76 year male with bilateral pedal edema

 76 yr male patient came with the complaints of Bilateral pedal edema and unable to walk since 20 days 

History of present illness 

Patient was apparently asymptomatic 20 days back then he developed bilateral lower limbs edema upto knee which is insidious in onset gradually progressive and aggravated on standing and walking ,relived on lying down .

Complains of pain in the legs since 20 days which is aggravated on walking and relived on lying down.History of burning sensation in the legs since 20 days.History of Shortness of Breath since 

No History of headache. Giddiness,



Patient is a farmer 4 years back ,then he stopped farming  due to generalized weakness.He wakes up by 6am ,by 9am he completes his breakfast containing jowar roti and curry then he will have a cup of tea with sugar.He takes lunch at around 2:30pm ( rice with curry and milk).At around 5:00 pm he again drinks tea with sugar and biscuits .He completes his dinner by 8:00pm and sleeps by 9:30pm.

Past illness 

He is a known case of diabetes since 15 years 

Not a known case of hypertension, asthma,epilepsy,CAD

Personal history 

Diet- mixed

Appetite-normal

Sleep adequate

Bowel and bladder movements are regular

No addictions or food allergies 

Systemic examination 

CVS:
Inspection
Chest wall is bilaterally symmetrical.
No precordial bulge is seen 
Palpation
JVP- Normal
Apex beat -felt in the left 5th intercoastal space in the mid clavicular line 
Auscaltation-
S1&S2 are heard,no murmur found

RESPIRATORY SYSTEM

Position of trachea- central
Bilateral air entry, normal vesicular breath sounds are heard.

CNS

Patient is conscious ,coherent and co operative , well oriented to time and space.
Speech normal.
No signs of meningeal irritation.
Motor and sensory system- Normal
Reflexes - present
Cranial nerves - intact













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