55 y.o man with trouble walking

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55 y.o man with trouble walking by Mind Map: 55 y.o man with trouble walking

1. chronic weakness and possible vestibular dysfunction

1.1. Very likelyy

1.1.1. Parkinson's

1.1.1.1. Stooped posture, short steps, retropulsion

1.1.1.2. No tremor

1.1.1.3. Workup

1.1.1.3.1. MRI

1.2. Moderately likely

1.2.1. Multiple sclerosis

1.2.1.1. :arrow_up: What findings increase disease probability?

1.2.1.1.1. Narrow-based gait

1.2.1.1.2. Hypertonia of legs

1.2.1.2. :arrow_down: What findings decrease disease probability?

1.2.1.2.1. Above age of 40

1.2.1.2.2. Male

1.2.1.3. Workup

1.2.1.3.1. MRI

1.3. Unlikely

1.3.1. ALS

1.3.1.1. :arrow_up: What findings increase disease probability?

1.3.1.1.1. Muscle weakness

1.3.1.2. :arrow_down: What findings decrease disease probability?

1.3.1.2.1. No muscle atrophy, no fasciculations, normal reflexes, no sensory deficits

1.3.1.3. Workup

1.4. Cant miss

1.4.1. Stroke

1.4.2. Cancer

1.4.3. Hydrocephalus

2. History

2.1. Social

2.1.1. Married

2.1.2. Security guard

2.1.3. 2 drinks of wine a night

2.2. Medical

2.2.1. HTN

2.2.1.1. lisinopril

2.2.2. Diabetes

2.2.2.1. Metformin

2.2.3. Other meds

2.2.3.1. Turmeric

2.2.3.2. Vitamin C

2.3. Family

2.3.1. Father stroke, HF

2.3.2. Mother DM, HTN

3. Present Illness

3.1. Trouble walking

3.1.1. Months

3.1.2. Hard to get out of chair

3.2. ROS

3.2.1. Nearly fallen

3.2.2. no changes urine or bowel movement

4. PE/data