CASE Name: Mr. D Age/gender: Male/73 Date/time: 05/15/2020, 8:45pm Cc: Legs are swollen HPI: 9months prior to consult, patient started experienced swelling in feet, which was intermittent in nature, without any associated symptoms like fever, pain, nocturia, dysuria, vomiting. Consulted in August 2019, diagnosed with hypercholesterolemia, and prescribe Lasix. He is working as a security guard. A month prior to consult, patient noticed that he get easily tired when he climbs few flights of stair, he told first he got swelling in feet and then up in to calf now. Hence, patient with same symptoms with no improvement in condition and due to persistence of swelling seek consult at clinic. Review of system: General: Conscious, no weight loss, no fever, (+) orthostatic dizziness Eye: (+) blurring of vision Ears: (-) vertigo Respiratory: (+) cough Cardio: No chest pain, no palpitation Gastro: No abdominal pain, no vomiting, no nausea, no change in bowel movement Genitourinary: No nocturia, no urgency, no dysuria, no hematuria, no discharge Musculoskeletal: No joint pain, no stiffness Extremities: Swelling in lower extremities Hematopoietic: pallor Past medical history: (+) HTN - medicine unrecalled (+) Diabetes (2000) - metformin taking irregularly (+) High cholesterol No hepatitis No history of cardiovascular disease No history of hospitalization No history of surgery No intake of non-prescription or herbal medicine Personal and social history: Working as a security guard Smoking history of 96 pack-years Alcohol on an average 10-15bottles per day Denies substance abuse Like to eat salty and deep oily fried foods Physically not active in exercise Family history: Both his father and mother have history of diabetes and hypertension, respectively. His father died because of stroke. Physical examination: Conscious, coherent, answers questions, mild respiratory distress, speaks in short sentences BP 160/100 mmHg, HR 90 bpm, RR of 24/min Temp. Ht 5’6 Wt 85 kg (+) pallor, dry skin Pale palpebral conjunctiva, anicteric sclera Equal chest expansion, trachea midline, crackles on both lung bases, no wheezes, Heart was adynamic, regular rhythm, point of maximal impulse at 6th LICS, anterior axillary line, no murmurs Abdomen was flabby, normoactive bowel sounds, soft and non-tender, no CVA tenderness Grade 2+ pitting bipedal edema, no gross deformities Full and equal pulses, pale nailbeds Fundoscopic examination: micro aneurysms, neovascularization and exudates in the retina of both eyes. Give comolete diagnosis. Give complete treatment plane, dose , frequency, nonpharacologic tx.

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Mr Piyush, first of all patient is an oldage person . So cataract/ARMD is cause for blurred vision. in old age hypercholesterolemia is very common,with smoking history & alcoholic. As per ur history he may have left ventricular hypertrophy leading to cardiomegaly. Please reffered the patient to an general physician if possible to a geriatric specialist later to an ophthalmologist for vision. It's not a case to give suggestions through these platforms. Don't forget chances of carcinoma.

Thank you doctor
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PT HAS LOT OF RISK FACTORS HE IS HYPERTENSIVE DIABEYIC CHRONIC SMOKER ALCOHOLIC POOR CONTROL OF D M AND HYPERTENSION JIGH CHOLESTEROL STRONG FAMILY HIDYORY OF D M HYPETENSION RECENTLY HAS DEVOLPED CONGESTIVE HESRT FAILURE NEEDS URGENT VONDULTSTION OF DIABETOLOHIST CARDIOLOGIST T M T ECHOCARDIOGRAM BY HAS TO CHANGE HIS LIFE STYLE RESTRAIN SMOKING AND ALCOHOL

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