57 M bilateral lower limb swelling and multiple joint pains

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Here is the case I have seen:

Date of admission:- 12-12-22

A 57 year old male farmer by occuption resident of suryapet came with

  

CHEIF COMPLAINTS OF:-

Swelling of bilateral lower limbs and right upper limb since 15 days, pain in multiple joints since 15 days , and difficulty in walking since 3 days.

HISTORY OF PRESENTING ILLNESS:-

• Patient was apparently asymptomatic 15 days back then he noticed swelling in bilateral lower limbs and upper limbs which was insidious in onset and gradually progressing extending upto knees.

• He also had complaints of pain since 15 days in multiple joints which was aching, insidious in onset, gradually progressing,non radiating.

•He also had complaints of difficulty in walking since 3 days .

•No complaints of loose stools, vomitings ,burning micturition.

• No complaints of pnd,cough,chest pain, palpitations.

•No complaints of decreased urine output,hematuria.

HISTORY OF PAST ILLNESS:-

He is  not a known case of DM,HTN, Bronchial asthma , Epilepsy , CAV , CAD.

PERSONAL HISTORY:- 

DIET:- Mixed

APPEPITE:- Normal

SLEEP:- Adequate 

BLADDER AND BOWEL MOVEMENTS :- Regular

ADDICTIONS :- Alcohol intake ,no smoking

FAMILY HISTORY:- 

No relevant family history

SURGICAL HISTORY :- 

No past surgical history

GENERAL EXAMINATION:-

Patient is concious coherent cooperative

Well oriented to time, place, person

Thin built moderately nourished

Pallor- present

Icterus - absent

Pedal edema - present

Cyanosis - absent 

Clubbing - absent 

Lymphadenopathy - absent

VITALS:- 

Temperature:- Afebrile (98.6)

Pulse rate :- 100 BPM,regular

Respiratory rate :- 20 cpm

BP:- 130/90

SpO2:- 98%

BEFORE:

NOW:

SYSTEMIC EXAMINATION:-

CARDIOVASCULAR SYSTEM:-

AUSCULATION:-

S1 ,S2 heard 

No murmurs

RESPIRATORY SYSTEM:- 

INSPECTION:-

•Trachea is central in postion.

•Movements are equal bilaterally.

•No scars or sinuses.

PALPATION:- 

•All inspectory findings are confirmed :- Trachea is central, movements equal and bilateral.

PERCUSSION:- 

• Resonant note heard bilaterally

AUSCULATION:-

•Bilateral air entry present- Normal vesicular breath sounds heard.

PER ABDOMEN:- 

•Scaphoid 

•Soft non tender 

•No organomegaly

•Bowel sounds present

•Tympanic note heard all over the abdomen.

CENTRAL NERVOUS SYSTEM:-

•Speech- Normal

•Reflexes - reduced

•No signs of meningeal irritation

•No focal nuerological deficit

PROVISIONAL DIAGNOSIS

•?Polyarthralgia

INVESTIGATIONS

ECG:

USG ABDOMEN:-

2D ECHO:-

TREATMENT:-

1.