A 36 YEAR OLD FEMALE WITH FEVER

 A 36 year old female, resident of Ammanabolu,housewife by occupation came to OPD with chief complaints of 

Fever since 26/7
Headache since 26/7
Neck pain since 26/7


HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 2 days back then she developed fever which was insidious in onset,intermittent,associated with chills and relieved on taking medication.
There is h/o vomitings 2 days back,no.of episodes were three and the episodes were preceded by nausea,the vomitings are non bilious,non projectile,contents are food and water.
H/O headache and neck pain since 2days
H/O generalised body pains on the first day of fever.
No h/o rashes on the body,cough,pain abdomen,loose stools,intake of food from outside.


DAILY ROUTINE

She usually wakes up at 6:00am and does her household chores,drinks tea or milk by 9:00am,then she prepares lunch for the family,she eats her lunch by 12:30pm,then she either talks to her neighbours or sleeps for sometime,in the night she eats dinner and sleeps around 10:00pm.
On the first day of fever,she consulted the nearby RMP and he prescribed paracetamol and the fever subsided temporarily.


PAST HISTORY

No similar complaints in the past
No history of diabetes, hypertension, asthma,CAD, or any thyroid abnormality.


PERSONAL HISTORY

Diet:mixed
Appetite:normal
Bowel&Bladder:regular
Sleep:adequate
Addictions:toddy occasionally
Allergies:none


FAMILY HISTORY 

 No significant family history


GENERAL EXAMINATION

Patient is conscious,coherent,cooperative and well oriented to time ,place and person.
She is moderately built and moderately nourished.

Pallor - absent
Icterus-absent
Cyanosis-absent
Clubbing-absent
Lymphadenopathy-absent
Edema-absent



VITALS

PR-78/min
RR-30cpm
BP-130/80mm of hg
Temperature-98.6°F
SpO2-98%

SYSTEMIC EXAMINATION

CVS: S1,S2 heard,no murmurs
RS  :bilateral air entry present
CNS:no focal neurological deficits
         All reflexes present
P/A:soft and non tender
         Bowel sounds present.


INVESTIGATIONS




PROVISIONAL DIAGNOSIS
   
   VIRAL PYREXIA under evaluation

TREATMENT

IVF(normal saline,ringer lactate) 50ml/hr

Inj Monocef 1g IV/BD

Inj PAN 40mg IV/OD/BD

Inj ZOTER 4mg IV

T DOLO 650mg PO/TID

T ULTRACET 1/2 tab PO/QID

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