67 FEMALE WITH DYSPHAGIA AND NECK SWELLING UNDER EVALUATION

 This is 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 patients clinical problms with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .



CHIEF COMPLAINTS:
C/o difficulty in swallowing since 2 years

HOPI:
Patient was apparently asymptomatic 2 years ago.
Then she noticed a swelling of size 2x2cm in front of neck which gradually progressed to present side of 4x4cm.
Associated with difficulty in swallowing food(solids intially later to liquids too), dyspnoea and hoarseness of voice.
H/o weigh loss present 
H/o constipation present
H/o burning micturition since 2 years

No h/o fever, palpitaions, sweating, heat intolerance.
No h/o lethargy, intolerance to cold
No h/o of any radiation exposure in the past.

PAST HISTORY:
she is not a k/c/o DM , HTN, CVA, CAD, TB, ASTHMA


GENERAL EXAMINATION:
Patient is conscious, coherent, and cooperative
Pallor present

 no icterus 

cyanosis, clubbing or generalised edema
No generalised lymphadenopathy.
VITALS : 
Temp: afebrile
PR-80bpm, regular
BP-120/70mm of Hg
RR: 14cpm
SPo2 -99%. On room air

SYSTEMIC EXAMINATION :
CNS : NFD
CVS - S1 , S2 heard , no murmurs
RESPIRATORY SYSTEM :
Bilateral air entry present 
NVBS 
PER ABDOMEN : soft, non tender

LOCAL EXAMINATION:
ON INSPECTION:
-a solitary swelling of size 4x4cm in front of neck.
-moving up with deglutition and not moving with protusion of tongue.
-Spherical in size
-surface is irregular
-margins are regular
-no visible pulsations over swelling
-skin over the swelling is normal
-surrounding skin normal



PALPATION:
no local tenderness or local rise of temperature.
All inspectory findings are confirmed
Spherical in size
Margins are regular
Surface is nodular
Hard in consistency
No pulsation or thrill
Skin over swelling is pinchable
Auscultation:
No bruit heard
Cervical lymph nodes:
A single lymph node of size 2x2 cm is palpable in anterior triangle of neck.
No other palpable lymph nodes in neck

ENT REFERRAL


INVESTIGATIONS:
HEMOGRAM
RBS
BGT

RFT:
LFT
TFT


CXR PA VIEW:
XRAY NECK AP VIEW:
XRAY NECK LATERAL:

2DECHO on 9/3/23
USG NECK

ECG 

USG ABDOMEN



DIAGNOSIS:
DYSPHAGIA AND NECK SWELLING UNDER EVALUATION

TREATMENT:
T.PAN 40MG PO/OD/BBF
T.MVT PO/OD
SYP LACTULOSE 15ML PO/HS

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