I)Personal

Details
Name:Arumugam s/o Muthusamy
Age
44 years
Address: 24, Jalan 1/338, Bk. Jalil, Kuala Lumpur
Occupation
clerk
Marital Status
married
Race: Indian
Religion: Hindu-(when overseas do not ask for religion)
II)CHIEF COMPLAINT-Fever for 5 days . (History taken from.)
III)HOPI_Five days ago patient started having fever.He felt very hot and feverish,but he did not take his temperature as he had no thermometer.
The fever occurred every other day day,and present throughout the day
It was usually worse in the early morning
Fever became worse whenever he covered himself with a blanket
On the 2nd. day of fever he went to see his regular GP.
The doctor took his temperature and told him that it was 380C. He gave him 2 types of tablets which caused the fever to subside for
about 5 hours after which the fever started again.
He felt better when he washed his face and neck with cold water.
When he finished his medicine the fever became worse, so he came to the hospital
Associated features/symptoms
Positive associated: he also had chills and shivering (rigor)
Negative associated : he did not have any rash, running rose, sorethroat,cough, aches and pain, painful micturition, diarrhoea or vomiting.
IV)Systemic Review:General Appetite good, no change, sleeps well,weight-no chang,e,o tiredness
Head-no headache
Eyes/Ears -no visual or hearing problem
CVS/RS-no chest pain
Abdomen-urine normal,
bowels normal, no change
Limbs-no weakness or sores
V)Past Medical History
Admission in 1995 Admitted to HKL for observation for dengue.
Surgery-2006 Admitted UMMC for removal of appendix.Recovered well.
No diabetes, high blood pressure, heart illness, asthma or other serious illness
Medication and allergy
On vitamin pills daily
No known allergy to any food or medication
VI)Family history
Father 68 years old, is a gardener and has high blood pressure.
Mother died of cancer of the stomach at the age of 60 years.
1 brother - 40 years old, is healthy.
2 children son 15 years old-admitted for malaria 1 month ago
- daughter 12 years old- healthy and well.
VII)Social History
Smokes 10 cigarettes a day past 20 years,Drinks beer at functions occasionally
He exercises by taking evening walks 3 times a week
Stays in single storey linked house in new housing estate with construction still going on. There are lots of mosquitoes in the vicinity.

Personal Details
Name:
Age:
Sex:
Address:
Occupation
Race:

Wong Ah Ngoh
41
Female
21, Jln SS2/23, Petaling Jaya,Selangor
Housewife
Chinese.

Chief complaint:
Pain in the small joints of both hands past 8 months.
History of Presenting Illness.
I noticed pain in the small joints of both of my hands about 8 months ago
Nearly all the joints of the hands are affected.
The pain was initially mild but for the last 2 months it has become very severe.
The pain is worse on waking in the morning, often lasting for several hours.
The pain is sometimes also present at night.
When I move my fingers in the morning eg.when I brush my teeth in the morning
or when I do sewing the pain sometimes become less.
The pain is sharp to dull
Associated symptoms:
There is also stiffness in the finger and hand joints on and off.
I noticed a lump in my elbow, gradually becoming bigger for the past 1 month.
It is becoming more difficult for me to do sewing or cooking which involves me holding the knife and cutting meat and vegetables.
Three months ago I went to see a specialist who did some blood tests and mentioned something called RF is positive.He told my son I have some joint disease. He gave me 2 types of
medicine-1type to take 1tablet daily and the other to take 5 tabs once weekly. I have started taking these 4 months ago; there is some improvement but the effect of the medication is slow.
I have been feeling more tired for the past 4 months.
For the past 2 months occasionally I am unable to sleep well due to the pain.
My family have noticed I am a bit pale lately .
I have occasional slight fever for the past 6 months which I ignored.
Worry: I am worried as I may not be able to continue with my hobby of sewing and I am also worried that the pain and stiffness will not get better but become worse and worse.
Systemic Review. No weight change, appetite good, bowels and urination are ok.
Past Medical History I have been having general tiredness and mild occasional finger joints pain for many years(about 4-5 years), which I have ignored before.
No admission or surgery or other long term illness.
Family History
Mother aged 66 had similar joint pain for many years -on occasional treatment.
Father aged 70, has hypertension .
Only child-no sibling. Two sons- both well.
Social History- I do not smoke or drink. I enjoy doing sewing,embroidery and knitting.