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Patient: M.E. (55 y/o male) Chief complaint: Painful erythematous swelling on the face

Patient: M.E. (55 y/o male) Chief complaint: Painful erythematous swelling on the face . HISTORY OF PRESENT ILLNESS. HISTORY OF PRESENT ILLNESS. PAST MEDICAL HISTORY. Diabetic for 27 years

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Patient: M.E. (55 y/o male) Chief complaint: Painful erythematous swelling on the face

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  1. Patient: M.E. (55 y/o male) • Chief complaint: • Painful erythematous swelling on the face

  2. HISTORY OF PRESENT ILLNESS

  3. HISTORY OF PRESENT ILLNESS

  4. PAST MEDICAL HISTORY • Diabetic for 27 years • Maintained on Gliclazide(Diamicron) for the first 10 years with unrecalled dose taken OD • Insulin maintenance (Humulin N 20 ’u’ in the morning and 15 ‘u’ in the evening) for the past 16 years • Cholecystitis- underwent cholecystectomyin 1996 • Underwent 3 operations for the right eye: • 2003- cataract surgery • 2004- glaucoma-trabeculectomy • 2007- corneal transplant; patient developed Graft Versus Host Disease which led to blindness

  5. FAMILY HISTORY • (+) DM – mother • (+) HPN - father • (+) HPN – brother • (-) Cancer, allergy, stroke

  6. PERSONAL AND SOCIAL HISTORY • Married (with 2 children) • Used to work as a “master cutter” at a tailoring shop but is currently unemployed • Occasionally smokes and drinks alcohol • Mixed diet

  7. MEDICATIONS • Insulin (Humulin N 20 ”U” in the morning and 15 “U” in the evening) • Vitamin B complex

  8. REVIEW OF SYSTEMS • No headache, vertigo, syncope • No epistaxis, nasal discharge • No neck stiffness, masses, lymphadenopathy • No tinnitus, ear discharge, loss of hearing • No dyspnea, cough • No chest pain, easy fatigability, nocturnal dyspnea, orthopnea, palpitations

  9. REVIEW OF SYSTEMS • No nausea, vomiting, hematemesis, dysphagia, abdominal pain, diarrhea, constipation, melena, hematochezia • No urinary urgency, dysuria, flank pain, urethral discharge • No joint stiffness, pain, swelling, muscle pain, cramps, weakness, wasting • (+) hyperpigmented scaly plaque on the dorsum of the right foot • No heat-cold intolerance • No pallor, abnormal bleeding, bruising

  10. PHYSICAL EXAMINATION • Conscious, coherent and oriented to time, place and person • Vital Signs: BP: 120/80mmHg PR - 90bpm, RR-24cpm, Temp: 37.3°C • Weight= 66 kg Height= 170cm BMI=23 • HEENT: (+) periorbital swelling, eyelash not matted, nonhyperemic conjunctivae, anictericsclerae • No nasoaural discharge, (+) swelling with violaceous discoloration of the lower lip and sorrounding skin topped with multiple erosions, crusts and pus, buccal mucosa cannot be assessed • NECK: supple neck, no masses, (-) palpable cervical LN,right, LN on the left cannot be assessed due to swelling over the submandibular area, (-) neck vein distension

  11. PHYSICAL EXAMINATION • THORAX & LUNGS: Symmetric chest expansion, (-) retractions (-) lagging, equal vocal tactile fremiti, resonant on all lung fileds, clear breath sounds • CARDIAC: Adynamicprecordium, (-) heaves, thrills and lifts, S1>S2 at the apex, S2>S1 at the base, (-) murmurs • Pulses full and equal on all extremities • ABDOMEN: soft, globular abdomen, non-tender, normoactive bowel sounds; Liver-smooth, non-tender, vertical span- 6 cm at the MCL; spleen & kidneys not palpable • EXTREMITIES: Motor strength grade 5/5 on all extremities, no sensory deficits • (+)pruritic, hyperpigmented plaque with scaly surface on the dorsum of the right foot

  12. Laboratory Results

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