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diagnose

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MDcooper
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09/22/06 - 02:38 PM

A previously healthy 50 year old woman comes to the physician bcz of double vision for three days.Her temp is 37C.The pt denies any nausea or vomiting.Ex reveals ptosis and slight divergence of the right eye.Extra ocular movements are limited in all directionsexcept laterally.The right pupil is larger than the left and poorly reactive to light.Ex of the fundus fails to reveal papilledema.Which of the following is the most likely underlying condition?

A.aneurysm of the post communicating artery
B.Ca of the right pulmonary axis

C.Diabetes mellitis

D.Giant cell artrtis

E.Syphilis

F.Systemic hypertension.

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yasmeen
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09/22/06 - 02:53 PM

saadtazjam
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09/22/06 - 03:17 PM

Ptosis+Miosis=Horners Syndrome
Ptosis+Mydriasis=Aneurysm Of Post Communivcating artery

MDcooper
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09/22/06 - 04:28 PM

Yes u r right this is 3rd nerve palsy.and it cant be horners syndrome due to lung cancer as the pupil is not constricted here.Do u know why how we say this is posterior communicating artery aneurysm and not DM,syhphilis,HTN or giantcell artritis?

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ssrpk
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09/22/06 - 04:42 PM

oculomotor nerve is present between the posterior cerebral artery and posterior communicating artery, therefore aneurysm of post.communicating artery can compress oculomotor nerve.

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ssrpk
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09/22/06 - 04:45 PM

for other diagnoses, yes they can be possible causes, but the question does'nt give any hint towards any of these, like history of std,or retinopathy,or absent peripheral pulses etc.

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robin082006
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09/22/06 - 04:56 PM

Good explanation

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saadtazjam
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09/22/06 - 08:04 PM

I agree

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