A 60 year old female came to GM OPD with Chief Complaints of fever since ③ days and cough associated with sputum since ③ days.Difficulty in swallowing and pain during swallowing since ③ days, hoarseness of voice since ③ days shortness of breath since ③ days

A 60 year old female came to GM OPD with Chief Complaints of fever since ③ days and cough associated with sputum since ③ days.
Difficulty in swallowing and pain during swallowing since ③ dogs, hoarseness of voice since ③ days shortness of breath since ③ days
HOPI:
The patient was apparently asymptomatic ③ days back then she developed high grade fever, cough with sputum which is whitish in coour non foul smelling and  non blood stained. There was a history of difificult in swallowing & pain  during swallowing there  h/o shortness  of breath ③ days back grade -II. decreased appetite since 5-6 months, loss of weight since 1 year.( 20kg wt loss)
PAST HISTORY:

History of giddiness and fall ,followed by unconsciousness.
Known case of hypertension since 1 year but since 5-6 months not on regular medication . Known case of thyroid  disorder since 1 year on medication. known case of DM || since ⑨ years and medication since then, tab- glibeclamide in morning, citagliptin and metformin afternoon, not a known case of epilepsy, Tb ,asthma.
No surgical history
PERSONAL HISTORY:
Diet - mixed 4 times meals per day
Appetite - decreased
Bowel and bladder - frequent micturation
Sleep - adequate,
No addictions
GENERAL EXAMINATION:
  pt is ccc moderately built and moderately nourished, well oriented with place and time,
No pallor, no icterus, no cyanosis, no clubbing, no lymphadenopathy.
Vitals:
Pulse rate- 123
Bp - 110/80
Rr- 22
Temp- 99 F
Oxygen saturation 96%
Systemic examination:
CVS: no thrills ,cardiac sounds S1& S2 heard. no cardiac murmers.
Respiratory: dyspnea and wheeze present. normal vesicle breath sounds and position of the trachea central .
Abdominal examination: no soft organomegaly
CNS: NFND
Investigations:

USG:
COLOUR DOPPLER:
ECG:


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