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70M came to OPD with Rt and Lt leg pain , stomach pain, irregular bowel movements, chest pain during swallowing

He is suffering from leg pain since 3yrs as he accidentally felt in his fields because of which rods were put in his legs. He is suffering from Rt and Lt legs pain , which is of dragging type. He is even suffering from stomach pain and constipation.  His chest pains during swallowing and is unable to eat on his own. Neck and whole body stiffness is noticed in the patient. P/O - Surgery to Rt shoulder and Hip(trauma ) and below the chest( as he used to spit blood from his mouth ) was done 30 yrs ago. Not a K/C/O - HTN,DM, asthma, TB PERSONAL HISTORY:-  Appetite - reduced , mixed diet, sleep - sufficient, bowel movements irregular, bladder movements normal , no addictions GENERAL EXAMINATION:-  No pallor, no icterus, no clubbing, no cyanosis, no edema  *Palpable Rt cervical lymphnode ( hard on palpation ) 
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67F came to OPD with pain in the Rt hand since 1yr and also with pain in the Rt and Lt knee joints.

She is a k/c/o Gastric ulcer since 20yrs. She is suffering from Painful Rt upper limb which is of dragging type since 1yr , which aggrevates during sleep as she used to sleep on Right hand. She Is even suffering from Rt and Lt knee joint pain since yrs , which is of pricking type. K/c/o - hysterectomy N/o - Bp, DM, thyroid , asthma, trauma, TB, CVA , CAD Personal history:-  Appetite:- normal , mixed diet , sleep :- disturbed, bowel and bladder movements - normal , no addictions NO SIGNIFICANT FAMILY HISTORY GENERAL EXAMINATION:-  No pallor, no icterus, no clubbing , no cyanosis , no lymphadenopathy , no edema RANGE OF MOVEMENTS:- shoulder - flexion, adduction, abduction, extension are normal;  Neck movement:- normal (no stiffness)  BP:- 120/80mm of Hg  PR:- 80bpm RR:-14rpm
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38F came to OPD for thyroid checkup

Patient is k/c/o thyroid since 9yrs , as she is suffering from hair loss, giddiness, tiredness. *Patient is on medication - thyronorm (25mcg)  PERSONAL HISTORY:-  appetite - normal , mixed diet, sleep - sufficient,bowel and bladder movements - regular , no addictions GENERAL EXAMINATION:-  no pallor , no icterus, no clubbing , no cyanosis , no lymphadenopathy BP :- 120/80mm of Hg PULSE RATE :- 64bpm RESPIRATORY RATE :- 12rpm
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53M with right lower back pain since 1yr , painful joints , painful swelling below knee since 15days

Patient came to OPD with C/O Right lower back pain since 1yr , joint pains and painful swelling below the knee since 15days. He is a k /c/o gouty arthritis referred from general surgery department. *Back pain was sudden in onset gradually progressive, dull type, which relieves on micturition and aggrevates on urine retention, he feels giddy on bending. *Joint pain since 5 yrs which relieves on medication.  *Pain below knee was of pinprick type. *In case of severe joint pains he suffers from fever , chills which releive on taking medication (dolo-650, paracetamol)  Patient is known hypertensive since 5yrs and is on medication ( amlodipin-5mg + telmisartan -40mg) from 4days. N/O diabetes milletus, thyroid , asthma, CAD, CVA , TB , any surgeries.  PERSONAL HISTORY:-   Appetite - normal, mixed diet ( allergic to meat - itching on face ) , sleep - sufficient, bowel movements - regular,bladder movements - poor stream of urine since 5yrs , occasional alcohol drinker , chews tobacco  for 10 da
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