A case of 42 yr old patient with multiple health problems

Gm final practical short case April 26, 2021 This is an online E log book to discuss our patient’s de-identified data shared after taking his/her/guardian’s signed informed consent” MBBS FINAL SHORT CASE ————————————————————————— 35 year old male patient, resident of ramchandrapuram, works as a daily wage labourer, a chronic smoker (1 pack of beedi every 2 days) and a chronic alcoholic (90ml daily) since 20 years presented with a 3 month history of painless papules with erythema that started initially over the face then gradually extended to upper limb, low limbs and trunk  No hypodense lesions  No fever  No pus No loss of sensations No genital lesions  Patient got over the counter  topical cream, soap and some oral drugs from nearby medical shop  He used them for 2 months, few lesions regressed but few persisted on nose, ear lobe, hands, legs and trunk. 14 days ago patient developed blackish skin discolouration over hands and feet with skin peeling, cracking, ulcer formation associate

LONG CASE: A 50 year old female patient a resident of Nalgonda, home maker came to the OPD with chief complaints of pain and stiffness in several joints since 1 year. HISTORY OF PRESENT ILLNESS She was apparently asymptomatic 10 years ago, then she developed a dull aching type of pain and stiffness in her finger joints(MCP joints) of right hand with limitations of movements at the joints.  Then within 6 months of onset the disease progressed to involve other joints of the right hand and left hand as well(wrist joint and elbow joint)  Within 4 years of onset she started feeling pain in the joints of the feet and ankle joint.  Since 3 months the pain became unbearable limiting her activities The pain was insidious in onset, slowly progressive dull aching type of pain, non radiating, associated with swelling, stiffness and limitations of movements in the involved joints. Stiffness and pain was more in the first 1 hour of waking up and gradually improved on movement. There are few exacerba