Case presentation Case presentation
2. 59 CC: 5 PI:1PTA URI symptom 5PTA . 3PTA . . 3. Past Hx :2PT . 10PTA - 4. Physical examination BT 38 cPR 100/min BP 120/80 mmHg RR 24/min Conscious, not pale, no malar rash, no oral ulcerLN -ve skin :hyperpigmented scar with hemorrhagic crust both forearms and legs lung :clear, equal BS heart:regular, normal s1s2,no murmur abd:soft, not tender, no mass,no hepatosplenomegaly neuro: pupil 3 mm RTL BE, decrease motor tone all extremities 5. Motor: Rt. Lt.DTRRt.Lt. deltoidIV IV bicepsIII+IV01+ tricepsIII+II 01+ wrist EX/FLEXIV/II0/000hip E/FIV/IIIV/IV knee E/FV/IIIV/III02+ ankle E/FV/IIV/I01+ Sensory: impaired both hand and feet above ankle BBK: plantar flexion Propioception: impaired 6. Problem list
7. Laboratory CBC:wbc 21,950Hct 35plt 277,000 N 42.5, L 12.3, Mo 3.4, Eo41.7 normochromic normocytic Rbc UA:sp.gr. 1.015, prot/sugar ve, Wbc 0-1,Rbc 0-1 FBS147,BUN 5,Cr 0.39 E lyteNa126,K 3.4,Cl 82,CO2 25,Ca 2 +9.1 LFTAlb 4.0,Glob4.0, AST 55,ALT 59,Alk 185 CPK356 ESR77 8. LaboratoryANA HT,chorea,seizures, testicular pain
62. LTRAvsCSS 63.
64. 65. 66. 67. 68. 69. 70. 71. LTRA ICS SABA LABA 72. 73. 74. 75. Quiz
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82. THANK YOUFORYOUR ATTENTION 83. 84. Differential diagnosis 1.29 85. 1.13