Cases for finals #2 – History

67 year old lady

  • 3 month history of problems with speech, swallowing and vision
  • speech slurred, especially when tired
  • vision okay first thing; as the day wears on, eyelids droop and gets double vision
  • jaw aches on chewing and liquids going up the nose in last 2 weeks
  • coughing lots


Right, so your punchy summary might be…

“Chronic, progressive neurological disorder, characterised by slurred speech, dysphagia, ptosis and diplopia.”

Nasal regurgitation of liquids suggests a flaccid weakness of the palate and coughing suggests aspiration.

The diurnal variation might be a useful clue

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