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A 77 year old female, a housewife by occupation came to the ophthalmology opd with chief complaints of diminision of vision in the right eye since 6 months. She was referred from Ophthalmology due to uncontrolled blood sugar levels while evaluating her for cataract surgery.
History of presenting illness:
Patient was apparently asymptomatic 1 year back when she had nocturia due to which she went to the hospital and was diagnosed with diabetes for which she was medication. She takes Glimeperide 1mg and Metformin 500mg daily ever since.
Patient has itchy skin lesion over left foot since one year. She also complains of itching over genitals since one year.
She developed diminished vision 6 months back which is insidious in onset, gradual in progression. h/o lacrimation and itching. Not associated with redness.
Past history :
Known case of hypertension since 1 year and on medication
Not a known case of TB, asthma, epilepsy
Personal history :
Mixed diet
Appetite is reduced
Normal bowel and bladder movements
Sleep is adequate
No Addictions
Daily routine :
Before
She used to wake up at 5:00 am. She walks 1/2 a kilometer to buy milk. Then at 8:00 am after having breakfast, she goes and sits at a shop beside the house and returns home at 2:00 pm for lunch and then goes to sleep. After waking up, she has dinner and sleeps at 10:00 pm.
Now
She used to wake up at 5:00 am. She walks 1/2 a kilometer to buy milk. Then at 8:00 am after having breakfast, takes medication. She goes and sits at the shop and returns home at 2:00 pm for lunch and then goes to sleep. After waking up, she will have dinner and sleep at 10:00 pm.
There is no change in the routine of the patient except for medication for diabetes and hypertension being taken regularly.
Family history:
Not significant
General examination
Patient was conscious ,coherent and well oriented to time and place.
Patient was moderately built and nourished
Vitals
BP 140/90 mm of Hg
Pulse 80beats /min
Temperature afebrile
Respiratory rate 16 cycles/min
No pallor, icterus, cyanosis, clubbing, lymphadenopathy
Eye:
Right eye
Diminised vision
Ocular movements are not limited
Right eye Left eye
Visual acuity Counting fingers, 2m 6/60
Lids normal normal
Conjunctiva Muddy Muddy
Cornea nasal pterygium nasal pterygium
Anterior chamber PACD = 1/2 CT PACD = 1/2 CT
Iris
Pupil normal size, reactive normal size, reactive
Lens IMSC grade I - II
Skin Examination:
single well defined
Silvery white plaque noted over the left foot
Systemic examination:
CVS- S1 S2 heard no murmurs
CNS- No focal neurological deficit
RS- Normal vesicular sounds heard
P/A-
scaphoid abdomen
non tender, no palpable mass
bowel sounds heard
Provisional Diagnosis: Metabolic Syndrome
Investigations:
Treatment History:
- tab. LOSARTAN 40 mg
- Injection Human Actrapid 10 IU given before each meal
- Inj. NPH 8 IU twice daily
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