# data[].attributes.body
no

# data[].attributes.body
1. A 43-year-old male

2. easy fatiguability

3. 3 months

# data[].attributes.body
1. A 43-year-old male

middle age men prone to get sick due to underlying disease

men prone to get cvs related, metabolic disorder

2. easy fatiguability

sx lack of energy

cvs related: heart disease, blood not pump effecinetly, anaemia

lung disease

hypoglycemia

systemic infection: immune system try to kill pathogen

muscle weakness

cns: nerve problem that control muscle motor

hypothyroidism due to decrease metabolic rate

3. 3 months

not easily solve

if eg hypoglycemia: solution glucose intake, but sx persist for 3 months

chronic

# data[].attributes.body
1. HOPI

s- general (systemic) or localised (msk) fatigue,

o- what the trigger of fatigue, whether in resting state or stress or acticity

c- physical or mental fatigue

r- include muscle weakness or breathlessness

a- SOB, palpitation, chest pain, weight loss, headache, pallor, syncope, fever, poor sleep, weakness, night sweat, seizure, polyuria, postural dizziness due to postural hypotension, numbness

t- fatigue occur at what time or all day

e/r- exertion, stress, medication, fasting / rest, sleep, medication, after eating, posture

s- how much the fatigue affect daily life

2. social history

occupation, schedule

diet and physical activity

sleep pattern

smoking, alcohol, drug abuse

travel history

3. PMH

chronic disease (HPT, DM, asthma, cvs related)

previous anaemia or blood disorder

surgery or hospital admission (medication, treatment)

previous infection

autoimmune

similar episode

use of medication (regular, sedative, OTC medication, traditional)

BMI

4. FH

red flags disease (chronic disease)

history of anaemia

cancer (MEN)

autoimmune disease

thalassemia

# data[].attributes.body
1. CVS related (IHD, heart failure)

2. metabolic disorder (DM, thyroid disorder, adrenal problem)

3. anaemia (IDA, GI bleeding)

4. autoimmune (Hashimoto thyroiditis, SLE, MS, fibromyalgia)

5. drug induce (ANTI-DEPRESSANT, ANTI-HISTAMINE, sedative anxiolytic hypnotic)

6. infection

7. respiratory related

8. psycological causes (stress)

9. CKD

10. Cancer

11. chronic fatigue syndrome

12. obstructive sleep apnea

# data[].attributes.body
1. loin pain - pain at back between rib and hip

# data[].attributes.body
1. excessive thirst

2. passing large amount of urine, more frequently than usual, especially at night.

3. He did not report painful urination or any discolouration of the

urine, feeling feverish or any loin pain.

4. PMH, SH and FH no significant history

# data[].attributes.body
1. excessive thirst (polydipsia) - too much water loss, high blood osmolarity, kidney cant conserve water, (receptor-baroreceptor), secondary to polyuria to maintain fluid balance

2. passing large amount of urine, more frequently than usual, especially at night (polyuria) - due to ADH deficiency, DM DKA RAAS inhibitor drug

( osmotic diuresis ), diabetes insipidus ( low ADH, water diuresis, urine output increase ), frequently waking up, sleep cycle disturb

3. He did not report painful urination or any discolouration of the

urine, feeling feverish or any loin pain - does not have UTI, no infection

4. PMH, SH and FH no significant - more likely having acquired disease

# data[].attributes.body
1. vital sign ( BP,RR,HR

2. BMI

3. Blood glucose ( HbA1c, random plasma glucose)

4. FBC

5. urinalysis

6. renal function test

PHYSICAL EXAMINATION

1. general inspection ( SOB, palpitation, pallor, sign hypothyroid, body habitus )

2. muscle examination ( reflex )

3. fundoscopy ( cataracts, retinopathy )

4. skin ( acanthosis nigricans, hyperpigmentation, neck armpit, dry skin (dehydration) )

5. stoking and gloves ( numbness, tingling )

# data[].attributes.body
1. CVS related (IHD, heart failure) - less likely

2. metabolic disorder (DM, thyroid disorder, adrenal problem)

3. anaemia (IDA, GI bleeding)

4. autoimmune (Hashimoto thyroiditis, SLE, MS, fibromyalgia) - less likely

5. drug induce (ANTI-DEPRESSANT, ANTI-HISTAMINE, sedative anxiolytic hypnotic)

6. infection - less likely

7. respiratory related - less likely

8. psycological causes (stress)

9. CKD - less likely

10. Cancer - less likely

11. chronic fatigue syndrome

12. obstructive sleep apnea

# data[].attributes.body
Achilles tendon reflex - ankle reflex

# data[].attributes.body
temp- normal

HR - normal

RR - normal

BP - high

BMI - obese

pt. is alert and oriented

LF, suppurtive ulcer and w/ adjacent cellulitis extending to ankle joint, foot is warm, w/ palpable peripheral pulse

Achilles tendon reflex and vibration absent on the LF

systemic review - N/A

# data[].attributes.body
temp- normal borderline high

no systemic infection, though inflammation to fight local infection

HR - normal borderline high

inflammation to fight local infection

RR - normal borderline high

inflammation, to fight local infection

BP - high

HTN, due to metabolic syndrome, (i.e. DM, increase in blood glucose, endothelial dysfunction, small artery loss elasticity, increase in PVR)

BMI - obese

risk factor of metabolic syndrome

pt. is alert and oriented

no CNS involvement

L/F, suppurative ulcer and w/ adjacent cellulitis extending to ankle joint, foot is warm, w/ palpable peripheral pulse

poor wound healing, pus formation, impaired neutrophil function, however still receive good perfusion

pulses present at macrovascular, can rule out ischemic ulcer, thus, most likely neuropathic ulcer

infection does spread to surrounding subcutaneous tissue, infection is progressive, require prompt management

Achilles tendon reflex and vibration absent on the L/F

neuropathy problem

systemic review - N/A

# data[].attributes.body
1. Blood glucose ( HbA1c, random plasma glucose)

2. FBC

3. urinalysis

4. renal function test

5. swab ulcer for C&S

# data[].attributes.body
1. CVS related (IHD, heart failure) - less likely

2. metabolic disorder (DM, thyroid disorder, adrenal problem)

1. diabetes mellitus

2. thyroid disorder

3. addison's disease

3. anaemia (IDA, GI bleeding)

4. autoimmune (Hashimoto thyroiditis, SLE, MS, fibromyalgia) - less likely

1. Hashimoto's thyroiditis

2. SLE

3. MS

4. fibromyalgia

5. drug induce (ANTI-DEPRESSANT, ANTI-HISTAMINE, sedative anxiolytic hypnotic)

6. local infection

1. cellulitis - foot ulcer

7. respiratory related - less likely

8. psychological causes (stress)

9. CKD - less likely

10. Cancer - less likely

11. chronic fatigue syndrome

12. obstructive sleep apnea

metabolic syndrome - HTN, obesity, dyslipidia

# data[].attributes.body
1. hb low

2. wbc high

3. neutrophil, monocytes high

4. rbg high

5. glucose high in urine

6. Foot ulcer swab culture and sensitivity: Bacteroides fragilis

sensitive to metronidazole, carbapenems, chloramphenicol, and

combinations of a penicillin and beta-lactamase inhibitors.

7. The patient was diagnosed to have type 2 Diabetes mellitus

complicated with a foot ulcer and started on metformin treatment.

8. The patient showed improvement, blood sugar levels decreased.

9. His foot was treated with a daily dressing in addition to an oral antibiotic

prescription.

10. The patient was counselled to optimise his weight and stick to a healthy

lifestyle, including adjustment of the diet. A goal was set on how much

weight he should lose by the next follow- up