case 2

33 year old women with the c/o 

Pinki sarkar

-Lowee back ache since 4years 

-Burning micturition 

-. Haematuria- 1 episode in August, 2nd episode in November. After which CT abdomen was normal.

-Cold intolerence since 2-3 months.

-anxiety and insomnia since 2 months,

Loss of taste since 2 months 

Hairloss since the past 2 weeks

Weight loss,

Gluteal region pruritis(?fixed drug reaction)

Irregular menstrual cycles.

TFT-Normal, Anti mullerian hormone-7. (high-normal)

IMVESTIGATIONS-

ECG,HAEMOGRAM,CUE,RFT,TFT.

USG ABDOMEN- Right polycystic ovary.

OBG REFERRAL- 33 year old P1L1 non tubectomised with AUB-O

Patient has been using barrier contraception for 7years. Now she wants to concieve.patient has been reassured,to avoid barrier contraception and if not conceived in 6 months evaluate after 6months of unprotected coitus

PSYCHIATRY REFERAL- for anxiety and insomia.

diagnosed as -ADJUSTMENT DISORDER

Pharmacotherapy-

Tab.CLONAZEPAM 0.25 MG 

     X--------X--------1.   For 1 week

Psychotherapy-

Cognitive behavioral therapy, family therapy adviced.

-Relaxation and Diversion techniques explained (Jacobson progressive muscle relaxation ) explained and taught to patient.

DERMATOLOGY REFERRAL-

For itchy skin lesions over the both buttocks since 3 years ,Diffuse dryness of skin +

Diagnosed as TINEA CORPORIS ET CRURIS+ HAIRFALL FOR EVALUATION.

RX- (1) LULIFIN CREAM  L/A B/D For 2 weeks 

  Morning and night.

(2) Tab. TECZINE 10 mg    O/D.   for 2 weeks

   -night.

TREATMENT -

(1)TAB.MVT PO/OD   X-----1-----X.    For 14 days

(2) TAB. CLONAZEPAM  0.25 mg 

   X-------x-------1 for 4 days