50 year old female with fever and loss of weight















 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.


A 50 YEAR OLD FEMALE RESIDENT OF NALGONDA CAME FOR DIALYSIS 

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS AGO THEN SHE DEVELOPED FEVER WHICH IS LOW GRADE CONTINOUS NOT ASSOCIATED WITH CHILLS AND RIGORS NOT RELIEVED WITH MEDICATIONS

HISTORY OF LOSS OF WEIGHT SINCE 4 MONTHS 

PATIENT WAS DIAGNOSED WITH CERVICAL CANCER STAGE3B AT OUTSIDE HOSPITAL ON OCTOBER 26TH

H/O OF VOMITING[5-6 EPISODES] NON PROJECTILE NON BILIOUS FOOD AS CONTENT 20 DAYS AGO

BURNING MICTURATION - SINCE 20 DAYS

PAST HISTORY:

K/C/O HYPERTENSION SINCE 2YEARS AND IS ON REGULAR MEDICATION

NOT A KNOWN CASE OF DIABETES, EPILEPSY, ASTHMA, CEREBROVASCULAR ACCIDENTS.

PERSONAL HISTORY:

SHE WAS A DAILY WAGE WORKER WHO STOPPED GOING TO WORK SINCE 1 YEAR BECAUSE SHE WAS FEELING VERY WEAK.

SLEEP IS INADEQUATE 

DIET IS MIXED

APPETITE-DECREASED

DECREASED URINE OUTPUT SINCE 1 MONTH

BOWEL FUNCTIONS ARE NORMAL

FAMILY HISTORY:

NOT SIGNIFICANT 

MENSTRUAL HISTORY:

NULLIPAROUS 

AGE OF MARRIAGE: 15 YEARS

GENERAL EXAMINATION :

PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE AND WELL ORIENTATED TO TIME, PLACE AND PERSON.


NO ICTERUS ,CYANOSIS, CLUBBING ,PEDAL OEDEMA,LYMPHADENOPATHY

VITALS:

BP-130/90mmHg

PR-70/MIN

RESPIRATORY RATE: 18/MIN

TEMPERATURE -AFEBRILE







SYSTEMIC EXAMINATION:

CVS : 

On palpation ‐

• Apex beat was felt in the left 5th intercostal space medial to the mid clavicular line on left side.

• JVP was normal 

• No precordial bulge 

• No parasternal heave

On auscultation ‐ S1, S2 heard , no murmurs 

RS-

On inspection ‐

• Chest is bilaterally symmetrical 

• Expansion of chest: Equal on both sides

• Position of trachea: Central

• No visible scars, sinuses, pulsations

On palpation : 

• Expansion of chest was equal on both sides. 

• Position of trachea: Central

• Tactile Vocal Fremitus: resonant note was felt.

On percussion: all lung areas were resonant 

On auscultation : 

• Bilateral air entry was present, normal vesicular breath sounds were heard. 

• Vocal resonance: resonant in all areas

P/A : soft, non tender, no organomegaly, no distension, bowel sounds 

CNS- higher intellectual functions normal 

No sensory or motor deficits noted 

INVESTIGATIONS:

BLOOD GROUP -O POSTIVE

21/11/22



22/11/22



23/11/22

25/11/22


27/11/22

5/12/22

CT on 26/10/22

TOTAL DIALYSIS-4

1st-22/11/22

2nd-24/11/22

3rd-28/11/22

4th-5/12/22

PROVISIONAL DIAGNOSIS:
CARCINOMA CERVIX stage3b With bilateral hydroureteronephrosis causing renal problems 
PATIENT IS ON MAINTENANCE DIALYSIS

TREATMENT 
1) T. LASIX 40mg PO/OD
2)INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE 
3)T.NODOSIS 500mg PO/BD
4)T.NEFIDEPINE 20mg PO/OD 
5)T.PAN 40mg PO/OD 
6)T. SHELCAL PO/OD

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