CASE SCENARIO FOR ELDERLY MALE WITH COMORBIDITIES

1. A CASE OF ELDERLY MALE
WITH COMORBIDITIES

2. PRESENTING COMPLAINT
• Cough
• Breathlessness 1month
• Generalised pruritis
• Pedal edema

3. PAST HISTORY
• Systemic Hypertension - 25 years
• Covid infection – June 2022 – 8 month
• Bilateral pedal edema – 6 month
• Worsening of symptoms – 1month

4. INVESTIGATED
• Evaluated from local hospital
• CBC – Normal
• Uric acid – 7.8
• Serum creatinine – 1.72
• ESR - 88

5. GENERAL EXAMINATION
• Patient was consious , oriented
• Multiple recordings of high BP – 180/100mmHg
• Otherwise, Vitals were stable
• No pallor, icterus, clubbing, cyanosis, Lymphadenopathy
• Bilateral pitting pedal edema (+) R>L
• Right lobe of Thyroid gland enlarged
• Scoliosis with convexity to left

6. SYSTEM EXAMINATION
• Tracheal shift to right
• Bilateral rhonchi
• Liver palpable 5cm below the right costal margin
• Splenic tip palpable
• Aortic bruit heard

7. INVESTIGATION
• LIPID PROFILE
• Elevated total cholesterol
• Elevated LDH
• LFT – unconjugated hyperbilirubinemia
• Serum creatinine – 2mg/dL (rising from 1.76 from latest)
• Thyroid profile – normal
• Serum Vitamin D – 10.77
• HbA1c- 6.6

8. • USG neck – MNG with TR2 and TR1 nodules and features of
thyroiditis.
• USG Abdomen – s/o renal disease with grade II parenchymal changes,
cortical echoes and prostatomegaly.
• ECHO – CAD, RWMA, mild to moderate MR, moderate LV dysfunction,
severe PAH.

9. • In view of uncontrolled hypertension and aortic bruit, renal artery
doppler was done which showed renal artery stenosis on the left side.
• He was seen by the Dermatologist for the generalised pruritus and
was diagnosed to have Xerosis with eczematisation
• He was seen by the Cardiologist and advised for
• CAG  Renal angio  PTA + Stent to Left renal artery ( if residual
renal function is normal.