The Student Room Group

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Reply 20
Revenged
lol... tell me about it... i once had a nose bleed in a night club and it took me about 30 minutes to notice... i left the building looking like i'd been in WW2...

:biggrin:
I was thinking more of the mate who picked a fight with a moving tube.

Fortunately, rather than one-under himself, he got a nasty bump on the head and a bit of concussion...
Reply 21
Jamie
I remember leaving cambridge after 3 years of pre-clinical medicine, and realising i could write down the inflammatory cascades and pain pathways of someone with a sprained ankle, but i wouldnt actually have a clue how to help them...
Tis classic pre-clin syndrome though isn't it?
Reply 22
Renal
Tis classic pre-clin syndrome though isn't it?


computer says no...
Reply 23
lecturer didn't even bother to turn up today for a 9am lecture... so i'm a bit annoyed i had to wake up for nothing... here is another case study i found on the web...

A successful 48-year old attorney was told he was hypertensive, but did not take his blood pressure medications. He was apparently well until 4 days after his birthday, when he developed several episodes of blurred vision, "like a shade coming down," involving his left eye. These attacks each lasted less than an hour. He was referred for neurologic evaluation but because of a busy schedule, canceled the appointment. Several weeks later, he complained to his wife of a left-sided headache. She found him 1/2 hour later, slumped in a chair apparently confused and paralyzed on the right side.
Neurologic examination in the hospital revealed total paralysis of the right arm and severe weakness of the right face. The leg was only mildly affected. Deep tendon reflexes were initially depressed on the right side, but within several days, became hyperactive; there was Babinsky response on the right. The patient was globally aphasic; he was unable to produce any intelligible speech and appeared to understand only very simple phrases. A CT scan revealed an infarct in the territory of the middle cerebral artery of the left side. Angiography revealed occlusion of the internal carotid artery. The patient recovered only minimally.

Questions
The patient was hypertensive. Is that a factor in this case?

If he had gone for his neurological examination, what could have been done?

He had the headache and visual problems on the left side but had motor problems on the right. How do you explain that?

Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?

The patient was globally aphasic. What does that tell you about the area involved in the lesion?
Reply 24
I hate neuro, I can't be arsed with this. Pass.
Reply 25
that's what happens to you when you are up at 6 am renal... i just copied and pasted from the web... no-one said you had to do it... lol...
Reply 26
Revenged
lecturer didn't even bother to turn up today for a 9am lecture... so i'm a bit annoyed i had to wake up for nothing... here is another case study i found on the web...

A successful 48-year old attorney was told he was hypertensive, but did not take his blood pressure medications. He was apparently well until 4 days after his birthday, when he developed several episodes of blurred vision, "like a shade coming down," involving his left eye. These attacks each lasted less than an hour. He was referred for neurologic evaluation but because of a busy schedule, canceled the appointment. Several weeks later, he complained to his wife of a left-sided headache. She found him 1/2 hour later, slumped in a chair apparently confused and paralyzed on the right side.
Neurologic examination in the hospital revealed total paralysis of the right arm and severe weakness of the right face. The leg was only mildly affected. Deep tendon reflexes were initially depressed on the right side, but within several days, became hyperactive; there was Babinsky response on the right. The patient was globally aphasic; he was unable to produce any intelligible speech and appeared to understand only very simple phrases. A CT scan revealed an infarct in the territory of the middle cerebral artery of the left side. Angiography revealed occlusion of the internal carotid artery. The patient recovered only minimally.

Questions
The patient was hypertensive. Is that a factor in this case?

If he had gone for his neurological examination, what could have been done?

He had the headache and visual problems on the left side but had motor problems on the right. How do you explain that?

Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?

The patient was globally aphasic. What does that tell you about the area involved in the lesion?

yes the fact he was hypertensive was important.

had he gone for the neurological exam he would have been told to change his lifestyle + take the anti-hypertensives?

erm, cause the nerves cross over?

what's *global* aphasia? either broca's area or wernickes? If by global you mean receptive aphasia, Wernicke's area's affected.

What are the actual answers??

edit: and the right arm and face were more affected than the leg because it was an MCA stroke and this doesn't supply the legs, the ACA does.
Reply 27
The patient was hypertensive. Is that a factor in this case?
Yes - risk of stroke
If he had gone for his neurological examination, what could have been done?
Carotid endarterectomy? or other such intervention
He had the headache and visual problems on the left side but had motor problems on the right. How do you explain that?
contralateral effects on motor nerves
Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?
? No idea, something about anatomy...
The patient was globally aphasic. What does that tell you about the area involved in the lesion?
? erm..that its knocked out the speech and language centres in left side of the brain
Reply 28
-->Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?

Middle Cerebral Artery.

-->Global Aphasia

Characteristic of large lesion that is supplied by the MCA (the entire MCA territory) leading to left side blowout of Wenicke's and Broca's area.
Revenged
lecturer didn't even bother to turn up today for a 9am lecture... so i'm a bit annoyed i had to wake up for nothing... here is another case study i found on the web...

A successful 48-year old attorney was told he was hypertensive, but did not take his blood pressure medications. He was apparently well until 4 days after his birthday, when he developed several episodes of blurred vision, "like a shade coming down," involving his left eye. These attacks each lasted less than an hour. He was referred for neurologic evaluation but because of a busy schedule, canceled the appointment. Several weeks later, he complained to his wife of a left-sided headache. She found him 1/2 hour later, slumped in a chair apparently confused and paralyzed on the right side.
Neurologic examination in the hospital revealed total paralysis of the right arm and severe weakness of the right face. The leg was only mildly affected. Deep tendon reflexes were initially depressed on the right side, but within several days, became hyperactive; there was Babinsky response on the right. The patient was globally aphasic; he was unable to produce any intelligible speech and appeared to understand only very simple phrases. A CT scan revealed an infarct in the territory of the middle cerebral artery of the left side. Angiography revealed occlusion of the internal carotid artery. The patient recovered only minimally.

Questions
The patient was hypertensive. Is that a factor in this case?

If he had gone for his neurological examination, what could have been done?

He had the headache and visual problems on the left side but had motor problems on the right. How do you explain that?

Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?

The patient was globally aphasic. What does that tell you about the area involved in the lesion?



mmmm k, will try to answer before looking at what others have said.
"like a shade coming down," - blatantly amaurusis fujax/TIA so at high risk then of CVA

The patient was hypertensive. Is that a factor in this case?

Yes. Even though the TIA/CVAs were caused by thrombotic events rather than haemorrhage, the hypertension increases the risk of turning a stable plaque intoan unstable one firing off thrombi.

If he had gone for his neurological examination, what could have been done?

well he was a tool for not taking his meds, but they would have dopplered his neck and no doubt found a big plaque in one of his carotids. they would then have warfarinised him plus aspirin to decrease his risk of a clot. O and put him on statin to stabalise the plaque.
or if at a big hospital they might have stented his necck (or endartarectomy) as an emergency.

He had the headache and visual problems on the left side but had motor problems on the right. How do you explain that?
Left side of brain supplies motor to right side of body.

Why was the right arm and face more affected than the leg? What does this tell you about which area/blood vessel was involved?

well i can't specify which branch of the MCA it was, but i thikn the medial sulcus area is the bit where leg motor function arise from, whereas face and arm is more lateral and inferior on the brain.

The patient was globally aphasic. What does that tell you about the area involved in the lesion?
well speech is sually left hemisphere, and is on the lateral, parietal aspect of the brain. theres lots of different areas that give aphasia though.
I'm guessing this 'tells you' the area affected is quite large?
Reply 30
Saffie
what's *global* aphasia? either broca's area or wernickes? If by global you mean receptive aphasia, Wernicke's area's affected.


two types of aphasia... broca's and wernicke's

broca's aphasia - patient can't talk but can understand
wernicke's apahasia - patient can talk but can't undersand (i.e. talks load of rubbish)

so seems that both broca's and wernicke's areas are effected like muse said...

'intelligible speech and appeared to understand only very simple phrases.'

answers are here... if you want...

http://www.indiana.edu/~m555/cases/blood1.html

there are quite a few more case studies if you need practice... or you can do what i do and read the answers and then try to work out what is going on...
Helenia
Am I being really stupid to think it's a pneumothorax for the first one?

No I dont think you are. I had that question in a pharmacy final 10years ago so they are really recycling.
pharmgirl
No I dont think you are. I had that question in a pharmacy final 10years ago so they are really recycling.


Gosh, patients are so boring! They keep coming down with the same conditions year after year...:rolleyes:
friendlyneutron
Gosh, patients are so boring! They keep coming down with the same conditions year after year...:rolleyes:


:biggrin:
Jamie
mmmm k

Is that intentionally like Mr Mackey? :p:
Jamie
they would have dopplered his neck
What is dopplering - running an ECG? :confused:
It's an imaging technique to monitor blood flow iirc.
Reply 37
Ron Stoppable
What is dopplering - running an ECG? :confused:

No, it's a kind of ultrasound, which measures flow in various vessels (using Doppler shift - something to do with frequency changing as you go past a fixed point?). You can get little mini probes which just repeat the signal they get as noise (which you use for things like checking patency of vessels in the lower limbs) and you can get much more sophisticated machines which create images and you can do all sorts of calculations with them. It sounds a lot cooler than it looks though.
OH gosh we did this in physics just recently. and the peak or something is double the time or distance or something because that's the time to get there and back. :p: I should have been more attentive.
Helenia
No, it's a kind of ultrasound, which measures flow in various vessels (using Doppler shift - something to do with frequency changing as you go past a fixed point?). You can get little mini probes which just repeat the signal they get as noise (which you use for things like checking patency of vessels in the lower limbs) and you can get much more sophisticated machines which create images and you can do all sorts of calculations with them. It sounds a lot cooler than it looks though.
Coolio - thanks for the explanation! How does it know which vessel to measure in an area of high vascular proliferation?

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