HoMeWorK~~
These are question patterns that might come out in short case for Medicine (From what i gathered from previous batch)
Get your brains running, try to think what findings can be expected in each case.
1) This patient is a 45 year old man complaining of recurrent episodes of syncope. Please examine the neck.
2)(A grossly obese patient with plethora lying on the bed) Look at this patient and conduct the relevant investigations.
3) (Patient on wheelchair with tremor) This patient have dementia and tremor. Conduct an examination to confirm the diagnosis.
4)(patient with tapered nose and stretched skin) Please examine the relevant systems.
5)(patient with partial ptosis) Please examine the eye.
Get your brains running, try to think what findings can be expected in each case.
1) This patient is a 45 year old man complaining of recurrent episodes of syncope. Please examine the neck.
2)(A grossly obese patient with plethora lying on the bed) Look at this patient and conduct the relevant investigations.
3) (Patient on wheelchair with tremor) This patient have dementia and tremor. Conduct an examination to confirm the diagnosis.
4)(patient with tapered nose and stretched skin) Please examine the relevant systems.
5)(patient with partial ptosis) Please examine the eye.
2 referrals:
i'll give a quick guess since I'm not really good at it..
1) Syncope can be cardiac, neurological or others.
For cardiac causes, heart failure can cause raised JVP, but I think this may not be the reason we examine the neck. Syncope can also be cause by arrhythmia, in this case perhaps atrial fibrillation caused by hyperthyroidism, so goiter may be palpable. anything else, I can't think of right now.
2)Plethoric is a sign of polycythemia, but I'd no idea what a grossly obese patient is having a plethoric face. Perhaps he could be drunk? Haha... Perhaps he could be cushingnoid, but I wouldn't be able to figure out anything. Care to enlighten me?
3) Dementia and tremor seems more of Alzheimer's disease. That would require mini-mental test and other neurological test beyond my comprehension, so I'll need more explanation here.
4) Never heard of tapered nose, is it like some ET? :P
Stretched skin may be a sign of connective tissue disorders such as Ehlers-Danlos or it could be due to steroids?
5) Partial ptosis can be Myasthenia Gravis, Horner's syndrome or facial nerve lesion (all causes including Bell's Palsy) I'm not sure how to examine the eye for MG(can ask the patient to count from 1 to 30 and observe for the weakening of voice over time), but Horner's can be elicited by examining for miosis on the affected side while the normal side is just.. normal? For facial nerve palsy, it can probably be obvious with the obvious nasolabial fold, but if the cause is of DM origin, you might be able to observe for retinopathy (whether using fundoscope or superficials such as cataract or glaucoma)
If I'd know the diagnosis, I would have known the findings. *Sigh*
1) Don't forget the lymph nodes as lymphoma can present as lethargy(the chief complain i hate the most)
2)If only u look at the patient, u would have known he's cushingoid. Most cushing patients have either plethora, acne or alopecia. Go to ward 3 to look. Look up for the 5 cardinal signs of Cushing.
3)I did not say the patient have dementia here. What i'm trying to tell u is either Parkinsonism or cerebellar disease.
4)ET is a differential if the patient's skin is green hehe... Tapered nose is very characteristic of scleroderma. Your guess is near. Ehler Danlos will not present to u with tapered nose. There is no way their skin can get that tight if its that elastic :P
5)Bells palsy wont cause partial ptosis as the muscle orbicularis oculi is actually innervated by the 3rd nerve. Examination of eye in MG include asking patient to maintain an upward gaze for more than 30 seconds, and eliciting the Pick's sign.(look it up). For horners u need to access the 3rd,4th and 6th nerve, the presence of opthalmoplegia as well as nystagmus to rule out PICA thrombosis.
Good try:) This are just examples....dun get too indulged in it. As u go along u will know more :)
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