72 year old female with tingling and numbness in both lower limbs

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A 62 old female who is a resident of voligonda , house wife by occupation came with the 

 Chief complaints

Tingling and burning sensation in both the lower limbs since 2 months 

Swelling of both the lower limbs since 2 months  

History of presenting illness

The patient was apparently asymptomatic 2 months back then developed tingling and burning sensation of the feet and progressed to knee which intermittent type (on and off) 

No aggravating factors and relieved by rest .

Pedal Odema since 2 months inscidious in onset gradually progressive from grade 2 to 3 pitting type

No aggrevating factors relieved on rest 

h/o of passing hard stools once in 2 days on standing non blood stained .

Past history

K/C/O HTN since 2 yrs

H/o cerebrovascular accident 1 year ago, catract surgery

N/K/C/O DM,TB,thyroid disorders,epilepsy,CAD,Asthma

No history of blood transfusions

Personal History

Married 

Daily wage labourer by occupation

Diet: mixed 

Appetite: lost

Bowel : irregular

bladder moments: normal

Addictions : beetle leaf since 10 yrs and stopped 1 Year ago

Family history

Not significant

Obstetric history

Age of marriage: 16 yrs

1st child birth: 18 yrs 

G3P3L2A0

Physical examination

On examination

Patient is conscious,coherent and cooperative well oriented to time,place,person 

No signs of pallor,icterus,clubbing,cyanosis,lymphadenopathy,pedal oedema 

Vitals

Temp: afebrile

PR: 98

Rr: 20/ min

Bp:120/90 mm Hg. 

Spo2: 98%

Systemic examination

CVS: S1,S2 heard, no murmurs heard 

Resp: BAE +

CNS :NAD 

Abdomen: soft and non tender

Shape:obese

Investigations:

Provisional diagnosis:

Peripheral neuropathy with acid peptic disease with pedal oedema with constipation. 

Treatment:

Tab.TELMA 40mg OD 

Tab.RAZOPRAZOLE -D 40mg OD

Tab.ECOSPRIN GOLD 20mg

Tab.PREGABALIM 75mg

Syp.CREMAFFIN 15ml