A 45 year old female elog with delayed milestones.

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She was admitted to the hospital on 6th feb. 

 A 40yr old female who was born out of consanguinous marriage grade III through a normal vaginal delivery. 

Her immunization is not known .

Since childhood she used to eat only one meal per day though she had a good appetite because of weakness, she had no energy to eat.

She used to sway side by side while walking,sometimes fell down and again she used to get up on her own.

She used to get ready to school by herself.(wearing uniform,combing hair)

She used to repeat her standard almost 2-3 times. She studied upto 10th std and gave up studies due to lack of interest.

She attained menarche at the age of 14yrs with normal flow 4-5 days/month with no clots. LMP- 5/2/2022

Once she complained of heavy bleeding for a month for which they went to local mbbs doctor who provided medications and her bleeding was relieved.

Now since 6 months ,she is having heavy bleeding per vagina during her cycles with clots for which they took medication which was prescribed earlier which was not relieved.

Then they went to local hospital where she was diagnosed as anemic and blood transfusion was suggested. But transfusion wasn't done due to unknown reasons.

Then she came to our hospital.

PAST HISTORY

Not a known case of DM, Hypertension, thyroid, Asthma, TB, Epilepsy.

FAMILY HISTORY

Not significant

PERSONAL HISTORY

Diet mixed

Loss of appetite. 

Paroxysmal dyspnoea. 

Bowel movements normal and burning micturition since one month

No addictions and no known allergies

GENERAL EXAMINATION

Patient is conscious,coherent and cooperative, thin built and malnourished

Pallor ++.

No icterus, cyanosis, clubbing, lymphadenopathy

Mild Edema present in lower extremities. 

VITALS

Temp-Afebrile

PR - 108bpm

BP-100/60 mmHg

Spo2 99%

GRBS - 87mg/dl

Systemic examination:

CVS:

Jugular venous pulse : raised. 

Inspection:

Normal chest wall which is symmetrical. 

Precordial bulge absent. No dilated veins, scars and sinuses. 

Apical impulse seen. 

Palpation:

Apical impulse: hyperdynamic. 

Parasternal heave: present. 

Precordial thrills present. 

Auscultation:

Normal S1 and S2 heard.