60 year old male with pedal edema and swelling of knee joint

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"



60 year old patient came to casualty with complaints of swelling of knee joint since 3 years 

Unable to fold the legs since 5 years 

Pain at knee radiating to the toe since 2 years 

Bilateral Pedal edema since 3 years 



 
Hopi :
Patient was apparently asymptomatic 7 years back and then he developed Generalized weakness for which he went to near by hospital and had routine checkup and diagnosed with Type 2 DM and was started on diabetic medication since then .3 years back patient gradually developed bilateral Pedal edema , pitting type Right leg edema > left leg edema 

Past history:
No h/o trauma present 
No h/o burning micturation ,anuria  frequency,urgency ,hesitating and frothing urine. 

K/c/o DM  since 7 years on 
1.TAB METFORMIN 500mg  PLUS GLICLICIDE 60 MG PO BD
2.TAB METFORMIN 1000mg PO OD

K/c/o HTN since 7 years on 
1 TELMA 40 mg plus AMLO 5mg PO OD
2.METOPROLOL 50 MG PO OD


Not a k/c/o asthma ,epilepsy ,CAD.

Family history:
Mother is hypertensive and diabetic 
His father had blood cancer (?leukemia)

Personal history :
Works in plastic industry 
Bowel and bladder regular 

General examination:
Patient is conscious/coherent/cooperative 

No pallor /icterus/cyanosis /clubbing /lymphadenopathy/koilonychia.

B/l  pedal edema present 


Right leg :

left leg :

Vitals :
BP: 110/70mm hg
Pr:86 BPM
RR : 17 CPM
SPO2 : 98 on RA 

Systemic examination :
 Cvs :s1 and S2 herad 
Rs : BAE +, NVBS HEARD 
P/A : soft  non tender 


PROVISIONAL DIAGNOSIS:



INVESTIGATIONS:
ECG 

Fasting blood sugar : 152 mg /dl

S creatinine: 1.5
Plan of care :

1.TAB METFORMIN 500mg  PLUS GLICLICIDE 60 MG PO BD
2.TAB METFORMIN 1000mg PO OD
3.TAB TELMA 40 mg plus AMLO 5mg PO OD
4.TAB METOPROLOL 50 MG PO OD

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