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  #1  
Old 02-15-2014
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Default Plz check my pn

A 62 yo f c/o lightheadedness for the third time since this morning .the patient was reading a book before she felt lightheaded .there was nausea, vision blurring , rt arm weakness associated with it.there was no ear problems , no recent uri .also, there was no relieving or aggravating factors.this episode lasted for 10 minutes.she had a hx of stroke last year

ros: Negative except the above
medications: Diuretics and pills for htn( she could not remember the names) and nkda
shx: Non-smoker and no use of etoh or illicit drugs
fhx: Nothing relevant


p/e
the patient was in no acute distress and her vitals are wnl.there was a weakness in her rt arm 3/5 but her other limbs are 5/5 .her cranial nerves(1-12) are intact .


Tia

lightheadedness
nausea
rt arm weakness
vision blurring
hx/o stroke last year


basilovascular insufficiency

lightheadedness
nausea
rt arm weakness
vision blurring
hx/o stroke last year


dx studies

cbc
ct for the head
duplex u/s for carotids
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  #2  
Old 02-18-2014
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come on guys...
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  #3  
Old 02-18-2014
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the p/e is short.

this is a neuro case, it needs a thorough neuro exam and a full cvs exam.

ddx: i will consider diuretic induced hypovolemia, then vertebrobasilar insufficiency before the tia.

the weakness is probably due to previous stroke.
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  #4  
Old 02-19-2014
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thanks man for replying,


would you mind if you tell me how to write a full neuro exam for my case foe example ?? and thank you
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  #5  
Old 02-19-2014
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Quote:
Originally Posted by dodo89 View Post
thanks man for replying,


would you mind if you tell me how to write a full neuro exam for my case foe example ?? and thank you
Hi,
i am also still preparing with focus on ice, but from what i have learnt,
there is a general neuro p/e which can be adjusted depending on the diagnosis you are considering.

Neuro: A&O x 3, recalls 3 objects, spells 'world' backwards, Lt or Rt handed,
CN II-XII intact, pronator drift, strength is 5/5 in all limbs, sensation intact to light touch in all limbs, DTRs 2/4 in patellar, ankle, biceps, supinator. babinski intact.

This might suffice for a light headedness case esp if your differentials tend towards cardiac cause.

however; for specific cases, you need to add some specific things e.g:

tremor: cogwheel rigidity, 3-5hz resting tremor , shuffling gait, glabellar tap, drooling saliva and oily face (add these to general exam), bradykinesia (slow movt when checking gait), cerebellar signs: finger to nose test WNL, alternating movt, tandem walk etc.

amnesia: in addition to recall x 3, ask for long term memory, rhomberg(post column in neurosyphilis)

depression: add appearance, mood, speech, insight, judgement,

hallucination: full mmse,

for suspected hypo/hyperthyroidism: tremor, extra ocular muscles (hyperthyroid), DTRs (hypothyroid)

backpain : lower limb strength, sensation, DTR, babinski, gait

so overall, the neuro exam is variable depending on the differentials being considered. it has to be focused, its almost impossible to do a full neuro exam for all cases.

hope this helps.
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The above post was thanked by:
drglo (02-19-2014)



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