A CASE OF VIRAL PYREXIA WITH ORAL CANDIDIASIS AND CERVICAL LYMPHADENOPATHY

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box

A 90 year old female resident of Nalgonda came to op with complaints of fever since 1 day, swelling of tongue and pain during swallowing since today afternoon.she also complaints of generalized weakness since morning.
She had h/o fever 4 months ago associated with redness of tongue and nausea which subsided on medication and later has h/o fall and sustained injury to right femur after which implant was placed.
No h/o rash,SOB,Cough
No h/o lip swelling
No h/o outside, allergies and food exposure
No h/o DM, HTN,TB, CVA, CAD,Asthma, Epilepsy.
Patient has normal appetite, takes mixed diet, regular bowel and bladder movements and no addictions
On Examination patient is conscious, coherent, cooperative.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema.
Vitals:
Temp-99 degrees F
PR-72 Bpm
RR-19 Cpm
BP-70/40 mm Hg on admission
Spo2:98% at room air
CVS-S1S2+
RS-bilateral air entry+,clear
P/A: soft,non tender,bowel sounds heard
CNS:NFD
B/L Sub mandibular lymph nodes+
Right eye-pupil constricted,not rracting
Left eye- post cataract
Uvula-centre
Gag reflex+
Provisional diagnosis:
? Viral pyrexia with ?oral hairy leucoplakia/?oral candidiasis
INVESTIGATIONS:
CBP:
HB-10.6
TLC-11,000
PTC-2.34 Lakhs
CUE:
Sugar:++
Albumin:nil
M.P strip test-negative
Absolute Eosinophil count-220 cells/cumm
Rapid Dengue-negative
Serology-negative
RFT:
urea-40
Creatinine-1.5
Na-142
K-2.9
Cl-96
LFT:
TB-1.05
DB-0.19
AST-19
ALT-37
ALP-216
TP-6.9
Albumin-3.2
A/G-0.89
ENT REFERRAL:
OMFS REFERRAL:
TREATMENT:
1)IVF 2NS,2RL,2 DNS @75 ML/HR
2)T.PCM 650 MG PO/TID
3)T.PAN 40 MG PO/OD
4)T.ZINCOVIT PO/OD
5)INJ.AUGMENTIN 1.2 GM IV/BD
6) TEMPERATURE CHARTING 4TH HOURLY
7)GRBS 8TH HOURLY
8) MONITOR VITALS AND INFORM SOS
11/11/21:
S:fever, swelling of the tongue and pain 
O:on examination patient is conscious, coherent, cooperative
Vitals:
BP-140/90 mm hg
PR-80bpm
RR-18cpm
TEMP-99.7 f 
A: viral pyrexia
Oral candidiasis
?sub mandibular infection/? Ludwig's Angina
Cervical lymphadenopathy 
P:
Treatment:
1)INJ.AUGMENTIN 1.2 GM/IV/BD
2)T.PAN 40 PO/OD
3)T.PCM 650 PO/SOS
4)INJ.METROGYL 500MG IV/TID
5)T.FLUCONAZOLE 100 MG PO/OD
6)T.ALLEGRA 120MG PO/H/S
7)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
8) CHLORHEXIDINE MOUTH WASH
9) IVF-2 NS,2 RL @100ML/HR
10) GRBS 8TH HOURLY
11)BP,PR,SPO2/TEMP 4TH HOURLY


12/11/21:
S:fever reduced, swelling of the tongue and pain reduced 
O:on examination patient is conscious, coherent, cooperative
Vitals:
BP-150/90 mm hg
PR-86 bpm
RR-18cpm
TEMP-98.4 f 
A: viral pyrexia
Oral candidiasis
?sub mandibular infection/? Ludwig's Angina
Cervical lymphadenopathy 
P:
Treatment:
1)INJ.AUGMENTIN 1.2 GM/IV/BD
2)T.PAN 40 PO/OD
3)T.PCM 650 PO/SOS
4)INJ.METROGYL 500MG IV/TID
5)T.FLUCONAZOLE 100 MG PO/OD
6)T.ALLEGRA 120MG PO/H/S
7)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
8) CHLORHEXIDINE MOUTH WASH
9) IVF-2 NS,2 RL @100ML/HR
10) GRBS 8TH HOURLY
11)BP,PR,SPO2/TEMP 4TH HOURLY


13/11/21:
S:swelling of the tongue and pain reduced 
O:on examination patient is conscious, coherent, cooperative
Vitals:
BP-130/70 mm hg
PR-82 bpm
RR-18cpm
TEMP-98.4 f 
Oral examination:
floor oF the mouth-white grey,pus discharge+ on the floor of tongue, bleeding point+ on tip of the tongue and floor
CVS:S1S2+;Pansystolic murmur+ 
RS:BAE+,right mild IAA crepts+
P/A: soft,non tender,bowel sounds+
A: viral pyrexia
Oral candidiasis with cervical lymphadenopathy
P:
Treatment:
1)INJ.AUGMENTIN 1.2 GM/IV/BD
2)T.PAN 40 PO/OD
3)T.PCM 650 PO/SOS
4)INJ.METROGYL 500MG IV/TID
5)T.FLUCONAZOLE 100 MG PO/OD
6)T.ALLEGRA 120MG PO/H/S
7) CHLORHEXIDINE MOUTH WASH
8) IVF-2 NS,2 RL @100ML/HR
9) GRBS 8TH HOURLY
10)BP,PR,SPO2/TEMP 4TH HOURLY

Comments

Post a Comment

Popular posts from this blog

VIRAL PYREXIA UNDER EVALUATION

Image
  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box A 50 year old male came to opd with complaints of high grade fever since 3 days associated with chills Cold since 3 days Cough since 3 days,productive, mucoid,not associated with shortness of breath No h/o chest pain, palpitations No h/o pedal edema, decreased urine output, abdominal distension No h/o HTN,DM,TB, Asthma, epilepsy Personal history: Appetite-normal Diet-mixed Bowel and bladder movements- regular No known allergies He's a known smoker,he smokes 5-6 cigarettes a day
Read more

A CASE OF ACUTE URINARY RETENTION UNDER EVALUATION

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box A 30 year old male,farmer by occupation resident of Nalgonda came to op And he has H/o RTA 3 Years ago after which he got implant in right tibia. H/o RTA 2 years ago, Injury to the same leg and sustained a superficial wound 1 year ago patient developed a small vesicle over left shin of tibia which increased in size with swelling of whole limb, blackish discoloration later multiple vesicles of large size developed over left lower limb,pt visited doctor where they punctured the vesicle
Read more

A case of 56 year old male with chronic kidney failure

Image
  “This is an online E log book to discuss our patient’s de-identified data shared after taking his/her/guardian’s signed informed consent.” FINAL EXAM SHORT CASE : A 56 yr old male patient resident of Aganmothkur,who is a farmer ,came to the hospital with chief complaints of shortness of breath since 1 day.    Patient was apparently asymptomatic 3 months back.Then he developed bilateral pedal edema of grade-4 pitting type and shortness of breath grade-3 for which he was hospitalised and was diagnosed to have Chronic kidney disease .Since then he had 11 sessions of hemodialysis .The last one was done as he had shortness of breath of grade-3 and bilateral pedal odema grade -3 pitting type . Past history:He went to hospital as he had fever and was diagnosed to have Hypertension 5 months back . Underwent surgery for intestinal perforation 2 yrs ago. GENERAL EXAMINATION: The patient is conscious, coherent, coperative .Moderately built and nourished. Pallor present Icterus present.  Bilater
Read more