Question

62 year old African male mechanic
chief complaint: weakness and lightheadedness of 5 weeks' duration
previous health and illness : Noncontributory

Present illness: until 1 yr ago, the patient was entirely well. At the time, he had to give up his weekly game of bowling because it made him too tired. During the next 8 months , he noted increasing fatigue, inability to concentrate on his work, and irritability. Five weeks ago, he noted unsteadiness of gait, particularly in the evening , numbness and tingling in his fingers and toes, and burning of the tongue. For the last few weeks his appetite has been poor, and has lost 12 pounds .

physical examination:
temp 99.2o F
P: 100/minute
R:12/minute Blood pressure: 130/88 mm Hg
HEENT: Scleral icterus. Conjunctivalpallor
Redden atrophic tongue
Heart: slightly enlarged to percussion
Regular rhythm: 2/6 apical systolic murmur w/o transmission
Neurological status: Ataxic gait. Positive Romberg test . Loss of position and vibration sense in the lower extremities
Impairment of recent memory

Diagnosis, Rationale?
Etiology, pathophysiology, prevalence,predisposing factors, clinical presentation and methods to diagnose.
Treatment plan , adverse effects are possible, patient had to be aware.

Answer 1

Answer :

The diagnosis of the disease is " peripheral neuropathy "

Because, the patient is having symptoms like weaknesses, and light headedness, increasing in fatigue, inability to concentrate on any works, and irritability, unsteady ness of gait, and tingling and numbness of fingers and toes, burning of the tongue,

These are signs and symptoms may seen in the patients with neurological disorder like loss of neurons functions that is peripheral neuropathy.

So the diagnosis is peripheral neuropathy.

Etiology :

* diabetis,

* chemo- indused neuropathy

* Heriditoty disorders,

* inflammatory diseases,

* autoimmuno diseases,

* protein abnormalities,

* exposure to toxic chemicals

* chronic alcoholism these are the causes or etiology.

Pathophysiology :

* due to any etiological factors there is an infection and inflammation of the neurons,

* there is a damage of the axon and myeline sheet, or cell body.

* it leads to there is no reflexes to the body parts, and there is a loss of sensation and memory loss ect.

Prevalence :

This disease is very rare in the age of 1 to 18 years.

And it is very common in 19 to 60 years.

Predisposing factors :

Prior exposure to neurotoxic drugs,

Vitamin deficiencies like vit B12, folate and B1 and B6.

Thyroid dysfunction

Alcohol exposure,

These are the predisposing factors.

Methods of diagnosis :

* vitamin deficiency test,

* immunoglobuline tests,

* diabetes test,

* imaging studies like CT SCAN, MRI, ect.

Treatment :

* analgesics like nonsteroidal anti inflammatory drugs,

* anti seizure medications, like gabapentine.

* vitamin administration like vitamins B 12, folate, vit B6 ect.