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This 10 page Class Notes was uploaded by Mabelle Gusikowski on Wednesday September 9, 2015. The Class Notes belongs to HUBIO 532 at University of Washington taught by Staff in Fall. Since its upload, it has received 19 views. For similar materials see /class/192006/hubio-532-university-of-washington in Human Biology at University of Washington.
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Date Created: 09/09/15
2008 Week 9 Case studies Case l Approach to neurology Q1 Contrast myopathy and peripheral neuropathy in terms of limb distribution atrophy and sensory involvement Give at least two examples of each A1 Myopathy Peripheral neuropathy Distribution Atrophy Sensory loss Examples Q2 Where does the lesion have to be if a patient has right third nerve palsy and left face arm and leg weakness A2 Week 917 Case 2 ALS A 56 year old female complains of gradual weakness of her right arm such that she can no longer open jars She dropped a glass one month ago She stopped playing tennis 3 months ago Her friends wonder why her speech is slurred She denies sensory congnitive and bowelbladder dif culties Q1 Keeping in mind a hierarchy of neurologic disease brain brain stem spinal cord motor neuron peripheral nerve neuro muscular junction and muscle which categories typically pres ent with weakness without sensory loss A1 Q2 The individual words amyotrophic lateral scleriosis ALS can help you remember a lot about the disease What does each of these words mean A2 Q3 Describe the exam ndings that you would look for in order to make a diagnosis of ALS A3 Week 9 18 Case 3 Multiple sclerosis A 23 year old female has painful right eye Visual blurring over the last two days In the past two years she has had three episodes each lasting between two and four weeks of numbness in the right hand weakness in the left foot and bladder retention They were all so mild she did not seek medical attention Q1 What is the clinical de nition of de nite multiple sclerosis and does she meet the criteria A1 Q2 MS is an autoimmune and primarily demyelinating disease What tests can be done to help con rm the disease and which property is being evaluated A2 Week 919 Week 9 20 Case 4 Myasthenia gr avis A 25 year old woman noticed drooping of her right eyelid in bright sunlight Occasional periods of double vision diplopia followed several weeks later and tended to occur late in the day Within three months she experienced intermittent proximal weak ness in her arms that was strikingly worse with strenuous lifting slurred speech and clumsiness All of her symtoms disappear after a short nap In the of ce her routine neurologic exam is normal Q1 What further bedside maneuvers might be employed to more fully evaluate the patient s complaint of intermittent weakness and diplopia A1 Q2 How does the Tensilon test work A2 Q3 List several different treatment options for the patient with myasthenia gravis A3 Case 5 Anatomy A 48 year old woman presented to the ER for treatment of a burn on her right hand that was caused by picking up a hot pan from the stove She did not feel the heat at the time and the burn did not hurt The exam showed evidence for old healed burns on both hands and pain and temperature loss in both upper extremities in dermatomes C5 T1 Position and Vibration sensation were intact Q1 What lesion could explain these ndings Draw it A1 Q2 What levels is this lesion A2 Week 921 Week 9 22 Case 6 Anatomy A 58 year old hypertensive man was admitted to the hospital for sudden onset of dizziness vomiting dysarthria and numbness in his face The exam revealed pinprick sensory loss on the right face and left body nystagmus to the left miosis ptosis and decreased facial sweating on the right ataxia of the right armleg hoarseness and the soft palate moved to the left when saying aaah Q1 Where is the lesion Is this lesion given a special name Which arteries are most often implicated A1 Q2 Identify the structure involved to give each of the symptoms A2 Case 7 Epilepsy A 37 year old man had the onset of jerking movements of his right hand lasting a few seconds and occurring every few days Two months after the rst event the patient had an episode of prolonged jerking of his right hand which spread to the arm and shoulder He then lost consciousness had generalized shaking bit his tongue and was incontinent of urine In the ER 30 minutes later he was able to talk His exam showed mild weakness in the right hand increased re exes on the right and an upgoing right toe Q1 Where is the lesion Can you explain the progressive jerking from his hand to other body areas A1 Q2 How are a primarily generalized seizure and partial seizure with secondary generalization different A2 Q3 Why is an EEG not always diagnostic of epilepsy A3 Week 9 23 Week 9 24 Case 8 Cereb139ovascular disease A 72 year old woman reports acute onset of right hemiparesis dysarthria and a mild right sensory loss On exam she is alert with normal Vision Strength on the right is 45 with arm drift symmet ric re exes and an upgoing toe Q1 Describe the major arteries to the brain and the connections made between the arteries within the brain A1 Q2 Where in the brain would you put this stroke A2 Q3 What is a lacunar infarction A3 Case 9 Movement disorder A 70 year old man comes to clinic for tremor It has been gradu ally getting worse for two years The tremor makes it hard to sign checks and eat soup Q1 How does one distinguish a Parkinson tremor from an essen tial tremor A1 Q2 What is your diagnosis in this case What other questions and physical exam would be helpful A2 Q3 Describe the difference between chorea dystonia and tremor A3 Week 9 25 Week 9 26