63F Urinary incontinence 4 years ,RA on DMARD 25 years
A 65 year old Hindu woman a housewife a resident of west bengal having a Bsc degree and belonging to middle class according to modified kuppuswamy scale presented to the general medicine OPD with
chief complaints of
-constipation since the past 3 years
-continuous dribbling of urine since the past 4 years
History of presenting illness
Patient was apparently asymptomatic 26 years ago , when she developed continuous dull aching pain in both the knee joints , which was exaggerated in the mornings and was bearable throughout the day , it was aggravated on walking and relieved on rest
associated with redness around the knees
no history of trauma
no history of evening rise of temperature
no history of cosmetic deformity(varicosity, skin discoloration)
-she underwent a bilateral knee replacement for knee stiffness
-is on DMARDS since 25 years
patient was incidentally diagnosed with hypertension 20 years ago during a follow up visit
-she was started on antihypertensive medications
patient complains of continuous dribbling of urine since 4 years
it was insidious in onset with a few drops during the day and gradually progressed to continue throughout the day , urine is yellow in color and ammonical in odour
patient reports recurrent UTIs where in she complains of
-burning micturition
-pain before micturition and while micturition
-no history of hematuria
-no history of frothy urine
patient also reports constipation since 3 years
she passes 1 bowel movement per 2-3 days , associated with pain
patient passes flatus
not associated with blood
not associated with abdominal distention
not associated with weight loss
TIMELINE
17th Feb
April 4
April 6 to April 9
17th April to 26th April
May 1st to 14th may
16th May to1st June.
26th june
Hip ulcer 26th June
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