A 60 year old male patient came with cheif complaints of shivering of right arm and forearm since 2years
HOPI -
Patient was apparently asymptomatic 2years back. He then developed shivering of right hand and forearm
Insidious onset and gradually progressive. Initially localised to fingers and later radiated to right arm
C/O- numbness , tingling
Pain & Tingling in the right thigh
Shivering is present throughout the day intensity increases and decreases.
PAST HISTORY - No history of trauma or injury in the past
N/ K/C/O- diabetes ,BP, TB ,epilepsy.
FAMILY HISTORY -
No significant family history
PERSONAL HISTORY -
Appetite - normal
Sleep-adequate
Diet-mixed
Bowel&bladder - normal
Micturition - Normal
Alcohol - occasionally since 25 years
Stopped 3-4 years back
Smoking -since 25 years, stopped
6years back
GENERAL EXAMINATION
Pallor is absent.
Icterus is absent
No cyanosis
No clubbing of fingers
No lymphadenopathy
No malnutrition
No clubbing of fingers
No oedema of feet and hands.
SYSTEMIC EXAMINATION
B. Cardiovascular system
No thrills
No cardiac murmurs
Cardiac sounds: S1 and S2
C. Respiratory system
dyspnea absent
No wheezing
No Vesicular breath sounds .
Position of trachea - central
D. Abdomen
Abdomen is scaphoid
No tenderness
No Palpable mass
Bowel sounds anew present
No bruits
No free fluids
E. Central nervous system
Patient was conscious and coherent well oriented to time, space and person
Speech is normal
Cranial nerves normal
Motor system normal
Sensory system normal
Glasgow scale normal
REFLEXES
Right. Left
Biceps ++ ++
Triceps ++ ++
Supinator ++ ++
Knee ++ ++
Ankle ++ ++
CEREBELLAR SIGNS
finger nose in coordination
Knee heal in coordination
GAIT
Normal.
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