[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient was hospitalised a number of years ago.  Please examine the patient’s neurology in their arms and discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191675″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This gentleman as a right fixed flexion deformity in the upper limb, with an inability to shrug the shoulders, lift against gravity or against forcein any of the modalities in the right upper limb.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Clinical features:

A patient with right hemiparesis would present with weakness of the right side of the body. They would have difficulty in walking, holding objects in hands, difficulty in balance and coordination, problem in making precise movements and have muscle fatigue. The patient may even find it hard to move from one side of the bed to the other. This prevents the patient from leading a normal life.

Initial investigation:

The initial step in a patient presenting with hemiparesis is finding the cause of this right sided muscle weakness. To rule out the site and extent of damage, neuroimaging studies are done after taking proper history. The patient may have a prior diagnosed disease which could be the reason of this weakness. Hence, proper history with medical imaging will lead to the cause.

Underlying pathology:

Pathology within the brain caused by trauma, brain tumor, stroke or cerebral palsy may result in right hemiparesis. Damage to the left hemisphere of the cerebral cortex results in hemiparesis of contralateral, that is, of the right side. Stroke being one of the major causes of right hemiparesis may be ischemic or hemorrhagic in nature. Since damage is in the dominant hemisphere, a patient with right hemiparesis can also present with aphasia. Other causes of right hemiparesis are a tumor or a demyelinating disease such as multiple sclerosis.

Common treatments:

Treatment depends on the etiology of the hemiparesis. Managing the underlying disease might help recover from this condition. In majority of cases, rehabilitation teams that involve physiotherapist and occupational therapist are called up to help the patient regain the strength and functionality of the weak muscles. Assistive devices such as walkers, walking sticks, braces, and wheelchairs might be help those who have problem walking on their own.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has a dense right hemiparesis.  The most probable cause is a previous CVA.  I would like to investigate further with a full history, completing my clinical examination, and arranging a CT scan of the head.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]