42Yr old female, with fever and vomiting

January 11, 2022

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NAME: Meghana Muddada

Roll no: 90

Batch: 2017

Case history:

A 42 y /F came to the casualty with complaints of fever , nausea , vomitings, constipation , generalised weakness since 7days ; burning micturition since 1day

HOPI-

Patient was apparently asymptomatic 1week back when she developed fever, which is intermittent, not associated with chills , rigors , associated with generalised weakness. Its also associated with nausea , constipation , passing flatus.

Patient also complaints of nausea associated with one spontaneous episode of vomiting. Following which the patient stimulated vomiting by herself whenever she feels nauseating.

No c/o loose stools.

C/o burning micturition since 1day .

Dry cough since 1day No c/o sputum , SOB , bleeding manifestations.

Not a k/c/o DM , HTN ,TB, Asthma , CAD

Personal history -

Diet - mixed

Appetite - Decreased

Sleep - Adequate

Bowel and bladder movements-- constipation Rashes and itching on eating non veg .

No addictions .

Family history - not significant.

On Examination -

GENERAL EXAMINATION

Patient is conscious Oriented Co-operative Moderately built Well nourished

Palor - absent

Icterus absent

Cyanosis – absent

Clubbing – absent

Pedal edema – absent

No lymphadenopathy

VITALS:

PULSE: rate : 100bpm, regular rhythm, normal volume, and character, felt in all peripheral pulses, no radioradial delay, condition of vessel wall normal.

BLOOD PRESSURE: 110/70mm of Hg measured in the left Upper limb with the patient in supine position

RESPIRATORY RATE: 26/min, type-thoracoabdominal.

TEMPERATURE: 98°F measured in the Axilla

SYSTEMIC EXAMINATION:

ABDOMINAL EXAMINATION:

INSPECTION:

Shape – Generalized fullness due to fat Umbilicus – Position: central, Shape- inverted Skin – normal with no scars, or sinuses, no dilated veins

Abdominal wall moves with respiration, no visible gastric peristalsis,no visible intestinal peristalsis

PALPATION:

No tenderness or superficial raise in temperature. On deep palpation, no significant organomegaly

Measurements - Abdominal Girth: 90cms, Distance between the Xiphisternum-Umbilicus is 18cms and Umbilicus-Pubic Symphysis is 22cms

No renal angle tenderness

PERCUSSION:

Liver span: 12cms

AUSCULTATION:

Bowel sounds – audible in right iliac fossa Bruit – Absent

CNS EXAMINATION:

Higher mental functions intact

Cranial nerve examination normal

Motor examination: Bulk: normal in all muscles Tone: normal in all muscles Power 5/5 in all muscles

Reflexes: superficial and deep reflexes present

Sensory system: Pain, temperature, touch, vibration sensations are present, Two point discrimination, tactile localisation present

Cerebellar functions normal

RESPIRATORY SYSTEM:

INSPECTION:

Upper respiratory tract: no significant findings

Lower respiratory tract:

Position of trachea is midline

Chest symmetrical

Movement of chest: equal on both sides with respiration

No visible dilation of veins no scars ,sinuses

PALPATION:

Trachea is in midline

Chest expansion: Normal and equal on botgh sides

Vocal fremitus: equal on both sides

PERCUSSION:. Right Left

Clavicular percussion. resonant on both sides Kronig’s isthumus. resonant on both sides Infraclavicular. resonant on both sides Mammary. resonant on both sides Axillary. resonant on both sides

Infraaxillary. resonant on both sides Suprascapular. resonant on both sides Infrascapular. resonant on both sides Upper/mid/lower

interscapular region. resonant on both sides

AUSCULTATION:

Breath sounds: Normal Vesicular Breath sounds heard in all auscultatory areas.

No added breathe sounds

Vocal resonance:

Clavicular percussion resonant on both sides Kronig’s isthumus. resonant on both sides Infraclavicular. resonant on both sides Mammary. resonant on both sides Axillary. resonant on both sides Infraaxillary. resonant on both sides Suprascapular. resonant on both sides Infrascapular. resonant on both sides Upper/mid/lower

interscapular region. resonant on both sides

CARDIOVASCULAR EXAMINATION:

JUGULAR VENOUS PULSE:

INSPECTION: Chest wall elliptical in shape and symmetrical,

Precordial bulge absent

Dilated veins, scars, sinuses absent

Apical impulse not seen

Pulsations – no visible pulsations

PALPATIONN:

Apical impulse – normal in left 5th ics , 1cm medial to midclavicular line.

No parasternal Heave or thrills

PERCUSSION: