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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 touch Proprioception N N N N N N N [...]
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 [...]
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 [...]
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/ [...]
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 note. DHx Verapamil (as treatment for AF) Amlodipine [...]