Question

15 1. Angel (23 yo male) is involved in a hunting accident. He's brought into Hospital with a GSW to the R thigh. Vitals are stabilized & patient is awaiting surgery. Neuro exam shows no R patellar tendon reflex and 1/5 muscle strength in quadriceps group. Patient has no sensitivity to light touch or pressure to his Ranterior thigh. What is the likely neuro diagnosis? What additional tests would you order? Prognosis? Please explain your reasoning. 2: Kelly (36 yo female) presents to clinic reporting that she has been clumsy lately. She exhibits some unsteadiness as she walks into the exam room & has a slight tremor when she reaches to shake your hand. She is ALOX3 with normal cognition and a pleasant affect. No pain, numbness or tingling. She has no muscle weakness, but her patellar tendon reflex tests elicit multiple oscillations. Name a few possible neurg diagnoses & tell me which is most likely? What additional tests would you order to rule out/confirm. Please explain your reasoning 3. Guillan-Barre Syndrome & Amyotrophic Lateral Sclerosis can both lead to paralysis. Compare/Contrast these conditions. Please include terms of etiology, symptoms and prognosis. 4. How do meds like Lexapro & Zoloft improve symptoms of depression? Explain the mechanism of action at the synaptic level and the level of conscious mood. Side effects? 5. Which is typically more serious: a hemorrhagic stroke or an ischemic stroke? Please compare/contrast these & explain the mechanisms of tissue injury in your answer.

Answer 1

" As, the patient's R patellar tendon reflex is absent so, there could be spinal cord injury I as patellar tendon reflex is a stretch reflex which tests the L L and a deqmcuts of spinal cod. do, Dieguesis - Spinal cord inpery: Additional testa z " X-Ray - Wee to rule out any vertebral problem, fractures is degeneratie clanges in dopine. ü) et sean - Cross sectional ēmage that can define bone, dislil other pooblenils. ie) MRL - Look out for any blood clots or other manes wherneation én speical cordia 1) Electromyography EMG) - measures elvetical activity of skeletal muscles at reat; identification of offected musde » ABG Analysis. iz complete Blood Count (be) & WBC court. There is always someshope of recovering some function ē SCI.. As the patient's left side is not affected only the right thigh is affected so, the sooner treatments are imple- mehrted to strengthen meis eles below the level of scI, the better the prognosis. The use of pleysical and occu- pational therapy during this time is the key to recovere patronen the extent of the function fully returning is typically seen in the first two years after initial enjury Scanned with CamScanner Th ilemjeezy.

2. Clo No muscle weakness, No реаи, пиль им са {tuliuү, o Patellar tendon rellent but a multiple .. Few poasible nelerd deaquosis are - oscillations, ? neiero deaguosisao i spinal cord damage, ii) Spinal cord lesion, vel cerebellar disease like cerebellar ataria 1) repper motor neuron lesion. Aeccoding to me the most likely diagnoses is - cerebellero atisieã. . • Additional fests to confirme the desquosis - E) CT Lean (competed Tomography) e) MRI (Magnetic Resonance maging) re) Lembar & panelure (spinal tapo w Genetic testing - To rule out for any genetic T mutation that causes one of the hereditary ataxee conditions Scanned with CamScanner

*** i ndoomme. Arroyotropkic lateral Sclerosis weakness - Neute, fregueully severe T-Falal system, omil fulminami pole, nousitis be marresive mero de that I obecbis the momen meninas em of the ene nounous, prouting amweli male penalysi! P Tlcology - unkum - Mulpimmune, sultings in pa Etiology ov - awknоwlемя mainly all menant. ✓ Acol - Samplona Symptoms --! Teyling, Panarollinaia - Mode aches I cramps - Weakners.of distal upper limbs endlinge type of paralysis (tarting from 1 + Weaknero Pongrenet inbesiedle feel) ! towards feet) ! my Roebbenej ligs. 7 Dysarthrian - Areflexic motor paralysis bysphagia I drooling will or wilhoulsensory distur. 1 bauces Prov anosis Prognosis PAS me overe, may take an Outlook for Als is poor, Dith long are year or more, most most pts dying of it, typically patients roceover completely foom resperatory failure abeet some have rendica L. Weak non , nicembram lucranioual pain . CamScanner

Juhaptie bloemen enphie Gizohet :00 is released on . .Sy kapse, 4. Lexapro & Zoloff improne Preo' l 55R! romptoms of depression - both are Selective Serotonen Receptake ending Inhibitor (SSRIs) ..Michanism of action Serotonite Inerences intoaeginapfie levels of neurotransmitter pro naptic par A verse Receptor deotesin by blocking the ending . sites receptake of neurotransmitter into presynaptic neuron their enhancing actious of serotonen on 5HTIA autoreceptors & thirs reducing cs the depressive mood. C CamScanner
5.
Hemorrhage ----- ------- i Hematoma expansion Thrombin Tissue disruption Mass effect & Intracranial pressure 1 Erythrocyte lysis, hemoglobin HO-1 Blood flow Herniation ROS Heme and iron Ischemia? BBB breakdown Fenton ROS Edema Neuronal damage Inflammatory reaction Primary brain damage Secondary brain damage
in case of hemmoregic stock .

in case of ichemic strick

Deprivation of oxygen Mitochondrial failure Overproduction of reactive oxygen species Anaerobic glycolysis BBB opening lon burden in cells, activation of matrix metalloproteinases, & inflammatory responses, etc. ATP decreased Dysfunction of ion pumps lon burden in cells Water flow into the cells Acidification Vascular edema Cell swelling Cell swelling Cell death Cell death Immediate brain injury Salvageable damage within minutes - hours Delayed brain injury Partially salvageable damage within hours - days

Now,

6 Hemory dauge mun kelauwe hemorrhagic stáove not suren daugemus na gas stovke is typically more tiños damagem brain cells but also may lead to increa- cesedi pertune ou the brain or spare enco in blood vessels. camScanner