52yr old male with involuntary movements of hand and itchy skin lesions

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 evidence based inputs. 


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

Case:(22/10/2021)

A 52year old male resident of bhogramguri of westbengal came to the casualty with chief complaints of involuntary movement of fingers since 6months(during resting),gradual onset,non progressive.
Itching over the scalp,brows,armpits since 12yrs.
Discoloration over the neck and shoulder since 12yrs ,
Decreased vision in both eyes since 6months(gradually progressive),
 ringing sensation in the ear since 3years(on/off)
No h/o. Giddiness

PAST HISTORY:
Not a K/c/o hypertension, DM, CAD, asthma, TB, epilepsy,CVA


PERSONAL HISTORY:
Mixed diet with normal appetite and disturbed sleep since 6 months ( only 1 1/2 - 2 hours per day).
he has normal bowel movements and bladder filling. 
addictions: takes alcohol since 10 years, 80ml per day. Stopped taking 6 months back
Tobacoo chewing.

No significant family history

GENERAL EXAMNATION:
Icterus+
Multiple, well defined, scaly plaques noted on BL axillae, groin, periumbilical are, buttocks, retroauricular areas, nape of neck extending to scalp. Generalised xerosis +
No pallor, cyanosis, clubbing, lymphadenopathy, pedal edema. 
VITALS:
BP: 120/60 MMHG, 
PR: 78bpm 
Temp: afebrile
SPO2: 98% 
Rr:18/min
Grbs:122mg%

RS: BAE+,NVBS heard
CVS: S1 ans S2 heard. No murmurs. 
P/A: soft and non-tender
CNS: No focal deformities. 

DAY-3(24/10/2021)
Soap notes

S-
C/o gas trouble
No fresh complaints

O-
Bp-130/70mmhg
Pr- 72bpm
Temp :98.4F
Rr:18cpm
Cvs:s1s2 heard
RS:BAE+
P/A: soft

A-
Investigations:


P:
4th hrly bp monitoring
Tab.PAN 40mg po/od

Dermatology referral in view of itching of all over body and scaly lesions:(24/10/2021)
C/o itchy,scaly skin lesions on both groins, buttock, abdomen, axillae, behind the ears, scalp on and off since 12 years
O/E:
Multiple, well defined, scaly plaques noted on BL axillae, groin, periumbilical are, buttocks, retroauricular areas, nape of neck extending to scalp. Generalised xerosis +

Diagnosis: INVERSE PSORIASIS+ SCALP PSORIASIS

Treatment suggested:
1. T. ATARAX 10 MG AT NIGHT FOR 7 DAYS
2. LIQUID PARAFFIN L/A ALL OVER THE BODY BD FOR 2 WEEKS
3. MOMATE CREAM L/A AT NIGHT ON ITCHY LESIONS FOR 7 DAYS
REVIEW IN DVL OPD AFTER 1 WEEK 

DAY-4(25/10/2021)
SOAP NOTES: 

S- 
Itching+
Complaints of disturbed sleep
Invountary finger movements +

O-
PR: 78 bpm
BP: 120/70 mm hg
CVS: S1 S2 +
RS: BAE+
CNS: NFD
P/ A : SOFT,NT, BS+

A-
INVERSE PSORIASIS+ SCALP PSORIASIS

P-
1. T. ATARAX 10 MG AT NIGHT FOR 7 DAYS
2. LIQUID PARAFFIN L/A ALL OVER THE BODY BD FOR 2 WEEKS
3. MOMATE CREAM L/A AT NIGHT ON ITCHY LESIONS FOR 7 DAYS

Wood lamp examination:
Inference: No fluorescence
DAY-5:(26/10/2021)
SOAP NOTES: 

S- 
Itching+
Complaints of disturbed sleep
Invountary finger movements +

O-
PR: 78 bpm
BP: 120/70 mm hg
CVS: S1 S2 +
RS: BAE+
CNS: NFD
P/ A : SOFT,NT, BS+

A-
INVERSE PSORIASIS + SCALP PSORIASIS

Psychiatry referral done:

P- 
1. TAB ATARAX 10MG PO / H/S 
2. LIQUID PARAFFIN ALL OVER THE BODY TWICE DAILY
3. MOMATE CREAM L/A OVER THE LESIONS AT NIGHT
4. T ALPRAZOLAM 0.25 MG PO/H/S SOS IF PATIENT IS SLEEPLESS

 

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