50 year old female with fever and loss of weight

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A 50 YEAR OLD FEMALE RESIDENT OF NALGONDA CAME FOR DIALYSIS 

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS AGO THEN SHE DEVELOPED FEVER WHICH IS LOW GRADE CONTINOUS NOT ASSOCIATED WITH CHILLS AND RIGORS NOT RELIEVED WITH MEDICATIONS

HISTORY OF LOSS OF WEIGHT SINCE 4 MONTHS 

PATIENT WAS DIAGNOSED WITH CERVICAL CANCER STAGE3B AT OUTSIDE HOSPITAL IN OCTOBER ON 26TH

H/O OF VOMITING[5-6 EPISODES] NON PROJECTILE NON BILIOUS FOOD AS CONTENT 20 DAYS AGO

BURNING MICTURATION 20 DAYS AGO

PAST HISTORY:

K/C/O HYPERTENSION SINCE 2YEARS AND IS ON REGULAR MEDICATION

NOT A KNOWN CASE OF DIABETES, EPILEPSY, ASTHMA, CEREBROVASCULAR ACCIDENTS.

PERSONAL HISTORY:

SHE WAS A DAILY WAGE WORKER WHO STOPPED GOING TO WORK SINCE 1 YEAR BECAUSE SHE WAS FEELING VERY WEAK.

SLEEP IS INADEQUATE 

DIET IS MIXED

APPETITE-DECREASED

DECREASED URINE OUTPUT SINCE 1 MONTH

BOWEL FUNCTIONS ARE NORMAL

FAMILY HISTORY:

NOT SIGNIFICANT 

MENSTRUAL HISTORY:

NULLIPAROUS 

AGE OF MARRIAGE: 15 YEARS

GENERAL EXAMINATION :

PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE AND WELL ORIENTATED TO TIME, PLACE AND PERSON.

PALLOR IS PRESENT

NO ICTERUS ,CYANOSIS, CLUBBING ,PEDAL OEDEMA,LYMPHADENOPATHY

VITALS:

BP-130/90mmHg

PR-70/MIN

RESPIRATORY RATE: 18/MIN

TEMPERATURE -AFEBRILE

SYSTEMIC EXAMINATION:

CVS : 

On palpation ‐

• Apex beat was felt in the left 5th intercostal space medial to the mid clavicular line on left side.

• JVP was normal 

• No precordial bulge 

• No parasternal heave

On auscultation ‐ S1, S2 heard , no murmurs 

RS :

On inspection ‐

• Chest is bilaterally symmetrical 

• Expansion of chest: Equal on both sides

• Position of trachea: Central

• No visible scars, sinuses, pulsations

On palpation : 

• Expansion of chest was equal on both sides. 

• Position of trachea: Central

• Tactile Vocal Fremitus: resonant note was felt.

On percussion: all lung areas were resonant 

On auscultation : 

• Bilateral air entry was present, normal vesicular breath sounds were heard. 

• Vocal resonance: resonant in all areas

P/A : soft, non tender, no organomegaly, no distension, bowel sounds heard.

CNS : The patient is well oriented to time, place, person.

Higher mental functions are intact.

Cranial nerve examination :‐

All cranial nerves are intact and functioning. 

Motor System Examination :‐

• Normal bulk in upper and lower limbs

• Normal tone in upper and lower limbs

• Normal power in upper and lower limbs

• Gait is normal 

. Reflexes are normal .

Sensory System Examination :‐

Normal sensations are felt in all the dermatomes.

No cerebellar signs .

No meningeal signs.

INVESTIGATIONS:

BLOOD GROUP -O POSTIVE

21/11/22

22/11/22

23/11/22

24/11/22

25/11/22

26/11/22

27/11/22

5/12/22

HB-7.8g/dl

CT on 26/10/22

Source: DC DUTTA TEXTBOOK OF GYNECOLOGY 7TH EDITION

TOTAL DIALYSIS-4

1st-22/11/22

2nd-24/11/22

3rd-28/11/22

4th-5/12/22

PROVISIONAL DIAGNOSIS:

CARCINOMA CERVIX stage3b With bilateral hydroureteronephrosis causing renal problems 

PATIENT IS ON MAINTENANCE DIALYSIS

TREATMENT:

1)RECEIVED TREATMENT IN HYDERABAD (CHEMOTHERAPY/ RADIOTHERAPY)???

 2)INJ LASIX 40MG IV/BD

3)INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE 

4)T NODOSIS 500MG IV/BD

5)T NICARDIA 10MG PO/TID

6)T OROFER XT PO/OD

7)T SHELCAL XT PO/OD