Part 2 book “First aid cases for the USMLE Step2ck” has contents: Epidural hematoma, epidural abscess, internuclear ophthalmoplegia, multiple sclerosis, subarachnoid hemorrhage, subdural hematoma, gestational diabetes, placental abruption, postpartum infection, postpartum hemorrhage, and other contents. | Neurology Case 1 250 Case 2 252 Case 3 254 Case 4 256 Case 5 258 Case 6 260 Case 7 262 Case 8 264 Case 9 266 Case 10 267 Case 11 268 Case 12 269 Case 13 270 Case 14 272 Case 15 275 Case 16 276 Case 17 278 Case 18 281 Case 19 282 Case 20 284 Case 21 286 Case 22 288 Case 23 290 249 N E U ROLOGY CASE 1 A 50-year-old left-hand-dominant man presents to his primary care physician with complaints of right hand weakness. He says 6 months ago he began dropping things with his right hand. In the subsequent months, his grip strength has weakened further and his handwriting has deteriorated. He has also noticed frequent twitching in the muscles of his right hand, forearm, and shoulder, and he has developed painful muscle cramps in his neck and back. He also reports occasional problems swallowing his food and says his speech seems “thicker.” The patient reports no other significant past medical history and denies any lower extremity disturbances or sensory deficits. Vital signs are within normal limits. The patient’s cranial nerve examination is significant for atrophy of the tongue, which also demonstrates fasciculations upon protrusion. On motor exam, the patient has significant thenar atrophy of the right hand, but not on the left. Right hand strength is 3/5, and left hand strength is 4/5. Triceps and biceps are 4+/5 bilaterally and deltoids are 5/5 bilaterally. Neuromuscular examination of the lower extremities is normal. Reflexes are 3+ in the upper extremities bilaterally and he also has a brisk jaw jerk reflex. Sensory examination is normal. The patient’s gait is normal, and he exhibits no ataxia. What is the most likely diagnosis? Amyotrophic lateral sclerosis (ALS). ALS is a neurodegenerative disorder that causes progressive muscle weakness and disability. ALS follows a relentless course and eventually leads to death, with dysphagia and respiratory muscle weakness causing recurrent aspiration pneumonias and .
