75/M WITH INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMBS AND LOWER LIMBS .
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Unit 6 admission:
Interns
K. Nikhil reddy
K.Divya
M. Swarna
B.Manivarma
Juveria
Dr. Manasa(pgy1)
Dr. Rashmitha (pgy2)
Dr. Sai Radha(pgy3)
Dr. Arjun kumar (asst.prof.)
Dr.Rakesh Biswas (HOD)
A 75 year old man, toddy tapper by occupation,came to casuality with Chief complaints of involuntary movements in right upper and lower limbs .
Patient was apparently asymptomatic 8 years back.Then H/o fall due to Giddiness ,for which he went to local hospital , diagnosed as hypotension,on x ray hip - ?Rt Inter trochanteric fracture, for which he didn't take any treatment.
2 years back, he diagnosed to have COPD.
Since yesterday morning,patient became unresponsive, taken to local hospital, there his GRBS-22 mg/dl, treated for his hypoglycemia.patient was normal till yesterday night.
Then he suddenly developed involuntary movements of Right upper limbs and lower limbs since 1.00am.According to attenders,patient took his last binge of alcohol 3 days back.
No H/o uprolling of eyes, tongue bite, incontinence of urine, deviation of mouth or weakness.
H/o Shortness of breath since 1.00 am , sudden onset,grade -IV.
No H/o chest pain, palpitations, syncopal attacks,PND, cough, cold.
No H/o pain abdomen, abdominal distension, burning micturition.
Past history:
K/c/o asthma for which he took
Not a k/c/o DM, HTN, TB, epilepsy, CVA, CAD.
H/o cataract surgery for left eye 5 years back.
K/c/o smoker since 40 years, smokes 2-3 chuttas/day.
K/c/o alcoholic since 40 years,drinks 90-180 ml/day.
General examination:
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.
Temp:99.7F
BP:120/80mmhg
PR:125 bpm
RR:38 cpm
Spo2:94%at room air
GRBS:97 mg/dl.
Systemic examination:
CNS:
GCS:E1V1M5.
Cranial nerves - couldn't be assessed.
Motor examination:
Tone.
Rt. Lt
UL. Normal. Normal
LL. Normal. Increased.
Reflexes:
Rt. Lt.
Corneal. +2. +2
Conjunctival. +2. +2
Biceps. +2. +2
Triceps. +2. +2
Supinator. +2. +2
Knee. +2. +2
Ankle. +2. +2
Plantar. Flexor. Flexor.
Sensory examination and cerebellar examination couldn't be assessed as patient is not oriented.
Meningeal signs:
Neck rigidity- negative
Kernigs and brudzinski signs- negative.
RS:
UPPER RESPIRATORY TRACT-NORMAL.
LOWER RESPIRATORY TRACT-
INSPECTION:
shape of chest- Elliptical
movements of chest-B/L SYMMETRICAL
trachea-central
Tracheal movements during Inspiration-normal
Apical impulse- 5th ICS IN mid clavicular line.
Drooping of shoulders-No
Supra/infra clavicular hallowing-More on left side
Intercostal fullness- absent
Sinuses,scars,nodules, dilated veins- absent
Use of accessory muscles of respiration-absent
PALPATION:
Trial sign-midline
Apical impulse- 5th ICS IN mid clavicular line
Chest movements-
AP diameter- 21cm
Transverse diameter-30 cm
Chest expansion-1cm equal on both sides
Spinoscapular distance-. R:40 cm,,L:40 cm
PERCUSSION:
R. L
SCA. Resonant. Resonant
ICA. Resonant. Resonant
MAMMARY. Resonant. Resonant
INFRA MAMMARY Resonant. DULLNESS IN 6TH ICS
AXILLARY. Resonant. Resonant
INFRA AXILLARY Resonant. Resonant
SSA. Resonant. Resonant
Inter Scapular.AResonant. Resonant
ISA Resonant. Resonant
AUSCULTATION:
BAE+, NVBS heard.
WHEEZE-B/L, DIFFUSE +.
CVS:
S1, S2 heard, NO Murmurs.
P/A:
Soft, non tender, no organomegaly.
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