Symptoms that cannot be Explained''

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Symptoms that cannot be Explained..

• Family Medicine Unit
• Prof. Cindy Lam
• Dr. Paul Chan

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Case

• Mr. Leung, 29 years old, Married
• Consult our clinic with wife on March 2001

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Presenting Problem

• Chest discomfort for 2 months

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Other Symptoms

• Bilateral hand numbness for 2 months
• On and off palpitation for 1 year
• Intentional hand tremor for 2 years
• Loud snoring, poor sleeping, daytime somnolence
• Feel irritable and emotional lability

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Physical Examination

• BMI 28.7
• Bilateral intentional hand tremor
• Tender over right 2nd costal cartilage
• CVS normal
• Respiratory normal
• Neurological exam normal

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Investigation

• Thyroid function test
• ECG

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Management

• Refer Sleep Clinic to rule out Obstructive Sleep
  Apnoea
• Explain costochondritis and reassurance
• Inderal 10mg tds prn

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Follow Up

• Thyroid function test normal
• ECG normal

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Unexplained Symptoms ?

• Palpitation
• Hand tremor
• Poor sleeping
• Feel irritable and emotional lability

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Further Psychosocial history

• Family history
• Career history

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Genogram
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Video
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Diagnosis

• Marital Problems with anxiety symptoms

Management

• Marital Counseling
• Prothiaden 25mg nocte