36 yr old female with fever

 A 36yr old female patient,resident of ammanabolu   Presented to med opd with cheif complaints of 

Fever since 3 days 

Headache since 3 days


History of presenting illness:

Pt was apparently asymptomatic 3 days back 

Then she developed high grade fever on 26th night which was sudden In onset,intermittent and associated with chills. 

Pt had severe throbbing headache and neck pain.

It was associated with 3 episodes of vomitings which was non projectile,non bilious,contained food particles.

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 past 

H/o asthma present for which she dosent use any medication 

No H/o htn, diabetes, epilepsy,cad,ckd,thyroid disorders 


Personal history:

Diet-mixed

Appetite-normal

Bowel and bladder-regular 

Sleep-adequate 

Addictions-toddy


Family history:

Not significant 


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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