General Medicine - Prefinal examination

MARCH 31,2022

This is an online e log book to discuss our patient identified health data shared after taking his/her guardian signed informed consent. Here we discuss our individual patient problems through a series of inputs from available global online community of experts with a aim to solve those patients clinical problem with collective current best evidence based inputs.This blog also reflects my patient centered online learning portfolio and valuable inputs on the comments box is welcome.

I have been given this case to solve in an attempts to understand the topic of patient clinical data analysis, to develop my competency in reading and comprehending clinical data including history, clinical finding, investigations and come up with diagnosis and treatment.

K.TEJA SREE , ROLL NO:54 , 9th SEM

CASE

A 41 year old male, painter by occupation ,resident of choutuppal came to the hospital with complaints of Itching and scaling of skin all over the body since 3 months

HOPI :

Timeline events:

The patient was apparently asymptomatic 25 years ago.

Then he had itching and scaling of the skin initially over the scalp and it was slowly progressed to forearms ,face, lower limbs, trunk and back.
It gets aggravated in winter and rainy season
He consulted various dermatologists and was given medication but it did not reduce.So he tried different medications and ayurveda.

Doctor said it was due to stress and anxiety.

2011
He went to RMP and injection(dexamethasone and triamcinalone) was given and his condition was relieved for 6months so he got married and after 3- 4 months of his marriage , once again he developed itching and scaling all over the body.

During this time he was working as a courier delivery man and he was exposed to heavy rain and aggravated his condition. So he went to same doctor , injection of dexamethasone and triamcinalone was given which relieved his symptoms immediately within one hour.

Since then he was taking one injection for every 2-3months.

2021 : in December he had infection at injection site( gluteal region on right side)and the pus was drained , it got relieved spontaneously .

He also had swelling of lower limbs which was pitting type associated with pain and he then visited local doctor . And received medication which got relieved.

Then he continued his injections but this time injection didn’t work and he also had weight loss (15 kgs) .

2022 : (March)
10 days ago he visited local doctor due to severe itching and scaling.then he referred to our hospital.

HISTORY OF PAST ILLNESS:

not a known case of diabetes, hypertension, CAD

no history of TB. epilepsy, asthma

Occupational history:

He has been changing his works due to his condition.

First he was a delivery person in Hyderabad then due to marriage he had to come to his hometown where he went to various companies but couldn’t tolerate to the chemicals due to his condition and rules of the company. He finally started working as a painter since 5 years