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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