It seems like it with the poor clinical picture given here, though I’m not sure without further testing, like pupilary light reflex, ophthalmoscopy to check edema and a proper Kernig test.
when supine, patient report back pain on hip flexion. no pain reported with same maneuver while sitting.
This seems like either a Lasegue’s test or a poorly done kerinig’s test with postive sign.
He report lack of proprioception on ankle bending. but stand well with eyes closed.
Here spinocerebelum pathway is damaged, but the site of damage could be anywhere along the pathway, probably even cerebellum.
He report inability to flex his elbow. on testing elbow flexion, both flexor and extensor contract vigorously with no net movement at elbow.
Sign of rigidity, but not Parkinson kind of rigidity. Dunno whats wrong here, although could be tissue damage and the muscles are resisting due to pain.
he suddenly fall in coma and become unresponsive. while testing for the coma his hand misses hitting his face, when released from above his head
have we done the tests to verify whether he s in coma or not? If it is the case he is having a cerebral incarcination. To test coma you follow the standard procedure why would you lift the pts hand and try to hit his face with it?
It s not malingering bc the pt has no obvious tangible gain here in faking the symptoms. And not hypochondriasis bc it just doesn’t fit in the criteria.
___________________
There are many things in this world that can’t be changed no matter how hard you try. That’s why you must not hesitate when the time comes where you have to give it all you’ve got.
|
| drhouse
Forum Senior
Topics: 21
Posts: 202
|
hey jackoknifes u were in the right direction but u made mistake changing yr ans
___________________
everybody can do it.... its just matter of time
|
| Dr.Papez
Forum Senior
Topics: 0
Posts: 152
|
I completely disagree with JOK!
------------------------------------------------------------------------- ----------------------------
It seems like it with the poor clinical picture given here, though I’m not sure without further testing, like pupilary light reflex, ophthalmoscopy to check edema and a proper Kernig test.
------------------------------------------------------------------------- -----
when supine, patient report back pain on hip flexion. no pain reported with same maneuver while sitting.
This seems like either a Lasegue’s test or a poorly done kerinig’s test with postive sign.
If some one has pain in that supine position with hip flexion you would expect the same in sitting too...UNPHYSIOLOGICAL- not Logical based on neurology knowledge.
------------------------------------------------------------------------- ----------------------
He report lack of proprioception on ankle bending. but stand well with eyes closed.
Here spinocerebelum pathway is damaged, but the site of damage could be anywhere along the pathway, probably even cerebellum.
Proprioception (Conscious proprioception) has nothing to do with cerebellum. We are testing posterior column sensation by this. When some one has loss of position sense in ankle, you would expect im to be very unstable with eyes closed-he has to ahve Romberg's sign if the loss of position sense is organic. hence one more unphysiological sign
------------------------------------------------------------------------- -------------------
He report inability to flex his elbow. on testing elbow flexion, both flexor and extensor contract vigorously with no net movement at elbow.
Sign of rigidity, but not Parkinson kind of rigidity. Dunno whats wrong here, although could be tissue damage and the muscles are resisting due to pain.
Rigidity is a possiblity. But in the context of other signs which are un-physiological-this is again non organic (simply becos the company they keep rather than isolated finding)
------------------------------------------------------------------------- -------------------------
he suddenly fall in coma and become unresponsive. while testing for the coma his hand misses hitting his face, when released from above his head
have we done the tests to verify whether he s in coma or not? If it is the case he is having a cerebral incarcination. To test coma you follow the standard procedure why would you lift the pts hand and try to hit his face with it?
I dont know what is cerebral incarcination. The test again is unphysiological-in a person with coma, he will hit his face as he cannot prevent it falling over the face-10/10 patients will hit their face if they are in coma (assuming that you dropped in the right direction so as to fall over the face)> So he is conscious enough to avoid hurting himself and hence not coma
------------------------------------------------------------------------- -----------------------
This is a clear case of non-organic illness- Malingering more likely than conversion disorder.
It s not malingering bc the pt has no obvious tangible gain here in faking the symptoms. And not hypochondriasis bc it just doesn’t fit in the criteria.
I dont think we have that information in the vignette.
___________________
|
| Dr.Papez
Forum Senior
Topics: 0
Posts: 152
|
But the answer is F- None of the above.
|
| drhouse
Forum Senior
Topics: 21
Posts: 202
|
hey Dr Papez, great work.
 
u got 10/10
in case of elbow flexoin, patient is not allowing flexion or extension to mimic some kind of neurological sign. rigidity or something else.
i found this q from one of the neurological test. they said it is case of malingering. they have not described any kind of secondary gain but they say it may be to get some secondary gain
___________________
everybody can do it.... its just matter of time
|
| Jackofknives
Ipwnpoker.com
Topics: 91
Posts: 714
|
I see now. didn’t feel like accusing someone in coma for malingering.
___________________
There are many things in this world that can’t be changed no matter how hard you try. That’s why you must not hesitate when the time comes where you have to give it all you’ve got.
|
| drhouse
Forum Senior
Topics: 21
Posts: 202
|
calm down Mr Jack..
its really imp to diff between malingering from organic conditions
___________________
everybody can do it.... its just matter of time
|
|
| |
| | | | | | | | 
