Nerve II

A 30 year old woman undergoes a prolonged pelvic surgery in lithotomy position. Post-operatively, she is noted to have acute foot drop. She cannot dorsiflex her foot against resistance; in order to walk, she has to flex her hip higher when walking. She also complains of loss of sensation over the top of her foot. Although she cannot evert her foot, inversion is preserved.

Challenge: Where's the lesion?

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Nerve I

This week, we're going to do some peripheral nerve palsies because I happen to be very weak (pun intended) on them.

A 30 year old man presents with wrist drop. On examination, he has weakness of his finger and wrist extensors. He also has loss of sensation over the dorsum of his hand. Triceps strength is normal. You give the patient some thiamine because of alcohol use, but that doesn't change anything.

Challenge: What's the lesion?

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No Cases This Week

Hi everyone,

Thanks for supporting this blog. As my yearly in-training exam looms nearer, I'm going to take a week off to study. Check in next Monday.

Thanks,
Craig

Nemo

I hope everyone is safe, warm, and healthy. The picture above is from the recent snowstorm in the Northeast, shown under GNU Free Documentation License, from Wikipedia.

Say a patient is pulled out of the vehicle above. She is brought to the emergency department, minimally responsive with a core temperature of 30 degrees. Her hematocrit is 36 (reference range 35.4-44.4). Her finger stick glucose is elevated to 200, and she is given insulin. From the extraction, she has some cuts and abrasions that continue to bleed. Despite a normal PT, PTT, and INR, you consider giving her clotting factors.

Challenge: Are you worried about the hematocrit? Tell me about the insulin. And would you give her some FFP?

Resistant

Two patients present with the same disease. A 60 year old man with three vessel coronary artery disease presents for a routine coronary artery bypass surgery. The surgery is uneventful until the team prepares to go onto bypass. Administration of a weight-based dose of heparin has very little effect on the patient's activated clotting time. His 25 year old daughter presents with her second episode of an unprovoked deep vein thrombosis.

Challenge: What's going on?

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Helium

Challenge: What is this?

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