72years old female with dov of right and left eye ,knee pain and hypertension

Hi, I am Y.Shasshank , 5th semester medical student. 

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 patients 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 comment box is welcome. 

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.  

CONSENT AND DE-IDENTIFICATION : 

The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being entirely conserved. No identifiers shall be revealed throughout the piece of work whatsoever.

Chief Complaint 

Patient gave the chief complaint of Complete loss of vision in right eye since 1 year ; diminution of vision in left eye since 6months;

Bilateral knee pain since 1 year

History of presenting illness

Patient was apparently asymptomatic 1year ago,then she developed

*Knee pain:

Since 1year ,which is insidious in onset , intermittent, dragging type of pain, extending upto foot, aggravated by walking, no relieving factors 

* Pedal edema:

  Bilateral

  Pitting type 

  Extending upto knee 

* History of fever 10 days back at the same time diagnosed with hypertension

* History of trauma to left leg one year ago

* No history of headache , general weakness , giddiness

* No history of chestpain, cough, cold ,sob

*No history of burning micturition, nausea, vomiting

Past history

K/c/o hypertension

N/k/c/o DM, epilepsy, asthma, tb, thyroid 

Past surgical history

Mastectomy of left breast 20 years back

Personal history

Married

Pure vegetable diet

Normal appetite

Bowel & bladder movements are regular

Adequate sleep 

Had a habit of consuming toddy occasionally 

Had an addiction of taking bedi in past , now stopped for more than 10years 

Family history

 Not significant

General examination

Patient is conscious, coherent, cooperative

No pallor 

No icterus

No cyanosis 

No clubbing of fingers 

No lymphadenopathy

Pedal edema - bilateral

Pitting type extending upto knee

Vitals 

Temperature

Bp: 130/ 70 mmhg

Pulse : 95bpm 

Grbs:82

Systemic examination

A. CVS

- No thrills

- S1 S2 positive

-no cardiac murmurs

B. RESPIRATORY SYSTEM 

- no dyspnoea 

- No wheezing

- central trachea

- vehicular breath sounds 

C. ABDOMEN

- scaphoid shaped abdomen 

- No tenderness

- No palpable mass

- non palpable liver and spleen

C. CNS

- conscious and coherent

- normal speech

Investigation 

ECG: