Benign hereditary chorea Acute pharyngitisUlcers secondary to ? Folliculitis, trauma withEczema Adjustment disorder

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Unit 1 Admission

ICU bed no 6 

A 23yr old female came with chief complaints of  involuntary movements of both upper limbs and Lower limbs since  5yrs of age 

HOPI

Patient was apparently asymptomatic before 5years of age.Then she developed involuntary movements of upper limbs and lower limbs for which she was prescribed with some medications which she has used for 2yrs.There was no control of seizures.

5yrs back she was taken to Supraja hospt in nagole where she was prescribed with some medications.She used those medications for 1month.She used to develop suicidal tendency upon using those medication.

1month back she was taken to an ayurvedic practitioner for same problem.Used ayurvedic medication

 Since 1month she developed increased involuntary movements of whole body

Involuntary movements are present mostly during sleep last for 1-5min

Sometimes she develop involuntary movements when she stands up from prolonged sitting position

She has H/O consumption of amniotic fluid in intrauterine life

She also have a h/o delayed milestone

Past history

N/K/C/O DM,HTN,TB,BA

Personal history

Diet - mixed

Appetite

Sleep -inadequate

General examination:

Patient is conscious , coherent, co-operative .

Pallor +ve , no icterus, cyanosis , clubbing , koilonychia , lymphadenopathy,edema 

Vitals 

Temp - Afebrile 

BP -120/70 mm Hg

PR - 84bpm

RR -14cpm

SpO2 - 99%@ RA

Systemic examination 

CVS -S1 S2 +ve , No murmurs 

RS - BAE+ , NVBS+

P/A - soft , non tender , BS+ve 

CNS - NAD

Provisional diagnosis :

? Chorea

Investigations 

Genetics refferal

Dermatology referral 

Psychiatry referral

ENT referral

Day1

S-c/o throat pain

1 fever spike yesterday 

O- pt had 16 episodes of choreiform movements yesterday night ,each lasting less than a minute

Pt - conscious, coherent

Afebrile 

Pr 100 /min

Bp 120/70 mmhg

Rr  cpm 

Spo2 98 % on room air

Cvs- s1s2+

Rs- b/l air entry +

Ophthalmology referral taken - no KF rings

Dvl opinion in v/o itchy lesions over gluten region and both lower limbs

Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars

Psychiatry referral - adjustment disorder due to physical illness

?dissociative motor disorder

A- ? Benign hereditary chorea

Acute pharyngitis

Ulcers secondary to ? Folliculitis, trauma with

Eczema 

Adjustment disorder 

P- To start on tab tetrabenazine 12.5 mg po bd

Tab Augmentin 625mg po bd

Tab levocitrezine 10mg po od

Salt water gargles 

Momate f cream for local application bd

Mupirocin gel for local application bd

Day2

S- c/o Disturbed sleep

throat pain decreased 

No fever spikes

O- pt had 14 episodes of choreiform movements yesterday night  ,each lasting less than a minute

Pt - conscious, coherent

Afebrile 

Pr 86 /min

Bp 120/70 mmhg

Rr  16cpm 

Spo2 98 % on room air

Cvs- s1s2+

Rs- b/l air entry +

Ophthalmology referral taken - no KF rings

Dvl opinion in v/o itchy lesions over gluten region and both lower limbs

Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars

Psychiatry referral - adjustment disorder due to physical illness

?dissociative motor disorder

A- ? Benign hereditary chorea

Acute pharyngitis

Ulcers secondary to ? Folliculitis, trauma with

Eczema 

Adjustment disorder 

P-

Tab Augmentin 625mg po bd

Tab levocitrezine 10mg po od

Salt water gargles 

Momate f cream for local application bd

Mupirocin gel for local application bd

Day4

S- c/o Disturbed sleep

throat pain decreased 

No fever spikes

O- pt had 25 episodes of choreiform movements yesterday night  ,each lasting less than a minute

Pt - conscious, coherent

Afebrile 

Pr 84 /min

Bp 120/70 mmhg

Rr  16cpm 

Spo2 98 % on room air

Cvs- s1s2+

Rs- b/l air entry +

Ophthalmology referral taken - no KF rings

Dvl opinion in v/o itchy lesions over gluten region and both lower limbs

Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars

Psychiatry referral - adjustment disorder due to physical illness

?dissociative motor disorder

A- ? Benign hereditary chorea

Acute pharyngitis

Ulcers secondary to ? Folliculitis, trauma with

Eczema 

Adjustment disorder 

P-

Tab Augmentin 625mg po bd

Tab levocitrezine 10mg po od

Salt water gargles 

Momate f cream for local application bd

Mupirocin gel for local application bd

To collect sample for 24hr urinary copper from today mrng.

Day 5

S- c/o Disturbed sleep

throat pain decreased 

No fever spikes

O- pt had 28episodes of choreiform movements yesterday night  ,each lasting less than a minute. Frequency and intensity of episode has increased

Pt - conscious, coherent

Afebrile 

Pr 84 /min

Bp 120/70 mmhg

Rr  16cpm 

Spo2 98 % on room air

Cvs- s1s2+

Rs- b/l air entry +

Ophthalmology referral taken - no KF rings

Dvl opinion in v/o itchy lesions over gluten region and both lower limbs

Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars

Psychiatry referral - adjustment disorder due to physical illness

?dissociative motor disorder

A- ? Benign hereditary chorea

Acute pharyngitis

Ulcers secondary to ? Folliculitis, trauma with

Eczema 

Adjustment disorder 

Iron deficiency anemia sec to ? Nutritional

P-

Tab Augmentin 625mg po bd

Tab levocitrezine 10mg po od

Salt water gargles 

Momate f cream for local application bd

Mupirocin gel for local application bd

To send samples for serum copper , cerruloplasmin and 24hr urinary copper excretion today 

Day6

S- c/o Disturbed sleep

throat pain decreased 

No fever spikes

O- pt had 28episodes of choreiform movements yesterday night  ,each lasting less than a minute. Frequency and intensity of episode has increased

Pt - conscious, coherent

Afebrile 

Pr 84 /min

Bp 120/70 mmhg

Rr  16cpm 

Spo2 98 % on room air

Cvs- s1s2+

Rs- b/l air entry +

Ophthalmology referral taken - no KF rings

Dvl opinion in v/o itchy lesions over gluten region and both lower limbs

Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars

Psychiatry referral - adjustment disorder due to physical illness

?dissociative motor disorder

A- ? Benign hereditary chorea

Acute pharyngitis

Ulcers secondary to ? Folliculitis, trauma with

Eczema 

Adjustment disorder 

Iron deficiency anemia sec to ? Nutritional

P-

Tab Augmentin 625mg po bd

Tab levocitrezine 10mg po od

Salt water gargles 

Momate f cream for local application bd

Mupirocin gel for local application bd