40 Y/O female with sjogrens syndrome with rheumatoid arthritis

 40 y/o female complaints of bilateral lowerlimb

pain  since 6 months came for routine follow up for evaluation of sjogrens syndrome 


M.sandhya 

roll no 94


This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box

40year old female who is a housewife    and came to opd with

CHIEF COMPLAINTS;

Bilateral lower limb pain since 6 months
came for,routine follow up for evaluation of sjogrens syndrome 

HISTORY OF PRESENT ILLNESS 

Patient was apparently asymptomatic 20 days back then she was unable to get up from bed and walk properly on 31/1/2023 and diagnosed with recurrent hypokalemic paralysis secondary to distal RTA with biopsy proven sjogrens syndrome 
Now patient complaints of bilateral lowerlimb mainly thighs since 6 months ,difficulty to get up from squatting position and difficulty to walk.
No tenderness, tingling sensation of both lower limb present initially now subsided, no numbness 

HISTORY OF PAST ILLNESS:

similar complaints in the past (recurrent hypokalemic episodes-4 episodes)
N/k/c/o HTN, DM,ASTHMA, EPILEPSY, CVA AND CAD

FAMILY HISTORY:-
insignificant 
PERSONAL HISTORY:-

DIET-mixed
APPETITE-normal
BOWEL and BLADDER-regular
SLEEP-Adequate.
ADDICTIONS- No

GENERAL EXAMINATION:-

Patient is conscious , coherent,cooperative.
Well oriented to time place & person 
Moderate built and moderately nourished.
Pallor absent
No cyanosis, clubbing, icterus, LN

Vitals : 
Bp -120/80 mmhg
PR -92 bpm ;
RR : 16cpm
Spo2 : 96 on RA
GRBS:97 mg/dl
CENTRAL NERVOUS SYSTEM;
patient is conscious 
speech is normal
no signs of meningeal irritation
Sensory examination: Normal
reflexes;      
                   RIGHT            LEFT

BICEPS       +2                     +2

TRICEPS       +2                     +2

SUPINATOR    +1                   +1

KNEE                  +2                    +2

ANKLE                +2                     +2
Rhomberg's negative
Cerebellum:
Nystagmus-absent
Tremors- absent
Finger nose test- normal
Dysdiadokinesia- absent

CARDIOVASCULAR SYSTEM:-
S1 S2 heard 
No murmurs.
RESPIRATORY SYSTEM:-
Dyspnea-absent
No wheeze
Breath sounds - vesicular
No Adventitious sounds 
ABDOMINAL EXAMINATION:-
No tenderness 
No palpable liver and spleen.
Bowel sounds - Present 

INVESTIGATIONS;



















TREATMENT:

1.TAB.WYSOLONE 10 mg PO/OD@8A.M
2.TAB.NAPROXEN 250 mg PO/SOS
3.TAB.HYDROXYCHLOROQUINE 200 mg PO/BD@8A.M 8PM.

PROVISIONAL DIAGNOSIS;K/C/O BIOPSY PROVEN SJOGRENS SYNDROME WITH RHEUMATOID ARTHRITIS WITH RECURRENT HYPOKALEMIA SECONDARY TO DISTAL RTA.




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