58 yr old male with neck pain and B/L knee pain

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A 58 yr old male farmer by occupation came with cheif complaints of 

Neck pain since 2-3 weeks

B/L knee pain since 3 months

Hopi

Pt was apparently normal 8 months back then he had c/o  chest pain SOB grade 3 then he consulted a private hospital where angioplasty was done he is put on medication since then using regularly

c/o neck pain since 2-3 months

c/o b/l knee pain since 3 months

c/o tingling and burning sensation of both feet since 1 yr 

No c/o reduced urine output,pedal edema,burning micrurition,pain abdomen,SOB,chest pain,orthopnea,PND,giddiness

Past history

k/c/o DM type 2 since 1.5 yrs for this he is using medication T.GLIMI M1 po/OD

k/c/o HTN since 3 yrs -Tab TELMA 40mg po/OD

k/c/o PTCA for this he is using medication -unknown

N/k/c/o TB, epilepsy,CVAthyroid disorder,bronchial asthma

Personal history

Diet:mixed

Appetite:normal

Bowel and bladder:regular

Sleep:adequate

Addictions:Alcohol 1quarter/day since 30 yrs stopped 8 months back and smoking stopped since 4 yrs 

Family history:not significant

General examination:

Pt is c/c/c moderately built and nourished

Pallor +

No cyanosis,clubbing,lymphadenopathy,pedal edema

Vitals:

BP:130/70mmhg

PR:96bpm

RR:18cpm

SPO2:99

GRBS:168

Systemic examination

CVS :sS1S2 heard,no murmurs

RS:BAE,no added breath sounds,NVBS

P/A:soft,non tender

CNS:NFND

Chest x ray

ECG

2D ECHO

Investigations:

Hb:10.8

Tc:5500

PTC:2.46lakhs/cc

Lft

Total bilirubin:0.56

DB:0.21

SGOT:17

SGPT:28

Alkaline phosphate:187

TP:6.3

A/G ratio:1.80

Rft

Urea:48

Creat:1.4

RBS:186

Provisional diagnosis: cervical spondylosis with osteoarthritis knee

Treatment:

1.Tab.ULTRACET PO/TID

2.Tab.SHELCAL 500mg PO/OD

3.Tab.GLIMI M1 PO/OD at 8am

4.Tab TELMA 40mg PO/OD