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GREAT JOB!Initial PresentationVital StatisticsInitial Presentation Stiff patches of skin on hands and arms; waxy texture; episodes come and go Acid reflux, difficulty swallowing, abnormal bowel movements Stiffness in joints (specifically hands and wrists)

Family Physician - TreatmentDiagnostic TestsUrinalysis Conducted at officeBlood Panel (CBC) Conducted off site

Maniken Skywalker32XDr. C. Dooku6/24/136/24/13KPXX+NEGATIVESend report ASAP to Dr. C. Dooku

Skywalker, Maniken120850MS

4/19/198132 yearsMale6/27136/27/13No impairmentRun by KP on 6/25/13DiagnosisAll tests returned within normal ranges

Skin and digestive issues could be due to changes in stress level or environment (patient mentioned recent intergalactic voyage and near death experience Gen. Grievous)Lack of regular stretching and exercise has contributed to joint pain and stiffnessTreatmentPrescription for antihypertensive (Lisinopril)

OTCs suggested - heart burn Prevacid - joint swelling and pain NSAID - skin oil based cream Glaxal Base, Eucerin

Regular stretching/exercise plan to be put in place

Referrals to Dr. Chuy Bacca and Dr. J.B. HuttAny Ideas?Visual Examination

Diagnostic Test Shave Biopsy of skin patch onposterior forearm

Test ResultsTreatmentOTC Moisturizer / Emollient CreamPrescription Topical Corticosteroid Cream AntihistiminesOral corticosteroids or immunosuppressive agents Any Ideas?Diagnostic TestsReferred by Dr. C Dooku

Upper GI endoscopy- This procedure uses a light, flexible endoscope was to see inside the upper GI tract. Anal myography- Used to determine if there is nerve damage causing incontinence.

Diagnostic TestsITest ResultsUpper endoscopy revealed inflammation of the esophagus.- Diagnosis: gastroesophogeal reflux disorder (GERD)

Anal myography revealed that there was no nerve damage.Test ResultsEsophagogastroduodenoscopy ReportDATE OF PROCEDURE: 7/12/2013PROCEDURE PERFORMED: Esophagogastroduodenoscopy (EGD)PHYSICIAN: Dr. J.B HuttINDICATION: Heartburn after eating meals. Burning sensation in esophagus and upper stomach region after eating.POSTOPERATIVE FINDINGS:1. Inflammation of the esophagus.MEDICATIONS: Versed 10 mg IV, fentanyl 75 mcg IV.IMMEDIATE COMPLICATIONS: None.PROCEDURE: Upper endoscopyTREATMENTS1. Over the counter H2 blockers such as amotidine (Pepcid AC, Pepcid Oral)2. Modify Diet Test ResultsAnal Electromyography Results - Normal

TreatmentGERD- Modify diet- H2 blockers (Pepsid, Zantac) reduce the production of stomach acidIncontinence- Modify diet be sure to eat foods high in fiber.

Referral to Dr. Wan Kenobi - RheumatologistAny Ideas?Diagnostic Test and ResultESR indicates presence of IgG and IgM- IgG = 13.2 U/L- IgM = 1.5 U/L

CRP present

Antinuclear antibodies detectedTreatmentBlood pressure medication (continued from Dr. Dooku) and monitoring at homeRenal function monitoringCorticosteroid cream for skin (continued from Dr. Bacca)Immunosuppressive medications to reduce internal organ involvementPhysical therapy to maintain dexterity and ambulation

Any Ideas?The End!