40year old female with facial puffiness


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 .


Hall ticket: 1701006049

 40 old female came  to OPD with chief 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 abdomen and Lower limbs 

Sob since 5 days

pedal edema since 5 days pitting type

H/O PRESENT ILLNESS

Patient was apparently asymptomatic 1 year 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 contained food particles. It was relieved on medication. 


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 , stopped going to work since 3 months
DIET MIXED
APPETITE decreased 
SLEEP NORMAL
BOWEL AND BLADDER HABITS : decreased urine output 
ADDICTIONS: NO
MENSTRUAL HISTORY:
Menarche -13 years
Regular monthly cycles
No of pads per day -2
No clots
Menopause -35 years
GENERAL EXAMINATION :

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

VITALS 

BP 110/80

PR 90bpm

TEMP 98.5degrees F

SPO2 98 @ RA

GRBS 106


No Pallor , ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY ,


SYSTEMIC EXAMINATION
CVS EXAMINATION
Inspection- 
The chest wall is bilaterally symmetrical
No raised JVP.
Palpation-
Apical impulse is felt in the left 5th intercostal space,  medial to the midclavicular line
 • No parasternal heave felt.
Percussion- no pericardial effusion
Auscultation-
S1 and S2 heard, no added thrills and murmurs are heard
P/A-

Inspection:

Abdomen is distended

Umbilicus is inverted

Movements :- gentle rise in abdominal wall in inspiration and fall during expiration. 

No visible gastric peristalsis 

palpation : SOFT, NON TENDER, NO ORGANOMEGALY

RS - BAE + , normal vesicular breath sounds















Random Blood sugar




Renal function test




Liver function test





Complete blood picture





Lipid profile 






Ultrasound:




X-ray








Provisional diagnosis : Steroid induced 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 

7-06-2022
Tab.Deflazacort
Ultracet
Luliconazole ointment
Rantac
Syp. Aristozyme

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