17 year old female with history of vomitings and loose stools since 1 week
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CASE:
17 year old female complaints of vomitings and loose stools since 1week
CHIEF COMPLAINTS:
Vomitings since 1week
Loose stools since 1week
Fever since 3 days
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic One week back,she had outside food followed by which she developed loose stools and vomitings.
Loose stools:- 4-5episodes, water in consistency, non foul smelling, no blood tinged.
Vomitings:- 4-5 episodes, non projectile, non bilious, contents include food particles,Which subsided on taking medication,
Fever was incidious in onset, associated with chills and rigor,which subsided on taking medication
10years back,patient's mother observed swelling over the neck 4*4cm approximately and was diagnosed withHYPOTHYROIDISM and was on TAB.THYROXINE 25mcg....
Patient has history of eating slate pencils since 4 years.(5-6 slate pencils per day)
3 years ago :- history of itching and was taken to hospital which subsided on taking medication.
Since 3months patient is observing irregular menses,followed by dysmenorrhea,with clots.
Patient also complained of generalised weakness since 1week
HISTORY OF PAST ILLNESS:
Known case of HYPOTHYROIDISM since 10years on TAB.THYROXINE 25mcg..
Not a known case of HYPERTENSION,DIABETES MELLITUS,ASTHMA, EPILEPSY.
PERSONAL HISTORY:
DIET:Mixed(non veg twice weekly)
APPETITE:Normal
SLEEP: Adequate
BOWEL AND BLADDER MOVEMENTS: Regular
ADDICTIONS: No Addictions
ALLERGY:Present 3years ago, subsided on taking medication.
FAMILY HISTORY:
Mother was a known case of THYROID and was on TAB.THYROXINE 100mcg..
GENERAL EXAMINATION:
Patient was conscious,coherent and cooperative,well oriented to time,place and person.
Pallor:++
Hyperpigmentation notes over the palate and the oral cavity.
Knuckle pigmentation
Hyperpigmentation over the palmar creases
Acanthosis nigricans ++
Icterus:- absent
Cyanosis:- absent
Clubbing:- absent
Lymph nodes:- Bilateral cervical and submandibular lymph nodes palpable.
Vital signs:
BP:- Supine :- 130/80 mm Hg
Standing :- 120/60 mm Hg
PULSE RATE :- Supine :- 88 BPM
standing :- 83 BPM
SPO2 :- 98
Respiratory Rate :- 18cpm
GRBS :- 98 mg/dl
SYSTEMIC EXAMINATION:
CVS:S1,S2 heard,no murmurs
RESPIRATORY SYSTEM:
Inspection: trachea central in position
Normal vesicular breath sounds heard
BAE ++
LOCAL EXAMINATION:
Inspection:swelling at the anterior part of the neck,does not move with protrusion of tongue and moves with deglutition
Palpation :- disseminated margins,nodular,
size:6*7cms
Percussion :-
Auscultation :- no bruits
ABDOMINAL EXAMINATION:
Inspection :- no scars
Palpation :- soft,non tender
Auscultation :- BOWEL SOUNDS HEARD
CNS EXAMINATION:
CRANIAL NERVES: INTACT
Power
Rt UL-5/5. Lt UL-5/5
Rt LL-5/5. Lt LL-5/5
Tone-
Rt UL -N
Lt UL-N
Rt LL-N
Lt LL-N
Reflexes:. RIGHT LEFT
Biceps. ++ ++
Triceps. ++ ++
Supinator. ++ ++
Knee. ++ ++
Ankle. ++ ++
Plantar:. Flexion Flexion
•SENSORY
crude touch N N
Pain N N
Temperature N N
Fine touch N N
Vibration Right Left
Upper limb. 15 sec 15 sec
Lower limb. 11 sec. 10sec
Tibia. 14 sec. 14sec
Toe. 15sec. 15sec
Finger nose co-ordination : +
FEVER CHART:
INVESTIGATIONS:
HAEMOGRAM:
SERUM IRON:
FERRITIN LEVELS:
PHOSPHOROUS LEVEL:
Diagnosis :- DIMORPHIC ANEMIA
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