Alhamdulillah the long and short cases were finished yesterday with countless thanks to Dear God. As a good bunch of my friends elsewhere have yet to get their short and long cases over with, I am going to share a couple of questions that I was asked during the cases, just if they would be of some help ;). These are upon discussions with some friends after we did the cases. Let me know if you think otherwise okay.
[E= Examiner, S= Student, P= Patient]
An overweight gentleman in his 60s sitting in a chair with a cast on his right forearm.
E: I want you to assess this gentleman's speech.
S: Ok. Hi my name is Sarah a final year medical student (looking at the patient). I'm going go ask you some questions and give you some instructions for you to follow, is that ok?
P nodded.
S: May I know are you right- or left-handed?
P showed his right hand.
S: May I know are you right- or left-handed?
P showed his right hand.
S: Ok can you describe the room for me?
P: errhmmerrhmmerghh.. (with fingers pointing to what he was saying, quite decipherable but with marked difficulty).
E: What are you assessing there?
S: Expressive dysphasia.
E: Ok. Is there a problem?
S: Yes, he has difficulty with the expression. E nodded.
S: I'm going to give you some instructions for you to follow and I want you to do them when I say 'now' alright. Close your eyes, lift up your left hand and touch your left ear. Now.
P closed his eyes, lifted up his left hand and touched his left ear. Perfecto!
E: So what are you assessing there?
S: Receptive dysphasia.
E: Any problems there?
S: He is able to follow the instructions correctly so no receptive dysphasia.
E: Ok. Do you want to ask him about names now?
S: Yes. Looking at patient. Can you tell me what is that? Pointing at a glass of water.
P: errghher j-u-g aaaa-o-ff-- waa--ter---r
E: What did he say there?
S: A jug of water.
E: Is there a problem?
S: Yes. It wasn't a jug!
E: Ok continue.
S: Would you like me to continue with the naming?
E: Hmm no. So having done the tests so far where do you think the problem is?
S: He has expressive dysphasia so the lesion is in the Broca's area.
E: Ok now look at the patient's face. What do you see?
S: The face nearly looked normal to my eyes so I decided to ask him a question. Can you smile for me, a wide smile.
P smiled. Very minimal weakness that it was difficult to ascertain whether that was due to poor effort.
S: Can you close your eyes really tight?
P closed his eyes. I was a bit unsure because both eyes were closed equally tightly. Should have tried to open them but wasn't too confident as was just asked to observe.
E: What do you see there?
S: Some drooping of one side of the face.
E: Which side?
S: Patient's right side.
E: Whereabout, show it to me.
S used her finger to point at the right nasolabial fold.
E: What do you think is happening?
S: Facial nerve palsy.
E: How would you further distiguish the types?
I knew he was going to ask me this!
S: Can you wrinkle your forehead please?
No problems wrinkling the forehead.
E: What does that mean?
S: The patient is able to wrinkle his forehead which means that the forehead is spared. This is an upper motor neuron lesion.
E: Alright now look at the patient's right arm, what do you see?
S: There's a cast on the patient's right forearm.
E: What do you think has happened to the patient?
S: Syncope...er stroke.
E: Stroke! Which lobe and which side is it?
S: Left frontal lobe. Broca's is in the inferior frontal gyrus to be exact. Contralateral side in this case.
E: What is the blood supply to that part of the brain?
S: Middle cerebral artery.
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If you managed to do this quicker the examination could go on into the causes of facial nerve palsy, management of different types of stroke as such. So if you get this, do it way better ya.
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| Thanks juniors! So schweet :). Only noticed this today in the surau, after the exams :S. It's the thought that counts after all isn't it? |
[To be continued]
P/s:
- Make prayers for us the Galwegian final meds pleasee ;) ;) ;). Thanks loves.
- I'm doing neurology for the intern shadowing which starts tomorrow week. Does this mean I should become a neurologist, or a neurosurgeon hmm...
- Next case: How do you know if an AFib is stable or deteriorating?
