A 25 year old female with Dengue.

 GM PRE FINAL PRACTICAL.

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• 25 yr old female patient resident of miryalguda,housewife by occupation came to OPD with chief complaints of fever and giddiness since 7 days.

History of presenting illness:

• Patient was apparently asymptomatic 7 days back the she developed fever  which was sudden in onset, continuous ,high grade fever, associated with chills and rigors which was relieved on medication .
• Fever is associated with headache,retro orbital pain.
• History of generalized weakness, body pains and joint pains.
• History of nausea and vomitings(non bilious) 3 to 4 times a day projectile
• History of cough (non productive)
• History of abdominal pain, burning micturition .

Past history:

•  no similar complaints in the past
• Not a know case of diabetes, hypertension,asthma ,Tb, cardiovascular disease , seizures, thyroid problems.

Treatment history: 

• Undergone blood transfusion during cesarean section due to heavy blood loss

Surgical history:

Undergone 3 cesarean sections

Personal history:

• Diet-mixed
•  Appetite-normal 
• Bowel -regular
• Burning micturition
• No addictions
• No allergis to food, drugs

DAILY ROUTINE: 

*Before illness

Patient wakes up at 6:00 Am

Does breakfast at 7:00 Am and sends daughter to school.

Does daily household work 

Then have lunch at 2:00 Pm and takes rest.

Snacks with fruits at 4:00 Pm

Have dinner at 9:00 Pm 

And then sleep before 10:00 Pm.

*After illness

Now she is waking up at 8:00 Am

She is not able to do daily activities 

Lunch- 1/4 cup rice with dal

Sleeps till 6:00 Pm evening

Wakes up at 6:00 Pm 

No snacks

Eats dinner at 9:00 Pm

Sleeps at 11:00 pm

Family history: not significant

Menstrual history: 

Age of menarche 13yrs

Cycles regular

Normal flow

General Physical examination: 

• Patient is conscious coherent co operative and well oriented to time place person
• Moderately built 
• Moderately nourished
• No history of pallor ,cyanosis , clubbing,lympedenopathy,pedal edema

Vitals :

• Bp:90/60mm hg 
• RR:20cpm
• Pulse rate:78bpm
• Temp:99.5c

Systemic examination:

CVS

• S1 n S2 heard 
• No murmurs

Respiratory system:

• Trachea central 
• Bilateral air entry present 
• Vesicular breath sounds heard
• No wheeze or other adventitious sounds

Per abdomen examination

• Shape of abdomen : scaphoid
• Umbilicous Central no scars sinuses visible pulsations engorged veins
• No local rise of temperature
• Tenderness present
• No palpable mass 
• No oragnimegaly
• Bowels sounds present

CNS

• Conscious, gait normal
• Normal speech 
• No meningial signs like neck stiffness
• Reflexs:    biceps   triceps supinator knee ankle 
• Rgt.        All are present
• Lft.

Provisional diagnosis: 

viral pyrexia with thrombocytopenia

INVESTIGATIONS

TREATMENT:

Iv fluids -DNS

Ringer lactate 

Inj.pan 40 mg iv/of

Inj.zofer 4mg iv /tid

Monitoring vitals