28 year old male with unusual presentation

Unit 3:

Interns:

Dr .Leela 

Dr Harsha 

Dr Archana

Dr Kalyan 

Dr Jeehariki


Dr Raveen PGY1

Dr Aashitha PGY2

Dr Aravind PGY3

Dr Vamshi PGY3

Dr Hareen SR

Dr Praveen Naik Ass Prof

DR. RAKESH BISWAS HOD


This  is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidencebased inputs. 



This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen today 17/2/2021

30 year old  year man presented to the casualty with the complaints of
Fever on and off since the past 3 years
Cough since 3 years
Weight loss since the past 3 years
Loss of appetite since 3 years
Upper limb weakness since the last 3 years

The patient works at fields paddy fields. He is the eldest son in his family. He has 2 younger siblings. His brother is a police officer and sister is a teacher. They live at a local village. 

He was apparently completely alright 3 years back after which he developed cough with productive sputum on and off which wasn't blood tinged. It was also associated with cold and fever which was low grade, nocturnal in variation. 
He started finding it hard to carry out his daily activities because of weakness.
He started feeling nauseous on seeing food. His appetite reduced.
He started loosing weight, his clothes became loose.
He started finding it hard to use his upper limbs in lifting weights.
He was unable to use his left thumb.

He is a thin built man, with temporal wasting and significant thenar atrophy.









Pallor +
PR - 70bpm
Bp - 100/60mmhg
Temp - 99F


CVS:Apex beat in left 6th ICS in the MCL
Ejection systolic murmur + radiating to axilla 
S1, S2+
Respiratory system -
Bilateral inspiratory crepts in IAA, IAA
Reduced breath sounds in Bilateral ISA
CNS -
HMF intact 
Tone reduced in all the limbs 
Power   Right.   Left 
UL.          +4/5.   +4/5 
LL           - 4/5.   - 4/4
Reflexes
B.              2+.         2+
T.               2+.         2+
S.               2+.         2+
K.                3+.        3+
A.                +.           2+
P.                Withdrawal.    Flexor




Serology: Negative
DIAGNOSIS:                                                        
? Myopathy
Heart failure secondary to ischaemic heart disease
Fever and cough since 3 years



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