Key physical exam vital signs including orthostatic

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Key Physical Exam Vital signs, including orthostatic&; complete neurologic exam; carotid and cardiac exam; lWlg exam; exam of the lower extremities. Presentation 26 yo M presents after falling and losing conscious, ness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused after regaining con, sciousness (as witnessed by his colleagues). • 55 yo M c/o falling after feeling dizzy and Wlsteady. 90 He experienced transient loss of consciousness. His past medical history is significant for hypertension and diabetes mellitus. Differential Generalhed tonic,donic Convulsive syncope Substance abuse/ overdose Malingering Hypoglycemia Drug,induced orthostatic hypotension (causing syncope) Hypoglycemia Cardiac arrhythmia Syncope (vasovagal, other causes) Stroke MI Pulmonary embolism Workup CBC Electrolytes, glucose Urine toxicology EEG MRI-brain CT-head LP-CSF analysis ECG Orthostatic vital signs CBC Electrolytes, glucose Echocardiography CT-head ECG V/Qscan eTA-chest with N contrast o,dimer
LOSS OF CONSCIOUSNESS (cont'd) Presentation 65 yo M presents after falling and losing conscious· ness for a few seconds. He had no warning before passing out, but recently had palpitations. His his· tory includes a coronary artery bypass graft. NUMBNESS/WEAKNESS Key History Differential Cardiac arrhythmia {causing syncope) Severe aortic stenosis Syncope (other causes) Seizure Pulmonary embolism Workup ECG Holter monitoring CBC Electrolytes, glucose Echocardiography CT-head Onset (acute, subacute, chronic, relapsing); distribution (unilateral, bilateral, proximal, distal); duration; progression; pain (especially headache, neck or back pain); constitutional symptoms, other neurologic symptoms; history of diabe· tes, alcoholism, atherosclerotic vascular disease. Key Physical Exam Vital signs; neurologic and musculoskeletal exams; relevant vascular exam. Presentation 53 yo M presents following a 20·minute episode of righr.sided arm and face numbness. His symptoms had totally resolved by the time he got to the emer· gency department. He has a history of hyperten· sion, migraine, diabetes mellitus, and heavy smoking. Physical examination is within normal limits. • 68 yo M presents with slurred speech, right facial drooping and numbness, and right hand weakness. Babinski sign is present on the right, he has weak· ness of the right side of his body. and his deep tendon reflexes are brisk. He has a history of hypertension, diabetes mellitus, and heavy smoking. Differential Transient ischemic attack (TIA) Stroke Migraine with sensory aura Hypoglycemia Seizure with Todd paresis Stroke TIA Seizure with Todd paresis Intracranial neoplasm Subdural or epidural hematoma Hypoglycemia Workup CT-head CBC Electrolytes, glucose Fasting lipid panel ECG MRI-brain, with DWI Doppler U/S-carotid Echocardiography EEG CT-head CBC Electrolytes, glucose PT/PTT/INR Fasting lipid panel MRI-brain, with DWI MRA Doppler U/S-carotid Echocardiography ECG 91
NUMBNESS/WEAKNESS (cont'd) Presentation

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