A 63year old female with c/o neck pain and b/l knee pain since 1 year. C/O decreases urine output since 1 year


History of presenting illness: 
Patient was apparently asymptomatic 1year back then developed neckpain,insidious ,gradually progressive, aggravated on bending forward and relieved with medication.
C/O b/l knee pain since 1 year insidious in onset and gradually progressive relieved with medication. 
C/o decreased urine output since 1 year, no burning micturition , no frequency/urgency /hesitancy.
No pedal edema, no SOB, no palpitations, orthopnea,PND 
C/o belching,burning sensation in epigatrium .
Past history:
K/c/o hypothyroidism since 2years and is on medication. 
Not known case of DM ,HTN ,epilepsy, asthma, TB 
Personal history: 
Diet: mixed
Appetite: normal
Sleep: adequate 
Bowel and bladder : regular
Addictions: none 

Daily rotinue: she wakes up by 6am in the morning freshens up and goes for a walk.  She has breakfast by 8am and watches TV.  Talks to neighbour's and rests.
She has her lunch by 1pm and sleeps for a while . Has dinner around 8pm and sleeps by 9pm. 

General examination: 
Patient is c/c/c 
Pallor : absent 
Icterus :absent 
Cyanosis: absent 
Clubbing:absent
Lymphadenopathy: absent 
Edema: absent 

Vitals:
BP:120/80mm Hg
Temperature:99.2F
Respiratory rate: 16cpm
Heart rate:82bpm

Systemic examination:
CVS: S1 S2 +
CNS: NFND
RS: BAE+ NVBS
P/A : Soft and non tender , no organomegaly 

Provisional diagnosis : 
? Cervical spondylosis
? Osteoarthritis 
Acid peptic disease with k/c/o hypothyroidism since 2 years . Left eye immature cataract.
 
Investigations: 
Treatment:
Tab THYRONORM 25mcg po/od 
Tab PANTOP 40mg po/od 
Tab MVT po/od 
E/D LUBREX 4times/day 

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