Reference no: EM133907444
Case Study : Neurological
Chief Complaint: I feel dizzy and the room is spinning
HPI:
Ms. B. a 45-year-old college professor comes to an urgent care clinic complaining of dizziness that has persisted for the past week. The symptoms started abruptly. She feels like the room is spinning around. The dizziness is worse when she moves from lying down to sitting up. The sensation lasts a few seconds and then goes away, but it causes her to feel nauseated. The first day the symptoms occurred, she vomited. She reports no fever, chills, weight loss, or night sweats. She does recall having an upper respiratory infection 2 weeks before the onset of the dizziness.
Ms. B has smoked one pack of cigarettes per day since the age of 15. She drinks alcohol at social events. She denies illicit drug use. She is divorced and has two young teenage sons.
She has a history of allergic rhinitis, for which she is currently not taking medications. Her sons were delivered by Caesarean section.
Her mother died in a mother vehicle accident when she was a young child; her father died of a heart attack at the age of 70 and had diabetes.
Objective Data
Vital signs: T 99.3 P 65 R 14 BP 110/75
Lungs: Resonant breath sounds vesicular
O2 Sat = 100%
CV = JVP 6cm above right atrium; carotid upstrokes brisk, without bruits
Good S1, S2: no S3, S4; no murmurs, rubs or clicks.
HEENT= PERLA. external ear canal patent; tympanic membrane with good cone of light
MUSK= full Range of motion in all joints
Neurological= Mental status: oriented to person, place and time.
Cranial nerves: CN II through XII intact including extraocular motion
Motor: good bulk and tone; strength 5/5 throughout
Cerebellar: Nystagmus with leftward gaze; RAMs, finger to nose, and
Heel to shin intact; gait with normal base.
Sensory: Pinprick and light tough are intact and symmetric
throughout.
Reflexes: 2+ and symmetric, with toes downgoing
Questions:
1. List and describe three tests of cerebellar function.
2. Describe the method of testing the sensory system for pain, temperature, touch, vibration and position that you believed was used during this assessment.
3. Give three differential diagnoses for the above listed patient (provide rational for your answers).