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Question of the day: Neurological exam

A 44 year old builder presents with weakness over the past 48 hours
A neurological exam reveals the following (N=normal):

Upper Limbs

Lower Limbs

Right

Left

Right

Left

Tone

N

reduced

N

N

Power (MRC)

4/5

4/5

3/5

4/5

Coordination

N

N

N

N

Sensation
Fine [...]

Answer to question (EMQ) of the day – a history of weakness and fatigue

Thanks for all of your great responses to our question of the day – some good analyses and discussion.
So here we go with the likely pathology …

Symmetrical findings make a central lesion less likely (they would localise).
The reflexes and sensation are intact, making a cord or peripheral nerve lesion unlikely.
The absence of fatigability [...]

Question (EMQ) of the day – a history of weakness and fatigue

A 64 year old man presents with a history of weakness and fatigue. He has lost 3 stone in weight. On systemic enquiry, he has no other clinical symptoms, other than a mild dry cough which he has had for 3 days and some occasional dysuria, present intermittently for 6 months. His examination findings are [...]

Answer to question of the day – atrial fibrillation

The answer is….. b. Warfarin
Based on NICE Guidance 36 (AF) and the CHADS 2 scoring system.
The CHADS2 score is an excellent aide memoir to anticoagulation in AF. It is based on:

CHADS2
Stands for
Score

C
Congestive heart failure
1point

H
hypertension
1point

A
Age>75
1point

D
Diabetes Mellitus
1point

S2
Previous stroke/ TIA
2 points

SCORE

2 or over=Warfarin
1= Warfarin or aspirin
0=aspirin

This [...]

Question of the day – atrial fibrillation

A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him “dying ” as a result of the AF.
PMHx:
Hypertension (treated), Mild COPD. Nil else of [...]

Question of the day – symmetrical arthritis

A 64 year old male presents with a symmetrical arthritis of both hands (history from the GP letter) with early morning stiffness. His X-rays of his hands done before clinic show the following:
Periarticular osteoporosis of the MCP joints
Erosion on the ulnar styloid
Symmetrical distribution of disease
Reduced joint space at the carpal [...]

Medical Students approaching finals exams with new technology at their fingertips

The following weeks will represent the culmination of years of hard work by medical students over the past 1-5 years. Revision patterns have been changing and increasingly medical students are approaching final examinations preparing for them using web based MCQ, OSCE and video guides. For the first time, resources like podcasts and the like have [...]

5 reasons why you can have an international site for medical revision

Is it possible to have an international site for medical revision? There is a diverse range of assessment methods in place in today’s medical marketplace, ranging from the familiar MCQ exam, to the OSCE format that may not be so familiar to some medical students in the US or in other parts of Western Europe [...]

How are you doing?

We’ve published our latest averages on our subscription site topic by topic. This helps our users compare things with other people subscribing. Remember, people revise for their exams in many different ways so it doesn’t allow you to make a direct comparison, but it will give you some idea of how people are doing in [...]