A 25 years Male Patient With Purpura

THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 
CHEIF COMPLAINTS:-
C/o painful skin lesions over the soles and fingertips since 4days
H/o burning sensation over epigastric region since 1month
HISTORY OF PRESENT ILLNESS :-
Patient was apparently alright 4days back complaint of painful skin lesions over the soles and fingertips .
H/o burning sensation over epigastric region since 1month associated with dry cough and headache. 
H/o abdominal tightness. 
No H/o fever.
H/o decreased appetite since 4years.
H/o backpain & Metacarpophalangeal (MCP) joint aggregating on work. 
HISTORY OF PAST ILLNESS :-
No H/o similar complaints in the past. 
H/o medication taken: Ofloxacin, Amoxicillin, Paracetamol,  Rabeprazole, Multivitamins. 
No other Comorbidities.
PERSONAL HISTORY:-
Married 
Occupation - Driver
Appetite-lost
Bowels- regular 
Micturition- normal 
No known allergies 
FAMILY HISTORY:-
No significant family history 
PHYSICAL EXAMINATION:-
A) GENERAL EXAMINATION 
Weight- 45 kgs
No pallor, cyanosis, icterus, lymphadenopathy, clubbing of fingers, oedema of feet, malnutrition, dehydration. 
VITALS:-
Temp- afebrile 
Pr-95 / min
Rr- 13/min
Bp- 100/80 mm Hg
SYSTEMIC EXAMINATION:-
a) cardiac murmurs-S1 S2 Positive
b) Respiratory system- no dysponea,wheeze
c)Abdomen- soft ,nontender 
                     - liver,spleen abdomen
d) CNS
     Level of consciousness-concious
     Speech- normal
     Signs of meningeal irritation like neck stiffness, kerning's sign- no
     Cranial system, motor system,sensory system- normal.
 e) skin- petechia,purpura noted over fingertips and soles.
INVESTIGATIONS:-
TREATMENT:-
1. Tab. ATARAX-25mg/PO/OD
2.Tab.PANTOP- 40mg/PO/OD
3.Tab.DOLO- 650 mg/PO/SOS
4. Tab. ULTRACET - half tablet /QID






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