A 73 year old man with fever and difficulty in breathing

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A 73 year old man, who is a retired bank manager, resident of chityala came to the medicine OPD with 

chief complaints of

Fever since 3 days

General weakness since 3 days

Difficulty in breathing since 2 days

Loss of appetite since 2 days

History of present illness-

The patient was apparently asymptomatic 3 days ago, he then developed low grade fever, no diurnal variation, relieved with medication, not associated with chills and rigor.

Generalised weakness from 3 days.

Shortness of breath since 2days which is insidious in onset and gradually progressive.

No h/o vomiting, loose stools, constipation, pain abdomen, cough

Past history-

Known case of HTN and DM since 15 years 

N/k/c/o Thyroid, Asthma, CAD, Epilepsy

No surgical history 

Family history-

No significant history 

Personal history-

 • Married

 • Mixed diet 

 • Appetite normal

 • Sleep adequate

 • Bowel and bladder movements regular

 • Allergies none

 • Addictions- alcohol 2 quarters /day

General examination-

Physical examination-

• No pallor

• No icterus

• No cyanosis

• No clubbing of fingers

• No lymphadenopathy

• No pedal oedema

Vitals-

• Pulse- 78bpm

• BP- 120/80 mm Hg