16yrs female with bluish discoloration of upper limb fingers

 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of “ patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

Chief Complaints:

16 yr old female came with chief complaints of bluish discolouration of fingers  since one month 

History Of presenting illness:

Patient was apparently asymptomatic one month back then she developed bluish discoloration of skin with was insidious in onset , asymptomtaic , no agrravating and relieving factors associated . 

H/o of exposure of naphthalene ball’s exposure in hostel 

No history of shortness of breath , no exposure to chemicals , no history of trauma , no history of photosensitivity. 

Past history - history of similar complaints in child hood at age 4 years

Past History:

H/O similar complaints in childhood

N/k/c/o  HTN,DiabetesTuberculosis,bronchial asthma,epilepsy,CAD.

Personal History:

Diet : Mixed 

Appetite : Normal

Sleep : Normal

Bowel and bladder moments :Regular 

Addictions:None

Family History:

Not significant 

General physical examination:

Patient is conscious ,coherent,cooperative.

Moderately built and nourished.

Pallor: Absent

Icterus: absent

Cyanosis: peripheral cyanosis on both hand fingers 

Clubbing: absent

Lymphadenopathy:absent

Pedal edema:absent 

Vitals:

Temperature - 98F

PR :-78 beats per minute 

BP :- 120/80mm Hg

RR:-19 cycles per minute

Systemic examination:

Cardiovascular system: 

Inspection-

Shape of chest-Normal  

No precordial bulge.

No dialated veins,scars and discharging sinuses.

No visible pulsations.

Palpation-

 Apical beat felt in 5th intercostal space.

No parasternal heave and thrills

Auscultation-

S1S2 heard 

No murmurs heard

Respiratory system:

-Inspection:

Trachea -appears to be central

Chest appears bilaterally symmetrical ,movements are symmetrical on both sides.

elliptical in shape.

No chest wall defects.

No scars and sinuses.

-Palpation:

All the inspectory findings are confirmed.

Trachea central in position

-Percussion                Right              Left

Supraclavicular          R                   R

Infraclavicular           R                    R

Mammary                   R                    R

Inframammary          R                    R

Axillary                        R                    R

Infraaxillary               R                    R

Suprascapular           R                    R

Infrascapular             R                   R

R-Resonant

-Auscultation        Right              Left 

Supraclavicular     NVBS             NVBS

Infraclavicular       NVBS             NVBS

Mammary            NVBS.               NVBS

Inframammary      NVBS              NVBS  

Axillary                    NVBS              NVBS

Infraaxillary            NVBS              NVBS

Suprascapular        NVBS              NVBS

Infrascapular         NVBS              NVBS

(NVBS- Normal vesicular breath sounds)

Central Nervous system:

  NFND                                  

Per Abdomen:

Soft,non tender 

No organomegaly

Provisional Diagnosis:

Acrocyanosis under evaluation 

Investigations: