61 year old female came to opd with C/O Giddiness since morning

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A 61 year old female came to casualty with the complaints of 

1.Giddiness since the morning@5am

2.4 episodes of vomiting since the morning 

HOPI:

Patient was apparently asymptomatic till morning then she developed giddiness sudden in onset, not associated with any fall, no loss of consciousness

4 episodes of vomiting since morning which is watery in content, non bilious, non projectile and no blood and mucus in vomiting, no nausea, no headache, no blurring of vision

No slurring of speech, no deviation of mouth 

K/C/O HTN since 4 years(on T. Telma 12.5mg for First 2 yrs and now using T. Telma 40mg from 2 yrs)

Not a K/C/O DM, TB, Epilepsy, CAD

Past history:

Occassionally she used to have headache and vomiting in mornings if she delays taking her antihypertensive medication

Personal history:

She used to work as daily wage laborer (stopped working since 4yrs ago)

Mixed Diet, appetite normal

Bowel and bladder movements normal

Occasionally drinks alcohol ( 1 glass toddy)

Menopause at age@

General examination: 

Pt is Conscious, coherent, cooperative

Patient has no Pallor, icterus, cyanosis, clubbing, lymphadenopathy, generalized oedema

PR:73bpm

BP:170/90mmhg

RR:16

SpO2:97

Temp:97.4

GRBS:152mg/dl

Systemic examination:

CVS examination:

No visible pulsations, scars, engorged veins. 

No rise in JVP

Apex beat is felt at 5 ICS medial to mid clavicular line. 

S1 S2 heard . No murmurs.

Respiratory system examination : 

Shape of chest is elliptical, B/L symmetrical.

Trachea is central. 

Expansion of chest is symmetrical

 Bilateral Airway E +

Per abdomen examination:

No visible pulsations and scars swellings.

Soft, non tender, no organo megaley.

Umbilicus is inverted. 

CNS EXAMINATION: 

1. HIGHER MENTAL FUNCTION: Normal

2.Cranial nerves: intact

3.Motor              Right                Left

Tone: 

    UL          N                     N 

    LL          N                       N  

             Power:

             UL          5/5                  5/5 

             LL           5/5                  5/5

         Reflexes:                    Right                  Left. 

           Biceps.                          ++.                    ++

          Triceps.                         ++ .                   ++

          Supinator.                      ++.                    ++

          Knee.                             ++.                    ++

          Ankle.                             + +.                   ++ 

          Plantar                        Flexion             Flexion

        4.SENSORY

    spinothalamic

           crude touch                N                                 N

           pain                             N                                 N

           Temp                           N                                 N

    post column

             fine touch                Lost at lateral aspect of B/L foot, rest all areas Normal

             vibration                   Lost on B/L medial malleolus and Lt knee rest all area Normal

             position sense         6/10                       7/10

             Romberg's: Normal

    cortical

              Stereognosis: N

5.CEREBELLAR

       Titubation: -

        Trunkal ataxia/ Gait ataxia: -

        Nystagmus: -

        Rebound phenomenon:-

        Wide based gait: +

        Intentional Tremor: -

        Pendular Knee Jerk: -

        Tandem walking: -

        Coordination

             Finger nose test: able to do

             Heel Knee: able to do

             Dysdiadokokinesia: -

6.ANS: Normal

7.Meningial signs: NO

8.Spine, cranium, peripheral nerves: Normal

9.Dix Hallpika test: 

On 15/10/22

Diagnosis: 

                       ?VESTIBULAR NEURITIS

              

Treatment:

Day 1:

1.T. VERTIN 8mg PO STAT

2.T. AMLONG 5mg PO STAT

Day 2:

1.T. VERTIN 8mg PO/BD

2.TELMA 40mg PO/OD

Day 3:

1.T. VERTIN 8mg PO/BD

2.TELMA 40mg PO/OD

3.T. PREGABA M PO/OD

4.T. ULTRACET PO SOS

 DAY-4

1.T.VERTIN 16mg PO/BD .

2.TELMA 40mg PO/OD

3.T. PREGABA M PO/OD

4.T. ULTRACET PO SOS

DAY-5

1.T.VERTIN 16mg PO/BD .

2.TELMA 40mg PO/OD

3.T. PREGABA M PO/OD

4.T. ULTRACET PO SOS