A 20 year old female with irregular cycles since 4 years ,pedal edema and abdominal distention since 2months
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Case presentation: A 20 year old female came with chief complaints of irregular cycles since 4 years ,pedal edema and abdominal distention since 2 months.
HOPI : Pt was apparently asymptomatic 8years back then she developed regular menses for 1 month for year ,there after since 4 years back gradually developed irregular menses once for 6-7months and on consulting Doctor he prescribed medication (unknown),1cycled menses occurred and these irregularity continuing with out medication (LMP - 14/10/20),then 2 months back urine output gradually decreased and progressed.
Then edema developed which first occurred over abdomen and pt experienced Sob ,developed oliguria 2-3times/day approximately 50-60ml /day and edema progressed to both upper and lower limb and all over face over 10 days then went to mamatha hospital for further treatment.There on evaluation ,she developed microcytic hypochromic with few macrocytes and few target cells
There is hyperpigmentation since 4 years
No H/o alopecia
Past history:No similar complaints in past
No H/o fever ,cold,cough .
No H/o chest pain,palpitafions ,sweating ,syncopal attacks .
No H/o burning micturation,malena,diarrhoea,pale stools,constipation.
No H/o any surgeries ,blood transfusions
No H/o intake of iron tablets.
Sob on ingestion of food,not associated with pain
FAMILY HISTORY :No H/O similar complaints inthe family
PERSONAL HISTORY:
He was on mixed diet, appetite normal, bowel habits normal ,no addictions
Menstrual history :
Attained menarche at the age of 12
Cycle :5/30, oligomenorrhea,no clots
LMP : 14/01/2020.
GENERAL EXAMINATION: pt is conscious, coherent, cooperative and oriented to time, place and person
no pallor ,icterus,cyanosis,clubbing, lymphadenopathy
There is edema of both limbs which is pitting type
Acanthosis nigricans present
VITALS:
Temperature-99.8°f on presentation
BP:120/80mmhg
PULSE:79pm
RR:19cpm
Spo2:98%
GRBS:103mg/dl
PER ABDOMEN:
INSPECTION : Abdomen bilaterally symmetrical.
Mild distention of abdomen,no flank fullness.
All quadrants moving equally with respiration.
Umbilicus is central and inverted.
No scars,sinuses,striae,pigmentation,echymosis,dilated veins and visible pulsations.
PALPATION: on palpation abdomen is soft and non tender
No Guarding and rigidity.
Spleen is palpable
PERCUSSION : No fluid thrill.no shifting dullness
AUSCULTATION : Bowel sounds present.
CVS:s1 s2 heard
RS: BAE clear, normal vesicular breath sounds heard,no added sounds
CNS:
MMSE:
MMSE:
1)Orientation: year,month,date,season,town,ward : NAT
Time,country,district,hospital: AT
Orientation total score (4/10)
2)Registration:registration for 3 objects: 3/3
3)Attention and calculation:0/5
4)recall after 5minutes:2/3
5)language for a)2objects : 2/2
b) 3stage command 3/3
c) return command 0/1
d) right sentence 0/1
e)repeat 1/1
6) Copying 1/1
Total score of MMSE = 15/30
Lobar function tests :
1) Executive functions
A) History giving and insight of the problems - ++.
B) forward and backward digit span - NATD
C) as many words in a minute with any letter - NATD
D) naming any animal, vegetables, fruits in one minute : 2-3
E) motor Luria test : negative
F) lobar integration test : negative
G) Luria graphic test : NATD
H) Set shifting A and B : NATD
2) Orbital and basal areas of frontal lobe
A) dressing sense : good
B) Go and no go test : good
C) stoop test : able to tell red colour and not for other colours
3) Parietal lobe :
A) Ideational appraxia : good
B) Right and left orientation : present
C) finger agnosia :
a) non verbal finger recognition : +
b) identification of named finger of the examiner : was confusing
D) visuospatial function : NATD
E) cotical sensations :
Asteregnosis present and graphasthesia was able to tell the direction but not the letters
F) calculations : NATD
4) Temporal lobe : memory and language : Good
5) Occipital lobe :
a) prosopagnosia : she is able to recognize familiar faces
b) visual memory : didn't perform.
Clock drawing test : NATD
NATD :Not able to do.
INVESTIGATIONS::
Thyroid profile:
