Harika

 73 YEAR OLD FEMALE RESIDENT OF NALGONDA WAS BROUGHT TO THE CASUALTY WITH C/O SWELLING OF BOTH HANDS SINCE 4 DAYS C/O DIFFICULTY SWALLOWING SINCE 1 DAY HISTORY OF PRESENTING ILLNESS PATIENT WAS APPARENTLY ASYPMTOMATIC UNTIL 4 DAYS AGO THEN HAD  C/O B/L UPPER AND LOWER LIMBS  SWELLING INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE PITTING TYPE, AGGRAVATED ON WALKING; RELIEVED ON LOWER LIMB ELEVATION.. C/O DYSPHAGIA TO BOTH SOLIDS AND LIQUIDS SINCE 1 DAY. NO C/O FEVER, COUGH, COLD, SOB NO C/O ORTHOPNEA, PALPITATIONS, PND NO CIO BURNING MICTURITION, INCREASED OR DECREASED URINE OUTPUT NO C/O LOOSE STOOLS, NAUSEA, VOMITINGS, CONSTIPATION PAST HISTORY: K/C/O HTN SINCE 15 YEARS, STOPPED MEDICATION SINCE 15 DAYS K/C/O CKD SINCE 15 YEARS K/C/O CVA SINCE 2MONTHS,  RIGHT HEMIPARESIS  K/C/O FLUOROSIS OF SPINE SINCE 13YEARS H/O RIGHT LOWER LIMB FRACTURE SURGERY(TIBIAL PLATING ) PERSONAL HISTORY: MIXED DIET APPETITE NORMAL BOWEL MOVEMENTS NORMAL BLADDER: NORMAL NO ALLERGIES NO ADDICTIONS FAMILY HISTORY