A 18 year old male patient came to the causality c/o 
Fever since 4 days

Fever- low grade,  intermittent, associated with chills and nausea
H/o  2-3 episodes of vomiting on 2nd day of fever 
No h/o loose stools or bleeding gums
H/o malena 1 episode
No h/o of hemoptysis, hematemesis

No h/o cold,cough,sob
No other complaints
PAST HISTORY:
No h/o DM, HTN, asthma, epilepsy, TB


PERSONAL HISTORY
Appetite-decreased
Regular bowel and bladder movements
No addictions


GENERAL EXAMINATION : 
Patient is conscious, coherent and cooperative  
No pallor, Icterus, cyanosis, clubbing, lymphadenopathy

VITALS : 
Temp: 100.6F
PR: 76bpm 
BP: 100/70 mm hg 
RR: 20 cpm  
Spo2 - 99%

CVS : 
S1, S2 heard , No murmurs 

RS : 
Position of trachea: central 
BAE present


PER ABDOMEN: Soft
And non tender 
Bowel sounds +

CNS: 
Patient is Conscious ,oriented to time,place and person 
HMF -intact 
Motor & sensory system: normal 
Reflexes: present 
Cranial nerves: intact 
No meningeal signs 

PROVISIONAL DIAGNOSIS-
Fever with thrombocytopenia(Ns1 positive)

USG abdomen 
1)gall bladder oedema
2)moderate ascitis
Investigations 

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