GM CASE 4

Case scenario....
Hi, this is k.vaishnavi , IIIrd BDS. This is an online eblog book discuss our patients health data after taking her consent.This also reflects my patient centered online learning portfolio.

Case sheet : a 82 year old women joined causality with fever, knee pain and difficulty in standing.

Chief complain: patient suffering from fever and knee pain since two days .

History of present illness : patient's was apparently asymptomatic 2 days . Then developed fever , a high grade fever which is not associated with chills or rigors , and no diurnal variation .
It is relieved on medication .
Pain in knee joint since two days .
There is no history of cold , cough , shortness of breath , burning micturation , vomitings , loose stools , giddiness .
History of past illness: patient was admitted 20 days ago with similar complains and was discharged one week ago.
There was drainage of fluid from knee joint.
Patient suffering from bp since 10 years.
No history of diabetes , asthama , arthritis, osteoporosis. 

Personal history: she used to wake up at 5:30am and used to have breakfast at 8:00am.
She does household work and have her lunch at 1:00pm and sleep at night by 9:00 pm . 
Appetite: normal appetite 
     Diet: vegetarian 
     Bowel movements: not regular 
      Addictions : no addictions 
     Micturition: no burning micturation 
     Know allergies: no allergies 
          TELMA 40mg since 10yrs

Family History:
      No significant family history .

GENERAL EXAMINATION:
Pallor : yes
Icterus :no
Cyanosis : no
Clubbing : no
Lymphadenopathy : no
Edema : no

VITALS:
Temperature: 99.8°c/f
Pulse: 92beats per minute
Respiratory rate: 18cycles per minute
Blood pressure: 120/80 mm of Hg
SPO2: 96%

SYSTEMIC EXAMINATION: 

Knee joint examination: 
     Inspection : swelling and erythema - negative .
     Palpation : all inspectory findings are confirmed
There is slight rise in temperature .
Upon flexion and extension - crepitus .
      Range of movements : slight pain and limitations of active and passive movements of flexion and extension and lateral and median rotation .

PROVISIONAL DIAGNOSIS: 
 knee joint effusion .
 
Questions from patient 
When will the repetion of fever reduces?

Questions from student 
Why there is repeating fever and joint pain for every 10days ?

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