A 60yr old female with involuntary movements of upper limbs
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C/O 1episode of involuntary movements of both upper limbs
HISTORY OF PRESENTING ILLNESS:
Patient was apparently alright 1yr back then she developed diminision of vision in right eye which is insidious in onset, progressive in nature.She also has c/o itching all over the body since 2months
No c/o chest pain,pain abdomen ,burning micturition,fever,cough,cold
—> Initially patient got admitted under ophthalmology department for diminision of vision on 07/09/23 then got transferred to dermatology department I/V/o itching all over body on 07/09/23 and they diagnosed as pruritis under evaluation.After she got relieved from itching she was tranferred to ophthalmology department on 11/09/23.
—> Now again on 13/09/23 at 10:20am pt suddenly fell from bed on floor over her face ,she was unconscious,non coherent and non cooperative ,deliriant,lower lip bite present.
No frothing,She clenched her fist ,arm and forearm are in flexion position.Irrelevant speech present.She regained her consciousness after 5minutes.Patient does not remember the incident attack.
BP-140/90mm hg at 10:15am
GRBS- 115mg/dl at 10:20 am
—> And then it was taken over by medicine department at 10:23am I/V/o history of GTCS seizures since 4 yrs and she has 1episode of seizures every 5-6months.
—> Patient was taken for OMFS cross consulatation I/V/o pain and bleeding in lower lip for which they diagnosed as laceration of lower lip measuring 2*1 cm approx and suturing was done using 3-0 vicryl
—> Patient was taken for orthopaedics cross consultation I/V/o pain in both the knees and tenderness present since the fall and they diagnosed as B/L grade 4 osteoarthritis of knee and advised X-ray b/l knee AP and lateral view
B/L KNEE LATERAL VIEW:
B/L KNEE AP VIEW:
Patient is a housewife. She wakes up around 5:30 am and freshens up and do the household activities.She takes her breakfast at around 8:00am. She takes her lunch at 12:30pm. Then, Takes a nap for
1-2hrs. wakes up around 4:00pm and have a cup of tea. She takes her dinner around
8:00pm, and goes to sleep around 10:00 pm.
GENERAL AND PHYSICAL EXAMINATION:
Patient is conscious ,coherent,cooperative
Moderately built and nourished
No signs of pallor,icterus,cyanosis,clubbing,edema,lymphadenopathy
VITALS:
Temperature-97.4F
PR-79bpm
BP-130/80mmhg
GRBS-98mg/dl
SPO2-98%
CVS examination:
No visible pulsations, scars, engorged veins. No rise in jvp
Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.
S1 S2 heard . No murmurs.
Respiratory system :
Shape of chest is elliptical, b/l symmetrical.
Trachea is central. Expansion of chest is symmetrical
Bilateral Airway Entry - positive
Normal vesicular breath sounds
Per Abdominal examination:
Soft , non tender
bowel sounds heard
CNS-
Bulk-normal in both upper and lower limbs
Rt. Lt
Tone:
UL. N. N
LL N. N
Power:
UL. 5/5. 5/5
LL 5/5. 5/5
Reflexes.
B. +2. +2
T. +2. +2
S +. +
K. +2. +2
A. +1. +1
P M. M
Finger nose test-normal
Finger-finger nose test-normal
Romberg’s sign-negative
Gait-normal
INVESTIGATIONS:
13/09/23
14/09/23
PROVISIONAL DIAGNOSIS:
Generalized tonic clonic seizure secondary to non compliance with B/L grade4 osteoarthritis of knee
TREATMENT:
1)Tab.Sodium valproate 200mg po/od
2)Tab.Taxim 200mg po/bd
3)Tab.pan 40mg po/od
4)Tab.Zerodol-p po/bd
5)Tab.Ultracet po/bd
6)Chlorhexidine mouth wash po/tid
7)Tab.Dolo 650mg po/tid
15/09/23
Date of admission : 07/09/23
Dr.Rakesh Biswas (HOD)
Dr.Sushmitha (SR)
Dr.Kranthi (PGY2)
Dr.Navya (PGY1)
S
B/L knee pains since 2days
Pain at the site of suture(lower lip laceration)
O
Patient is conscious/coherent/cooperative
PR: 72bpm, regular
Bp: 110/70 mmhg
SPO2: 98% at RA
CVS: S1 S2+ , no murmurs heard
RS: Bilateral air entry+, NVBS heard
CNS: NFND
P/A:soft,non tender,bowel sounds heard
A
Generalized tonic clonic seizure secondary to non compliance with B/L grade4 osteoarthritis of knee
P
1)Tab.Sodium valproate 200mg po/od
2)Tab.Taxim 200mg po/bd
3)Tab.pan 40mg po/od
4)Tab.Zerodol-p po/bd
5)Tab.Ultracet po/bd
6)Chlorhexidine mouth wash po/tid
7)Tab.Dolo 650mg po/tid
[15/09/23, 2:34:15 PM] Rakesh Biswas Sir: Update?
[15/09/23, 2:55:51 PM] Tejaswini Kandhada: 15/09/23
Date of admission : 07/09/23
Dr.Rakesh Biswas (HOD)
Dr.Sushmitha (SR)
Dr.Kranthi (PGY2)
Dr.Navya (PGY1)
S
B/L knee pains since 2days
Pain at the site of suture(lower lip laceration)
O
Patient is conscious/coherent/cooperative
PR: 72bpm, regular
Bp: 110/70 mmhg
SPO2: 98% at RA
CVS: S1 S2+ , no murmurs heard
RS: Bilateral air entry+, NVBS heard
CNS: NFND
P/A:soft,non tender,bowel sounds heard
A
Generalized tonic clonic seizure secondary to non compliance with B/L grade4 osteoarthritis of knee
P
1)Tab.Sodium valproate 200mg po/od
2)Tab.Taxim 200mg po/bd
3)Tab.pan 40mg po/od
4)Tab.Zerodol-p po/bd
5)Tab.Ultracet po/bd
6)Chlorhexidine mouth wash po/tid
7)Tab.Dolo 650mg po/tid
[15/09/23, 4:17:03 PM] Rakesh Biswas Sir: Utility of taxim?
[15/09/23, 5:39:02 PM] Tejaswini Kandhada: Sir it was prescribed by omfs team as they did suture for the laceration of lower lip
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