45 Y/O MALE, DAILY WAGE WORKER , FATHER OF 4 , C/O GENERALIZED WEAKNESS SINCE 16 YEARS

INITIAL ASSESSMENT - 

Physical examination - 

45 y/o male, daily wage labourer by occupation, resident of yellatuni village, melacheruvu mandal, father of 4  came to Orthopedic OPD with

 C/O Generalized weakness since 2 months
C/O burning sensation of both UL and LL
K/C/O DM Type II since 4 years  not on any medication
Was refered to the GM OPD. 
Patient was able to walk and do cycling but has stopped now due to development of giddiness and decreased sensation of both LL
H/O fall from tree due to slipping @12 Y/O after which he developed Tinitus and Hearing Loss 

H. O. P. I. - 

H/O scrotal swelling with lower back pain diagnosed with Hydrocele and underwent surgery during the stay he was diagnosed with Diabetes Mellites but is not on any medication since then. 


6 montho ago developed Scaly Hypopigmented Papules associated with itching, initially developed in B/L LL and spread upwards and involved B/L Lower buttoks and Lower abdomen ( was acquired from his wife) . 
H/O hard stools associated with bleeding per rectum since 2 months
2 months ago H/O Outside food  intake and developed vomiting for 1 day and developed progressive generalized weakness in both LL and decreased sensation in UL and LL. 

Personal history-

Married, normal appetite . 
Non vegetarian. 
Bowel movement -constipation. 
Bladder movent - normal . 
No known allergies. 

Occasional alchol intake
Stopped tobacco chewing 30 years ago. 

FAMILY HISTORY - 

No similar complains in the family. 

Physical examination-
NO - Pallor  Lcterus, Clubbing, Cyanosis, Lymphadenopathy, Pedal Edema. 

No malnutrition . 
No dehydration. 
Temp - afebrile. 
Bp - 110/70 mm of Hg. 
PR - 86 bpm. 
RR - 14 cpm. 
CVS -  s1 and s2 heard no murmurs, no thrills. 
RS- position of trachea - central, no wheeze, no dysponea , breath sounds normal . 
Abdomen -shape scaphoid, no mass per abdomen, herneal orifaces normal. 
PA-soft , non tender. 
CVS Examination -
Patient is C/C/C well oriented to time, place and person . 
TONE - Right and Left Upper and Lower limb normal. 
REFLEX -
Biceps - RTand LT  --- +1.
Triceps - RT and LT --- +1.
Knee jerk reflex - RT and LT --- +1.
Ankle jerk reflex - RT and LT --- +1.

Finger nose test - Normal. 
No dysdycokinesia. 
No nystagmus. 
Atexic gait. 

Provisional diagnosis - 

CIDP - Chronic Inflammatory Demylenating Polyneuropathy. 

Tinea corporis Etcpuris. 




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