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Neurology: Dr.
Murphy’s Clinical Vignettes
Lumbar Radic
| 50
y/o with low back pain:
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O/E:
Motor 4/5 left quads; 5/5 left adductor longus; otherwise 5/5 strength
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Sensation:
decreased over anterior left thigh
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DTR’s:
2 plus except absent left patellar jerk
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| 50
y/o with LBP:
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O/E:
Motor 4/5 right ankle flexion
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Sens:
decreased
pinpprick (pp)/light touch(lt) over lateral surface right foot and dorsal calf
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DTR’s:
2 plus except absent right ankle jerk
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| 50
y/o with LBP:
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O/E:
Motor -
4/5 left ankle extension, ankle inversion and eversion, 2/5 EHL.
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Sens:
decreased pp/lt over left lateral calf and dorsal foot
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DTR’s:
2 plus symm
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| 50
y/o with LBP: |
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O/E:
Motor 4/5 right knee extensors and hip adductors
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Sens: decreased pp right medial calf
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DTR
‘s: 0
right patellar jerk
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| 50
y/o with LBP:
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O/E:
Motor- 1/5 left ankle extension, eversion, EHL; 4/5 ankle inversion
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Sens:
decreased left lateral calf and foot
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DTR’s:
1 plus and symm
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| 50
y/o with LBP:
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O/E:
Motor- 2/5 right hip flexors
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Sens:
decreased sharp and temp over right anterior thigh
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DTR’s:
1 plus right patellar, otherwise 2 plus |
Cervical
Radic
| 60
Y/O with neck pain:
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O/E:
Motor 4/5 right biceps, deltoid
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Sens: decreased pp over right
biceps
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DTR’s: 0 right biceps
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| 60
Y/O with neck pain:
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O/E:
Motor 3/5 left triceps; wrist extensors
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Sens: decreased left dorsal
hand
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DTR’s:
0 left triceps
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| 60
Y/O with neck pain:
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O/E:
Motor 4/5 right grip |
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Sens: decreased right radial
palm, including radial aspect 4th digit Positive
tinel’s
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DTR’s: 2 plus symm
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| 60
Y/O with neck pain:
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O/E:
Motor 2/5 right triceps and wrist flexors
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Sens: decreased right long
finger and 3rd MCP joint
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DTR’s: 0 right triceps
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| 60
Y/O with neck pain:
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O/E: Motor 4/5 left forearm pronation/suppination; wrist extension
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Sens: decreased left digits 1
&2 and radial forearm
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DTR’s: 1/3 left
brachioradialis
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| 60
Y/O with neck pain:
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O/E: Motor 4/5 left grip
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Sens: decreased left
digits 4 (ulnar aspect) & 5 and hypothenar area
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DTR’s: 2 plus and symm
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CVA
| 70
Y/O complaining of weakness:
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O/E:
MSE normal
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CN: left homonymous hemianopia (macular sparing)
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Motor: 5/5
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Sens: intact
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DTR’s: symm with downgoing toes
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| 70
Y/O with weakness:
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O/E:
MSE: non-fluent aphasia
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CN: right homonymous hemianopia; right facial droop and sensory loss
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Motor: 2/5 right arm; 5/5 right leg
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Sens: decreased right arm
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DTR’s: 3/3 right arm, 2/3 leg, upgoing right toe
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| 70
Y/O with weakness:
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O/E:
MSE: scanning (ataxic) speech
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CN: nystagmus R>L lateral gaze
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Motor: 5/5
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Sens : intact
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Coord: ataxic right finger-nose-finger, heel to shin.
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DTR’s 1/3 symm with downgoing toes
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| 70
Y/O with weakness:
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O/E:
MSE: unremarkable
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CN: left facial droop
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Motor: 3/5 left arm/leg
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Sens: intact bilaterally
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DTR’s : 1/3 left arm/ leg with upgoing left toe
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| 70
Y/O with weakness:
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O/E:
MSE: left neglect
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CN: left facial droop and sensory loss; right gaze deviation
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Motor: 3/5 left arm; 4/5
left leg
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Sens:
questionable decrease sharp left arm/leg; extinguishes on left with dual sensory
stimulation.
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DTR’s:
3/3 left arm, leg, upgoing left toe
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| 70
Y/O with weakness:
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O/E:
MSE normal
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CN: right facial numbness
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Motor: 5/5 bilaterally
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Sens: decrease to all primary modalities on the right
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DTR’s : 2/3 symm, bilateral downgoing toes |
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