67yr Male with Left hip joint pain and Tinea corporis
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PRESENTING COMPLAINTS:
Pain at left Hip region since 21days.
Itching over the forehead and groin since 4months.
Forgetfulness since 1 1/2 years.
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 1 1/2 yr ago, he has an alleged H/O fall from bicycle due to giddiness and generalised weakness and was taken to hospital;CT scan showed Acute Ischemic infarct in right MCA with right basal ganglia calcification.(Since then he had forgetfulness of recent events).He used medication for six months.
Patient had multiple itchy,scaly skin lesions on buttock,groin and lower abdomen since 4months , for which he used unknown topical medication.
Patient had sustained injury to left hip due to fall on road while walking 20days back ,since then he is complaining of pain in the left hip region.
No H/O other injuries
No H/O Head injury, Loss of consciousness, Seizures.
No H/O Fever, Headache, Vomitings.
HISTORY OF PAST ILLNESS:
No similar complaints in the past.
Not a K/C/O HTN,DM,TB,Epilepsy,CAD.
PERSONAL HISTORY:
Appetite- Normal
Sleep- Normal
Bowel and Bladder movements- Regular
Upper limb Lower limb
Right Left Right Left
Tone: Normal Normal Normal Normal
Power: 5/5 5/5 5/5 5/5
Reflexes: Right Left
Biceps + +
Triceps + +
Supinator + +
Knee + +
Ankle — —
Plantar Flexion Flexion
Local Examination of Left Hip:
Skin- Normal
Swelling -absent
Tenderness - present
No local rise of temperature
Crepitus - absent
Distal pulses - present
Active toe and ankle movements - present
Abduction - painful
Adduction- Normal
Movements (Rom) - painful and restricted.
MMSE: (Mini Mental State Examination)
I. Orientation
Year /Season / Month/Date/Time - 2/5.
Country / State/ Town /hospital /Floor - 5/5.
II. Registration -3/3
III. Attention and Calculation - 5/5
IV. Recall - 1/3
V. Language
Naming 2 objects - 2/2
Repeating sentence- 1/1
3 stage command - 3/3
Read & obey written command-1/1
Write a sentence - 1/1
Copy a pair of intersecting pentagons - 0/1
Total - 24/30
2D-Echo:
ECG:
On 31/10/22
On 1/11/22
X-Ray of Pelvis with both Hips:
—Fracture of left acetabular roof & superolateral aspect of left femoral head with significant surrounding soft tissue edema as described.
—Mild left hip joint effusion with surrounding soft tissue edema likely superadded infection .Suggested MRI contrast for further evaluation(but wasn’t done)
—Undisplaced fracture of left inferior pubie ramus with surrounding soft tissue edema.
LAB INVESTIGATIONS:
TREATMENT:
1) TAB. ULTRACET 1/2tab PO/QID
2) TAB. TECZINE 5mg PO/HS
3) LULIFIN CREAM for local application B/D
4) TAB. ECOSPRIN AV 75 P/O OD
COURSE IN HOSPITAL:
A 67yr male clinically presented with above mentioned complaints.
Upon admission necessary investigations were sent after initial examination. For pain in hip region, orthopedics opinion was taken and an MRI of both hips was taken ( Fracture of left acetabular roof &superolateral aspect of left femoral head with significant surrounding soft tissue edema as described, Mild left hip joint effusion with surrounding, soft tisue edema likely superadded infection Suggested MRI contrast for further evaluation, Undisplaced fracture of left inferior pubic ramus with surrounding soft tissue edema) and diagnosed with left hip osteoarthritis. patient had a 4month long history of skin lesion on buttocks and abdomen for which dermatology opinion was taken and advice followed.He was started on LULIFIN CREAM and oral TECZINE medication, following which itching sensation has been subsided gradually. He has been discharged in a hemodynamically stable condition.
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