65 YEARS OLD FEMALE WITH SYNCOPE .
Siddam sushmitha
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This is the case of a 65 years old lady housewife, resident of Chinatunalgudam.
The patient presented to the casualty on Thrusday (30/11/2023) after episode of loss of consciousness .
Patient was apparently asymptomatic two days ago , then she had an episode of syncope , associated with sweating , and after walking for a longer period of time .
Not associated with palpitation , flushing , chest pain , muscle weakness , slurring of speech, headache .
The patient was brought to the casualty and given medication and recovered completely .
6 days ago - History of chest pain which was sudden in onset , in the centre of chest , squeezing type , non progressive , not radiating and with shortness of breath following exertion , which were both relieved on rest .
She went to an RMP and was diagnosed with DENOVO HYPERTENSION and was given an anti hypertensive agent .( which she consumed for the first time 3 days ago )
PAST HISTORY
No similar complaints in the past
She is a known case of hypertension since 3days
Not a known case of Diabetes Mellitus , Asthma , TB,CVD,CAD
No history of blood transfusions .
History of treatment for cellulitis of leg was taken by the patient .
FAMILY HISTORY
Family history shows patient's 3 sibilings with DM
PERSONAL HISTORY
Mixed diet , normal appetite
Adequate sleep
Normal bowel and bladder movements
No allergies
Addiction - sutta- 4 cigarettes/ day since 40 years
Alcohol or toddy - 1 glass daily
GENERAL EXAMINATION
The patient is conscious , coherent and cooperative
Moderately built and moderately nourished
There is absence of Pallor , icterus cyanosis, koilonychia, lymphadenopathy .
Pedal edema present
VITALS
BP- 120/80mmHg in sitting position with cuff in the right hand at the level of the heart
PR- 67 bpm, normal rhythm ,
RR- 20cpm
Temp- Afebrile
SYSTEMIC EXAMINATION
CNS
Higher Mental Functions
Normal speech and language
Normal memory
No delusions or hallucinations
Cranial nerve examination
- I : Intact bilaterally
III, IV, VI : Extraocular movements free and full bilaterally
V : Intact bilaterally
VII:Intact bilaterally
VIII: No nystagmus, intact bilaterally
IX,X : Intact bilaterally
XII : Intact bilaterally
MOTOR SYSTEM
Bulk- normal
Power : normal power of
- Shoulder , Elbow , Wrist , Smalll muscle of hand and hand grip bilaterally
- knee , ankle bilaterally
Muscle tone :normal
Reflexes
-normal : Biceps , triceps , knee jerk , ankle jerk bilaterally
Cerebellar signs : Normal
Sensory system examination
Upper limb : Normal
Lower limb
- Crude touch , temperature , fine touch ,vibration sensation present bilaterally
- Pain sensation is normal bilaterally
CVS
S1 s2 heard , no murmur
No thrill
Apical impulse felt
RESPIRATORY
Normal vesicular breath sounds in all areas
No adventitious breath sounds
PER ABDOMEN
Obese abdomen, umbilicus central and everted
Soft , non tender
No hepatomegaly no splenomegaly
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