PBL 3 session 2

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PBL 3 session 2 by Mind Map: PBL 3 session 2

1. Step 8

1.1. Diagnostic decision

1.1.1. Lateral medulla syndrome

1.2. Mechanism

1.2.1. left lateral medulla infarction

1.3. Presentation

1.3.1. hoarse speech

1.3.2. nausea and vomiting

1.3.3. loss of consiousness

1.3.4. loss of pain and sensation contralateral in the body

1.3.5. loss of temp ipsilateral in the face

1.4. Supporting data

1.4.1. MRI

1.4.2. MRA

1.4.3. doppler

1.4.4. hx and physical exam.

1.5. 10 minutes

2. Step 6

2.1. Review session 1

2.2. Report new knowledge

2.2.1. anatomy of the brain blood supply

2.2.2. centers in the brain

2.2.2.1. consiousness

2.2.2.2. vomiting

2.2.2.3. nausea

2.2.2.4. speech

2.2.3. ischemic stroke

2.2.3.1. epidemiology

2.2.3.2. etiology

2.2.3.3. pathogenisis

2.2.3.4. diagnosis

2.3. 30 minutes

2.3.1. The scribe does not have to write in this step!

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain

3.1.1.1. 69 yo

3.1.1.2. 2 days before

3.1.1.2.1. experiened funny turn, sudden dizziness, nauseam loss of balance and vomiting

3.1.1.2.2. she layed down

3.1.1.2.3. lasing 30-60 min

3.1.1.2.4. she was normal before that

3.1.1.3. while walking out, she suddnly became nausous and collapsed and striking in her left limp

3.1.1.4. could not remember the accedent

3.1.1.5. presented to ED 60 min after the event

3.1.2. Previous medical / surgical history

3.1.2.1. 10 year history of HTN

3.1.2.1.1. last reading 145/85

3.1.2.1.2. taking diuretic

3.1.2.2. serum level the last year was normal

3.1.3. Drug history / allergy

3.1.4. Family history

3.1.4.1. parents died

3.1.4.1.1. father from: Heart attack

3.1.4.1.2. mother from: cancer

3.1.4.2. 65 sister, alive

3.1.5. Social / occupational history

3.1.5.1. collecting materials

3.1.5.2. academic retiered

3.1.5.3. lives with her husband in small house

3.1.5.4. 2 adult sons, 1 daughter

3.1.6. Systemic review

3.1.7. Physical examination

3.1.7.1. vital signs

3.1.7.1.1. afebrile

3.1.7.1.2. pulse 95

3.1.7.1.3. BP 170/100

3.1.7.1.4. RR 16

3.1.7.2. inspection

3.1.7.2.1. briuse left hip but can move the limp easily

3.1.7.3. neurological examination

3.1.7.3.1. alert and oreinted

3.1.7.3.2. hoarse speech with no dysphasic errors

3.1.7.3.3. neck briut?

3.1.7.3.4. has absence pain and sensation in left face to posterior of the ear and superior top crown of head

3.1.7.3.5. power in all limps and trunk are normal

3.1.7.3.6. pupil examination?

3.1.7.3.7. nystagmus to the left

3.1.7.3.8. difficult swallowing water coughs and slutters

3.1.7.3.9. poor movement of lift side of palate

3.1.7.3.10. pain and temp on right side are severely diminished

3.1.7.3.11. light touch & vibration are intact

3.1.7.3.12. intention tremor on left finger

3.1.8. tests results

3.1.8.1. ECG

3.1.8.1.1. mild LVH

3.1.8.2. CT

3.1.8.2.1. 3 hours after event

3.1.8.3. MRI

3.1.8.3.1. acute infarct in left lateral medulla

3.1.8.4. MRA

3.1.8.4.1. left vertebral artery was torturous

3.1.8.4.2. suggestive of thrombus

3.1.8.4.3. right vertebral artery cannot be seen

3.1.8.5. doppler

3.1.8.5.1. reduced flow in both vertebral arteries

3.1.8.6. Echo

3.1.8.6.1. mild LVH but normal volume and contraction

3.2. 50 minutes