YEAR 4 HISTORY

Question 1

1. What general kind of disease process was going on over last yr for this pt?
2. What occurred suddenly? Why was he hospitalized, describe the event.
3. Name 2 CNS conditions that can lead to convulsions.
4. What problem did the pt have with his speech? What is it called? Where would the lesion be in the brain for this prob?
5. Why did her doctor advise steroids & anticonvulsants after surgery? What additional measures did her doctor suggest, why?
6. Enumerate any two symptoms that relate to an intracranial space occupying lesion in this patient?

Answer 1

1. The subtle loss of neurological functions over time are suggestive of tumor, since blood supply problems, such as stroke, would have a rapid onset.
2. The patient had an ep of “fits’’, which is medically known as epileptic seizure or convulsion. He experienced tonic clonic movements of the body with rolling of his eyes, frothing from the mouth, urinary incontinence & loss of consciousness.
3. A)Intracranial space occupying lesions (ICSOL), B)Grand mal epilepsy, C)Traumatic brain injury (TBI), D)Stroke
4. In the past yr, pt occasionally had difficulty finding the right words needed for ordinary things. It is called Motor (expressive or non-fluent or Broca’s) dysphasia. This abnormality results from a lesion affecting the lower post frontal lobe of the dominant hemisphere of the brain.
5. Anticonvulsants & steroids were given to control convulsions and cerebral edema. Doctor advised radiation therapy, to reduce the risk of recurrence.
6. A)Headache, B)Vomiting, C)Convulsions, D)Symptoms of motor affection

Question 2

1. What is this pt pack year?
2. What type of aphasia is this?
3. What is this pt’s BMI?
4. What was the🥇indication of neurological prob in this pt?
5. What is the medical term for this pt “pic”?
6. What is the pathological nature of this prob from the clinical presentation of the pt?
7. What are some RF?
8. What would the neurologist recc if the pt came in the beginning stage of illness?
9. What are 3 modalities of tx the pt received?
10. What areas of the brain appear to be affected in this pt?
11. What does the speech involvement tell abt the area involved in the lesion?

Answer 2

1. 40-60 pack years
   (1 pack = 20 cig; If cigarettes given: # of cigs x # of smoking yrs →divided by 20; If packs given: # packs x # of smoking yrs)
2. It is global aphasia since the pt had lost ALL ability to understand written/spoken words (Wernicke) & to speak/write (Broca).
3. 29.9 Kg/m^2 🟨🟥
   🟦 underweight: <18.5
   🟩 normal: 18.5-24.9
   🟨 overweight: 25.0-29.9
   🟥 obese: >30
4. Pt had 2 eps of “tingling” feeling & weakness on the rt arm & rt side of face. This shows he had a sensory motor abnormality associated with neurological disease.
5. ☑️ These eps are called transient ischemic attacks, TIAs, which are focal neurological deficits caused by vascular insufficiency. ☑️ Symptoms resolve by 24 hrs. ☑️ Unlike stroke (>24hrs), when a TIA is over there’s no injury to the brain.
6. Rapid onset of weakness suggests a vascular event (stroke)
7. A)HTN, B)SMOKING 🚬 , C)OBESITY, D)HYPERLIPIDEMIA, E)Fx of heart disease, HTN, & DM
8. The cause for these TIAs could have been determined; antiplatelet agent (aspirin) would have been given; or surgery (endarterectomy: surgical removal of plaque from a blocked artery)
9. A)Anti-HTN, B)Antiplatelets, C)PT for weakness
10. Left MCA territory
11. Speech involvement means that the dominant side of the brain is affected, which is nearly always the left lobe in right handed people. So, the left side of the brain deals with communication.