55 year old female with dizziness and vomitings

 A 55 year old female, homemaker from AP Lingotam came to the casuality with 

C/o Dizziness since 3 hours prior to admission

HOPI

Patient was apparently asymptomatic 1 day ago then she felt dizzy which was associated with tension in the neck and headache. She was taken to a hospital after fainting where blood pressure was recorded to be 170/90 mmHg so was given one tablet of Propranolol half hour following which patient had 3 episodes of non projectile vomitings for which she was given Ondansetron but no improvement was seen. Patient was then brought to our hospital and was semi conscious at the time of admission. 

Past history

No similar complaints in the past.

Suffering with Joint pains since 15 years and is on medication. 

Not a k/c/o Diabetes mellitus, Hypertension, Asthma, Tuberculosis, Epilepsy, CAD. 

Menstrual history: Attained menopause 8 years back. 

Personal history

Diet - Mixed

Appetite- Normal

Sleep - Adequate

Bowel and bladder movements - Regular

Addictions - None

Family history - No similar complaints in the family. 

Drug history - Taking medication for Joint pains since 15 years (drug name unknown) 

General Physical Examination

Patient was Conscious, Coherent and Cooperative. 

Well built and well nourished.

No Pallor, Icterus, Cyanosis, Clubbing, Koilonychia, Generalised lymphadenopathy, Edema. 

Vitals

Temperature - Afebrile

Pulse - 82 bpm

Respiratory rate - 20 cpm

Blood pressure - 140/90 mmHg at admission                                          improved to 110/70 mmHg

SpO2 - 98 % 

GRBS - 99 mg/dL


Systemic Examination

CVS - S1, S2 heard

RS - BAE present

Abdomen - Soft, non tender

CNS -

                           Right                   Left

Tone     UL       Normal              Normal

              LL        Normal             Normal

 Power               Right                  Left

              UL          3/5                       3/5

              LL          4/5                       4/5

Reflexes             Right                  Left

   Biceps                +                          +

   Triceps               -                           -

   Elbow                 -                           -

   Wrist                  +                          +

   Knee                   +                          +

   Ankle                  -                           -

   Plantar            Flexion               Extension


Investigations

Hb - 12 gm/dL

Renal Function Tests

Serum Urea  -  24

Serum Creatinine   -   0.7

Serum Uric acid     -     39

Serum Calcium     -     10.2

Na+     -    136

K+       -     3.7

Cl-       -     106

Electrocardiography


Chest Xray



2D echo shows Aortic Stenosis and Diastolic Left        Ventricular dysfunction. 

MRI Brain shows no abnormality

USG Abdomen - Distended gall bladder


Provisional Diagnosis

HYPERTENSIVE URGENCY. 


Treatment

Inj. PAN   40mg   IV

Inj. ZOFER  4mg    IV

Tab. VERTIN  16mg  po  TID

Tab.  PROMETHAZINE   25mg po  TID

BP monitoring 4th hourly





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