Numbness/weakness Flashcards

1
Q

Key history in numbness/weakness

A
Distribution (unilateral, bilateral, proximal, distal)
Duration
Progression
Pain (e.g. HA, neck or back pain)
Constitutional symptoms
Other neurologic symptoms
Hx of DM, alcoholism, atherosclerosis
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2
Q

Key physical exam in numbness/weakness

A

Vital signs
Neurologic and musculoskeletal exams
Relevant vascular exam

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3
Q

68 yo M with 20-minute episode of slurred speech, R facial drooping and numbness, and R hand weakness that are all now resolved
+ PMHx of HTN, DM and heavy smoking

A

Transient ischemic attack (TIA)
Hypoglycemia
Seizure

CT-head, CBC, electrolytes, glucose, fasting lipid panel, ECG, MRI-brain, Doppler US - carotid, echocardiography, EEG

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4
Q

68 yo M with slurred speech, R facial drooping and numbness and R hand weakness
+ Babinski’s sign present on R
+ PMHx of HTN, DM, heavy smoking

A

Stroke
TIA
Seizure

CT-head, CBC, electrolytes, PT/PTT/INR, fasting lipid panel, MRI-brain, Doppler US - carotid, echocardiography, ECG

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5
Q

33 yo F with ascending loss of strength in lower legs over last two weeks
+ recent URI

A

Guillain-Barre syndrome
Multiple sclerosis
Polymyositis

CBC, electrolytes, CPK, LP-CSF analysis, MRI-spine, EMG, nerve conduction studies, edrophonium test (for myasthenia gravis), serum B12

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6
Q

30 yo F with weakness, loss of sensation, tingling in L leg starting this morning
+ R eye pain, decreased vision and double vision
+ “Electric shocks” down spine upon flexing head

A

Multiple sclerosis
Stroke
Conversion disorder

CBC, ESR, VDRL/RPR, MRI - brain and spine, LP-CSF analysis, retinal evoked potentials

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7
Q

55 yo M with tingling and numbness in hands and feet (glove-and-stocking distribution) over last two months
+ Hx of DM, HTN, alcoholism
+ Decreased soft touch, vibratory and position sense in feet

A

Diabetic peripheral neuropathy
Alcoholic peripheral neuropathy
B12 deficiency

HbA1c, ESR, calcium, serum B12, UA, serum and urine protein electrophoresis (for multiple myeloma)

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8
Q

40 yo F with occasional double vision, droopy eyelids at night with improvement by morning

A

Myasthenia gravis
Horner’s syndrome
Multiple sclerosis

Edrophonium test (for myasthenia gravis), serum ACh receptor antibodies, CXR, CT-chest, MRI-brain, EMG

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9
Q

25 yo M with hemiparesis after tonic-clonic seizure that resolved after a few hours

A

Todd’s paralysis
TIA
Stroke

CBC, electrolytes, EEG, MRI-brain, Doppler US - carotid

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10
Q

56 yo obese F with constant tingling and numbness of thumb, index finger and middle finger (median nerve distribution) worsening over last five months
+ works as a secretary
+ Hx of fatigue and 20 pound weight gain over same period

A

Carpal tunnel syndrome secondary to hypothyroidism
Overuse injury of median nerve
Medial epicondylitis

Phalen’s maneuver and Tinel’s sign
Nerve conduction studies
TSH
CBC

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