A 23 Year Old Female With Sore Throat

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 July 11, 2021

A 23 Year Old Female With Sore Throat


CHEIF COMPLAINT:-

A 23 year old female presented with complaints of :-

  • Sore throat since 3 days
  • Loss of smell since 2 days
  • Cold since 2 days


HISTORY OF PRESENT ILLNESS:-

Patient was apparently asymptomatic 3 days back. The patient has been in contact with a COVID positive person.



HISTORY OF PAST ILLNESS:-


No history of Diabetes , Hypertension , TB, CAD or Asthma.



PERSONAL HISTORY:-


Occupation: Student
Appetite: Normal
Diet: Mixed
Bowel movements: Regular
Micturition: Normal
No known allergies 
Habits/ Addictions: None



FAMILY HISTORY:-


Not significant




PHYSICAL EXAMINATION:-

  • Mild pallor present
  • No icterus
  • No cyanosis, clubbing, oedema or lymphadenopathy 

Vitals

  • Pulse rate:- 92/ min
  • Respiration rate:- 24 breaths/min
  • Blood pressure:- 120/80 mm of Hg
  • Sp02:- 97%



PROVISIONAL DIAGNOSIS:-


COVID-19. RTPCR +ve




INVESTIGATIONS:-

1. Hemogram










2. CRP (C reactive protein)










3. D-Dimer











4. Renal function test:-










5. Blood sugar - Random 












TREATMENT:-



1. Tab PCM 650mg PO/TID
2. Tab PAN 40 mg PO/TID - 8 am
3. Inj Neomol Ig/IV/SOS if temperature >101 F
4. Syrup Benadryl 5ml/PO/TID
5. Tab Cetrizine 5mg PO/BD
6. BP/PR/RR/Spo2 charting 4 th hourly 
7. Tab Azithro 500 mg RO/OD
8. Temp charting 2nd hourly 
9. Tab Zincovit PO/OD for 30 days



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