75 year old female who is a  farmer came to the casuality with complaints of 

hematuria since 15 days

generalized weakness since 1 month

HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic 9 years back & then got diagnosed with adenocarcinoma of lung for which he took 4 sessions of chemotherapy . 8 months back he developed shortness of breath ,i/v/o covid diagnosis he got a HRCT  in which his nodules were again visible for which he again was put on chemotherapy . He got admitted in our hospital i/v/o anemia .

PAST HISTORY : 

k/c/o metastatic adenocarcinoma lung stage IV B/L lung nodules 

K/c/o thymoma -S/P thyrocotomy & ecxision 2019

EGFR: ewild type

not a known case of DM, HTN,

O/E :  

Patient is consious , coherent and cooperative

Bp:100/50mm hg 

PR ; 85 bpm  regular

Cvs : s1 s2 +

Rs : BAE +

P/A: soft , non tender 

                             

                           

ECG:- 

PROVISIONAL DIAGNOSIS: 

Metastatic adenocarcinoma lung stage 4 B/L lung nodules  thymoma -S/P thyrocotomy & excision 2019

Investigations : 

hb: 5.6gm/dl

TLC: 6,100

PCV: 16.7

MCV:- 32.2

RBC: 1.74

PLT: 4.03

LFT:-

TB:- 0.75

DB:- 0.20

AST:- 21

ALT:- 14

ALP:- 129

Alb:- 3.2

A/G :- 1.15

RFT:- 

Urea :- 24

Creat:- 1.1

Uric acid :- 4.8

Ca:- 9.6

Na:- 142

P:- 2.7

K :- 3.2

Cl:- 98

Serology:- NEGATIVE 

Plan: 

1) TAB PANTOP 40mg PO/OD

2) TAB ONDANSETRON 8mg PO/TID

3) TAB ULTRACET PO/OD

- 1 PRBC  transfusion