal edema ,pitting type, Grade 2 ,not associated with any SOB. With occasional low backache- no aggravating and relieving factors.It is the time where patient consulted orthopedician..The doctor said it was age related and they used aceclofenac, rabeprazole,calcium supplements, and used for 1 month.The pt knee pains, pedal edema got relieved.The patient was normal for about 3 months (with out any complaints of knee pains and Low back ache and Pedal edema).after 3 months, she again started developing B/L knee joint pains, a/w pedal edema , pitting type and with Low back pain, then used Zor D, colgel and calcitriol .Symptoms got relived With that medication, And she was normal up to 4-5 months, Again after that she developed B/L knee joint pains, with pedal edema and Low backache then the patient went to private hospital ,where they took injections and tablets ( Records not available) -injections were given to knee joints, Initially to left and later on the right knee joint.Not being satisfied with the medication, Pt visited another hospital. There pt was treated with intramuscular injections and Tablets (records not available), pt couldn't get symptomatic relief with this medication... Mean while her husband got admitted in General surgery ward in our hospital,so patient took opinion from our Hospital orthopedician , from there it was referred to General medicine opd in view of B/L pedal edema.No h/o of orthopneoa, PND, palpitations, dizziness ,decreased urine output,facial puffiness,generalised edema, head ache, blurring of vision or diplopia .
PAST HISTORY: Not a k/c/o HTN,DM,Asthma,TB,jaundice
PERSONAL HISTORY:Diet : Mixed
Appetite : Normal
Bowel and bladder : regular
Sleep : Inadequate
Occasional toddy drinker
FAMILY HISTORY :no similar complaints in family
GENERAL EXAMINATION:
Pt is conscious,coherent, cooperative moderately built and moderately nourished.
Bilateral pedal edema present, pallor present
No icterus, cyanosis, clubbing, koilonychia and lymphadenopathy
Vitals :Afebrile
BP: 120/80 mmhg
PR : 72 bpm
RR : 12cpm
Spo2. : 98 % RA
SYSTEMIC EXAMINATION:
CNS: Higher mental functions: Normal
Cranial nerves : intact
Motor system: Right. Left
Bulk UL N. N
LL. N. N
Power. UL. 5/5. 5/5
LL. 5/5. 5/5
Tone. UL. N. N
LL. N. N
Deep tendon reflexes:
Biceps. :Present. Present
Triceps present. Present
Supinator present. Present
Knee. Present present
Ankle Absent. Absent
Superficial reflexes:
Corneal. :Present. Present
Conjunctival: present. Present
Abdominal: Present. Present
Plantar. : Flexor. Flexor
Cerebellar examination:
Finger nose test : +. +
Dysdiadochokinesia: - -
Rombergs. : - -
Sensory examination:
•Spinothalamic Tract
Pain. +. +
Crude touch. +. +
Temperature. +. +
•Posterior column
Fine touch. +. +
Vibration. UL/LL. 10/8. 8/8
Proprioception +. +
•cortical
2 point discrimination. +. +
Graphasthesia. +. +
Tactile localisation. +. +
Stereognosis. +. +
Gait:
JOINT EXAMINATION: Tenderness
Right. Left
Shoulder. - -
Elbow. - -
Wrist. - -
MCP. - -
PIP. - -
DIP. - -
Lower limb
Hip. +. +
Knee. +. +
Crepitus is present in B/L knees
Ankle. +. +
( Achilles’ tendon region)
MTP. - -
PIP. - -
DIP. - -
Joint restriction:Hip : flexion and extension
Knee. : flexion and extension
Modified schober test : 4-4.5 cm present
Lateral bending test :10cm
Fabers test : Negative
Respiratory system:B/L air entry present
CVS : s1,s2 heard No murmurs
Per abdomen : soft,non tender,No organomegaly .
INVESTIGATIONS:
FBS:100mg/dl
DIAGNOSIS:Spondyloarthropathy with bilateral knee joint pains with pedal edema under evaluation
TREATMENT:1) Tab. Dolo 650 mgPO/TID
2)Tab.MVT PO/OD
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