A 63 year old man came to the OPD with chief complaints of swelling on left lower limb and chest pain
Chief complaints
A 63 year old man from Nalgonda, farmer by occupation came to the OPD with chief complaints of swelling on left lower limb since 5 days, chest pain on and off since 6 months associated with intermittent cough and swelling on the back since 6 months.
History of present illness
Patient was apparently asymptomatic 6 months back. Then he developed chest pain which was stabbing type , non radiating and relieving factors. There was a Swelling on left lower limb which was sudden in onset- since 5 days. Swelling is of non pitting type.
No history of fever, body pains, palpitation, SOB.
Another swelling or Lump is present on the left side of the back which is 5 * 4 cm in size and insidious in onset, gradual in progression with no aggravating or relieving factors.
He had tremors in hands only when holding something
History of past illness
The patient is Diabetic and Hypertensive and is on regular treatment- metformin and glimeperide
No TB, Asthma, Epilepsy, or any thyroid disease.
Personal History
He is married
Farmer by occupation
Mixed diet
Regular bowels
Normal micturition
No known allergies
Alcohol occasionally taken
No tobacco or drug use
Family history
No history of DM / HTN / CAD / cancer / TB / Genetic diseases in any of the known family member
Physical Examination
A. General Examination
Moderately built
No pallor
No icterus
No cyanosis
No clubbing of fingers
No lymphadenopathy
No dehydration
Oedema of feet is seen
No dehydration
Temperature: Afebrile
Pulse rate : 68 beats per minute
RR : 14 per min
BP : 140/90 mm of hg
Systemic Examination
A. Cardiovascular system
Cardiac sounds : S1 and S2 normal
No cardiac murmurs
B. Respiratory system
No dyspnoea
No wheezing
Position of trachea : central
Vesicular breath sounds
No adventitious sounds
D. Abdomen
Shape - distended
No tenderness
No palpable mass
E. CNS examination
Conscious/ alert
Normal speech
No signs of meningeal irritation ( no neck stiffness and a negative kernigs sign)
Normal reflexes
Investigations
Blood sugar
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