46 YEAR OLD FEMALE COMPLAIN OF INCREASED JOINT PAIN SINCE 2 YEARS

46 YEAR old female a resident of ranga reddy district and a homemaker by occupation was transferred to the general medicine OPD with

Chief complains
Bilateral joint pain in the hip since 10 years.
Lower back pain since 10 years.

History of presenting illness
Patient was apparently asymptomatic 10 years ago then she developed bilateral hip joint pain and difficulty in walking without support. 
The pain was insidious in onset, gradually progressive aggrevating factors walking kneeling no medication taken
2 years ago the pain increased and the patient visited hospital. Pain relief medication was given but medicine not taken regularly.

12 days ago she visited our hospital and was transferred to GM department where indepth history was taken.

-Co hip joint pain since 10 years increased 2 years ago.
-Co burning sensation during micturation.
-Co weight gain since 1 year.

-Co facial puffiness 2 months
-Co decreased urine output

PAST HISTORY
-Not a known case of DM,epilepsy, Asthama,CVA, CDA.
-Taking bp medication since one year one tablet every 3 days.

Menstrual history

-Age of maturity- 13 years.
-Hysterectomy 23 years ago.

Family history

-No similar complains in the family

Personal history

Diet- mixed
Appetite- decreased since 10days
Sleep- adequate
Bowel and bladder habits-
Urination frequency decreased
Bowel habits normal
-No addiction 
-No known drug allergies


General physical examination

The patient is concious coherent cooperative well oriented to time place person 

Moderately build moderately nurished
Pallor- present
Icterus- absent
Cyanosis- absent
Kolonichya- absent
Lymphadenopathy- absent
Edema- present pitting type
Vitals
Temperature- afebrile.
BP- 130/90 mm of Hg.
PR- 80 bpm.
RR- 14 cycles per minute.
Spo2- 98%

Examination
×Trendelenberg sign- negative
×Squat test- positive
×Trendelenberg test- positive
×Inguinal ligament tenderness- absent
×Hip flexion- reduction in range of motion
×Abduction 45°and adduction20°-30°- pain felt and range of motion reduced
×Internal rotation 30°and external rotation 30°-70°- pain felt and range of motion reduced

Systemic examination

CVS Examination- S1,S2 heard, no murmurs.
Resperatory system examination- vesicular breath sounds heard.
CNS examination- normal.

Investigation findings
Diagnosis

1) Chronic Kidney Disease (grade lll RPD changes)
2) Diabetes Mellitus
3) Hypertension
4) B/L Hip Osteoarthritis


 






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