55yr old female with fever and headache


Final exam Short case

Name: M.Tejaswini
Halltkt:1701006107


A 55yr old female came with chief complaints of:
-fever since 4 days
-headache since 4 days

History of present illness

Patient was apparently asymptomatic 4 days back then she developed fever which was insidious in onset, continous type relieved with medication and not associated with chills and rigors.

Fever was associated with diffuse headache which was throbbing type present throughout the day and relieved with medication.
There was 1 episode of vomiting which non projectile, non bilious, content was food.
She also had neck stiffness.
There's no history of photophobia, giddiness,seizures.

Past history
No similar complaints in past
Not a known case of DM, HTN, TB, asthma, epilepsy

Personal history
Diet:mixed
Appetite:normal
Sleep:adequate
Bowel and bladder: regular
No addictions
No known drug and food allergies

Family history
Not significant

General examination
Patient is conscious, coherent, coperative. Moderately built moderately nourished
No pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy, generalised edema.
Vitals: 
temperature:99.3F
Pulse rate: 78bpm
Resp rate:18cpm
BP:120/80mmhg
Spo2:99%
Systemic examination
1)Central nervous system
-Higher mental functions: intact
-Cranial nerve examination: normal
-Sensory system examination: normal
-Motor system examination: 
  Bulk,tone and power of the muscles is normal
-reflexes: normal
-meningeal signs:
    Brudzinski: positive
    Kernigs: positive




2)Respiratory system
Inspection: 

Shape- elliptical 

B/L symmetrical , 

Both sides moving equally with respiration .

Palpation:

Trachea - central

Expansion of chest is symmetrical. 

Vocal fremitus - normal

Percussion: resonant bilaterally 

Auscultation:

 bilateral air entry present. Normal vesicular breath sounds heard.

3)CARDIOVASCULAR SYSTEM:

Inspection:

Shape of chest- elliptical 

No precordial bulge or pulsations 

JVP - not raised 

Palpation:

Apical impulse was felt at 5th intercoastal space 1 cm medial to mid clavicular line

On auscultation , S1 S2 heard  No murmurs

4)PER ABDOMEN:

Inspection - 

          Umbilicus - inverted

          All quadrants moving equally with respiration

          No scars, sinuses and engorged veins , visible pulsations. 

          Hernial orifices- free.

Palpation -  

soft, non-tender

no palpable spleen and liver

Percussion - tympanic note heard 

Auscultation- normal bowel sounds heard

Provisional diagnosis:

Meningitis


Investigations:

Complete blood picture

CSF analysis
Sugar:81
Proteins:12.6
Chloride: 113

Skull xray:

NS1 antigen is positive

ECG



Chest xray:




MRI
2D echo


Treatment:
- inj Ceftriaxone 2gm IV BD
-Inj dexamethasone 6mg IV TID
-Inj vancomycin 1gm IV stat
-Tab Paracetamol 650mg TID
-syrup cremaffin.

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