Thursday, 21 April 2022

Medicine case 2

 

A 42 yr old female came with complaints of headache since 5-6 years. Retro orbital pain +

Patient was apparently asymptomatic 6 yrs back and then developed headache and retro orbital pain. Pain was present continuously through out the day and aggravates in the evening and subsides after taking medication (pain killers).


She was asymptomatic 6 years back.


8 years back her mother died of cancer


7 years back her father died of drowning in water


6 years back her differently abled brother died of cancer.


She is worried about getting the cancer herself as people tell her that she might get cancer as both her mother and younger brother had died of cancer.


She is traumatized with the thought she might also die since six years due to cancer. 


She has two sons aged 25 and 23. Elder son is working in construction industry as labourer in kerala. Younger son is in village completed his BA degree. She says they are having financial challenges and she is worried about her sons too. She is worried that some health issue may affect them too. 


Psychological Course of treatment:


Placebo pain medication


Cognitive behaviour therapy

Not a k/c/o DM, HTN, TB, Asthma

No H/o major surgeries in the past

Tubectomised 23 yrs back


Appetite - Normal
Diet - Mixed
Sleep - Adequate
Bowel and bladder movements - Regular 

Habit of Ghutka chewing

O/E :
Pt is c/c/c
Temp - Afebrile
BP - 110/80 mmHg
PR - 79 bpm
CVS - S1S2 +, no murmurs
RS - BAE +, clear
P/A - Soft, NT
CNS - NAD

ENT opinion - 

Headache - insidious, progressive, band type, aggravated in the night, relieved partially on medication associated with photophobia, phonophobia. Nausea +

No H/o trauma to head. No H/o facial heaviness, post nasal drip & smell abnormalities.

No H/o Nasal obstruction, Nasal discharge, paroxysmal sneezing, itching in the nose.

O/E: Grade I tonsillar Hypertrophy +.                              

Mild tenderness present on B/L ethmoid &frontal sinuses.                                                                       - No symptoms suggestive of chronic Rhinosinusitis

Ophthal opinion - 

                 Right Eye           Left Eye 

   V/A:        6/12 . NI              6/6

 Normal fundus study

Advised regular spectacle use for near vision

Eye drops LUBREX 4times/day in both eyes

Provisional diagnosis :

 ? Somatoform disorder with depression

Treatment - 

TAB DOLO 650 mg SOS

TAB NAPROXEN 250 mg SOS

TAB PAN 40mg PO OD

TAB MVT PO OD



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