QUIZ II

a. i.

ii.
iii. iv.

iv.
v. vi.

Esi is a 69 year old woman who complains of backache worse on lying down and aggravated by cough. She is unable to go about her normal duties because of weakness in the lower limbs. What are the causes of proximal muscle weakness? Myasthenia Gravis read Eaton-Lambert Syndrome Muscular dystrophies Polymyositis Dermatomyositis Guillain-Barr syndrome Thyrotoxicosis Acromegaly

 What

is your diagnosis? Paraparesis 2 Spinal Cord Compression

Which

questions should be asked during the history to confirm your diagnosis? band-like pain around the level of compression, stiff muscles, urinary and faecal retention, paraesthesia numbness,

 What

findings could be expected on physical examination? In the acute phase, spinal shock, so signs of LMNL i.e. tone ,reflexes. Later signs of UMNL tone, reflexes, spastic weakness, extensor plantar reflex response
What

studies should be ordered to confirm your diagnosis? i. plain x-ray of the spine; AP and Lateral ii. CT myelography iii. MRI

The consultant reviews the patients history and she has chronic cough and haemoptysis. She also has finger clubbing. f. List 2 differential diagnosis. i. Pulmonary Tuberculosis ii. Bronchogenic Carcinoma also look for Hypertrophic Pulmonary

Osteoarthropathy

In the course of the investigations, she complains of polydipsia and polyuria. g. What is the likely cause of the above symptoms? It is due paraneoplastic syndrome from the bronchial Ca caused by hypercalcaemia.

h. What laboratory test will you ask for? Serum calcium concentration and it will be elevated. The senior resident is asked to investigate the lower limb weakness. What should be done before performing radiologic studies? Dexamethasone i.v. 4mg/6h

What are the treatment options for this patient? 1. chemotherapy 2. radiotherapy 3. surgery; laminectomy
j.