GENERAL MEDICINE Internal assessment answer sheet

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45 M L lower limb weakness

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  A 45YR OLD MALE TRACTOR DRIVER CAME TO THE OPD WITH CHIEF COMPLAINTS OF LEFT LOWER LIMB WEAKNESS. AMC BED 2 45yr old male, Tractor driver by occupation ,came to the OPD with chief complaints of  LEFT LOWER LIMB WEAKNESS since 5 days.  Weakness only from knee to foot. Acute in onset. No any progression in weakness. No H/O vomitings fever, diarrhoea NO H/O slurring of speech                Giddiness                Normal bowel and bladder movements.  No any sensory symptoms, tingling, numbness         On last Saturday  night at 12:00AM , he had his dinner , walked into his room and slept ,all by himself. Later after that he wanted to go to washroom, he was NOT ABLE TO LIFT HIS LEFT LOWER LIMB ,if he tries to stand, he was falling off. PTCA 3YRS BACK. NOT A K/C/O DM,HTN, ASTHMA, TB, EPILEPSY. NO significant family history No significant drug history. PERSONAL HISTORY: Takes mixed diet Appetite is normal Regular bowel and bladder movements Adequate sleep Alcohol, smoking occasionally. O/
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OSCE AND LEARNING POINTS.

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OSCE:  1)Therapeutic window of stroke                   The main treatment for an ischemic stroke is a tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A healthcare provider will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke symptoms start. Drugs like  alteplase, reteplase, and tenecteplase can be used. 2)Fibronolytic therapy:        streptokinase, anisoylated plasminogen-streptokinase activator complex, urokinase, and recombinant human tissue-type plasminogen activator. All 4 of these drugs activate the fibrinolytic system by converting plasminogen to the active enzyme, plasmin. 3) Dual antiplatelet therapy vs aspirin therapy:    https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.033033 4)Frontal lobe functions parietal lobe functional tests Parietal lobe:     5)UMN LESION: - Pyramidal & Extra-Pyramidal descending tracts are involve
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A 65 yrs old female with difficulty in moving left upper and lower limbs.

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This is an online elog documenting de-identified patient health data after taking his signed consent to enforce a greater patient centered learning.  The privacy of the patient is being entirely conserved. No identifiers shall be revealed through out the piece of work whatsoever. CASE DISCUSSION : A 65 yr old female coming from Rajavaram  was brought to the casualty with   CHIEF COMPLAINTS of: Weakness in right and left upper limbs and lower limbs since 5 days Difficulty in moving left upper limbs and lower limbs since 4days. Inability to speak since 4 days.   Fever since 4 days. HOPI Patient was apparently asymptomatic 5 days back she developed weakness on Saturday in left upper and lower limbs which was sudden in onset , gradually progressed and is completely unable to move since 4 days. She is also unable to speak due to deviation of mouth later that day Next day ,the weakness of both limbs of left side became severe and completely lost her speech and not responding to commands. She
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