60 year old with joint pains

60 year old female with joint pains 

21 July, 2023

Chief complaints 
A 60 year old female, who was an agricultural labourer by occupation (but has stopped working since 4 years), came to the hospital with complaints of pain in both knees since 4-5 years, facial swelling since 2-3 months, pedal edema since 1 week.

HISTORY OF PRESENTING ILLNESS
The patient was apparently asymptomatic 4-5 years ago. She then started developing pain in both her knees which is aggravated on walking and standing, relieved on resting and medications (painkillers). She stopped working due to the pains.

2-3 months ago, she developed facial puffiness which was insidious in onset and gradually progressive in nature. It appears maximally in the mornings and gets relieved by the end of the day. 

1 week ago, she had pedal edema upto her ankles which was pitting in nature. This also appears maximally in the morning and subsides by the end of the day. Her edema greatly subsided by itself after a week.

She came to the hospital now to find a working solution for her joint pains and to find out about why her pedal edema appeared and disappeared.

DAILY ROUTINE
The patient wakes up in the morning at 5:30 and begins household chores, eats breakfast at 8:00. She smokes tobacco at this time.

She then passes her time by talking with family members or guests till 11:00, when she cooks her lunch and eats lunch late, around 3:00-4:00pm

She has tea occasionally in between, when she visits family. She spends time sleeping or talking with friends and family in person or on the phone.

At night, she doesn't feel hungry. She may or may not smoke tobacco again. She then sleeps at around 10:00pm.

This has been her routine since 4 years, after she stopped working.

PAST HISTORY
Not a known case of diabetes, hypertension, CVA, CAD, TB, asthma

FAMILY HISTORY
Not significant.

TREATMENT HISTORY
The patient has a history of using NSAIDS 3-4 days a week since 4 years for the joint pains, suggested by and RMP.

PERSONAL HISTORY
Appetite: normal
Diet: mixed
Sleep: adequate
Bowel movements: regular
Micturition: normal
No known allergies
Addictions: Smokes tobacco once or twice a day everyday

MENSTRUAL HISTORY
Attained menopause 20 years ago

OBSTETRIC HISTORY
Age at marriage: 18 yrs
Age at first childbirth: 20
Obstetric formula: G5P5L5
All normal vaginal deliveries

GENERAL EXAMINATION
The patient is conscious, coherent, cooperative and well-oriented to time, place and person.
The patient is moderately built and well-nourished.
No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy
Pedal edema present in right foot(grade 1)

Vitals
Temperature: Afebrile
Blood pressure: 120/80mm Hg
Pulse rate: 82 bpm
Respiratory rate: 18cpm

SYSTEMIC EXAMINATION

CNS: Patient is conscious, coherent and cooperative, well-oriented to time, place and person

CVS: S1, S2 sounds heard, no murmurs

Respiratory system: trachea central, normal vesicular breath sounds heard, no added sounds

Abdomen: distended, no palpable organs.

INVESTIGATIONS
Ultrasound
ECG
Provisional diagnosis
Facial puffiness under evaluation
TREATMENT
Took Potassium citrate and magnesium citrate for pedal edema, given at government hospital.
Aspirin
Rosuvastatin
Furosemide 





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