This is a case EB, 58/Female, married from Lapaz, Iloilo who came in Physical Exam

due to Bilateral Lower Extremity Weakness. Temp: 36.˚C

BP: 120/80 HR: 92
History of Present Illness RR: 20 O2 sat: 97%
2
4 months prior to admission, patient experienced sudden onset of BMI: 18.7kg/m
numbness and weakness of bilateral lower extremity upon waking up. No
associated signs and symptoms noted. She was still able to perform Awake, oriented, wheelchair borne, not in CPD
household chores and ambulate. No consult done. No medications taken Anicteric sclerae, pinkish conjunctivae
2 months prior to admission, increased in duration of lower Adynamic precordium, normal cardiac rate and rhythm, (-) murmur
extremity weakness associated with numbness persisted but patient still (+) 4x6cm solid, no movable, non tender Right Breast mass
able to ambulate without assistance. No consult done. No medications Symmetrical chest expansion, clear breath sounds
taken. Flabby abdomen, hyperactive bowel sounds, soft, nontender
1 month prior to admission, progression of lower extremity DRE: good sphincter tone, (-) mass, (-) blood/fecal matter on examining
weakness was noted. Patient was still able to walk but with assistance. finger
1 week prior to admission, patient unable to stand and walk but still Grossly normal extremities, full pulses, (-) pedal edema
able to move both lower extremities. Intermittent episodes of disorientation
and memory lapses were also noted. No consult done. Neurologic Examination
On the day of admission, due to persistence of signs and symptoms, GCS 15, oriented, coherent, and follows command
folks brought patient in this institution for further evaluation. Cranial Nerves
I – able to smell VIII – normal hearing
II – isocoric pupils, BRTL IX, X – positive gag reflex
Past Medical History III, IV, VI – intact EOMs XI – turns head to sides, shrugs
Hypertensive for 4years maintained on Losartan and Amlodipine V – V1-V3 intact shoulders
(-) DM VII – no facial asymmetry XII – tongue midline, no atrophy
(-)BA
(-) PTB treatment Motors:
(-) known food and drug allergies 5/5 on right upper extremity
No previous hospitalization and surgery 4/5 on left upper extremity
4/5 on bilateral lower extremities
Family History Sensory: 100% on all extremities
(+) Hypertension and DM - both sides DTRs: 1+ on all extremities
No history of Malignancy

Personal/Social History
Patient is a highschool graduate and work as a caretaker.
Non smoker
Non alcoholic beverage drinker
Diagnostics
Chest Xray PA view: essentially negative cardiopulmonary findings
ECG 12 Leads: sinus tachycardia at 107bpm
EMG MCV: Generalized Polyneuropathy

CBC Na 141
Hb 127 K 4.11
Hct 0.39 Creatinine 54,2
5 ILOILO MISSION HOSPITAL
WBC 7.42 Uric acid 615 FBS 5.67 DEPARTMENT OF INTERNAL MEDICINE
seg 72 SGPT 151 LDL 1.81
lym 21 Cholesterol 3.62
platele 313 Triglyceride 1.0
t
THE
GREAT MASQUARADER
Urinalysis
pH 7
Spec grav 1.01
(-) sugar
(-) albumin
15-17 pus cells
0-3 RBC SERVICE AUDIT
Few squamous cells

SUE ANDRADE
1ST YEAR RESIDENT