28 year old male, was found conscious at the site of a motor vehicle accident. W

Question

28 year old male, was found conscious at the site of a motor vehicle accident. Witnesses described a head on collision of Mr H’s sedan with a truck coming from the opposite direction. The sedan was badly damaged in the accident. Mr H complained of severe headache and dizziness. He had multiple lacerationsin the scalp, profuse facial bleeding and a significant amount of blood in the oropharyngeal cavity. Mr H does not have any history of hypertension or diabetes. He is a non-smoker and consumes 2-3 alcoholic drinks per week.

Physical examination

Vital signs: Temperature 36.8 C;Pulse 140bpm;

Blood Pressure 110/70 mmHg;

Respiratory rate 10 breaths/min

Head: Evidence of trauma, multiple lacerations Neck:

No obvious lacerations, no evidence of tracheal deviation

Face:Multiple facial lacerations, oedema, racoon eyes

Chest: Bruises, no deformity, no obvious lacerations

Lungs: Clear Heart: Increased heart rate, no murmurs

Abdomen: Soft, normal bowel sounds

Extremities: A few bruises on the right arm and right leg

Neurologic Exam Mental status: Fluctuating mental status, at times oriented to time and place, at other times lethargic. Could not recall what happened. Followed simple commands.

Cranial Nerves: Left pupil round and reactive to light. Right pupil 6mm not reactive to light.

Motor: Able to move all four extremities.

Follow up Neurological examination:

Motor:4/5 strength in the left upper and lower extremity, normal strength on the right side

Reflexes: Increased reflexes in the left arm and left leg. Left Babinski’s sign.

Gait: Unsteady Coordination: Not tested

Sensory: Left arm and leg did not move in response to painful stimulation. Right arm and leg moved in response to pain.

ANSWER THE FOLLOWING QUESTIONS

1. List 10 key signs and symptoms in this case.

2. On the basis of signs and symptoms identified in Question 1, where is the lesion most likely to be localised? Justify your answer on the basis of the history, physical and neurological examination.

3. Discuss a most likely diagnosis for Mr H’s condition by discussing possible risk factors and underlying pathophysiology. What can be other possible differential diagnosis? Support your answer with reasoning.

Please answer all questions

Explanation / Answer

1. The 10 key signs and symptoms are:

A. severe headache and dizziness

B. multiple lacerations in the scalp

C. profuse facial bleeding

D. significant amount of blood in oropharyngeal cavity

E. evidenve of trauma in head

F. multiple facial lacerations

G. oedema

H. raccoon eyes

I. bruises on chest

J. fluctuating mental status

2. Lesions are most likely to be localised on head, chest and abdomen. It is formed due to the presence of bruises or lacerations on some body parts or inside the body structures.

The physical examination of lesions on skin involves observation of distribution pattern of cutaneous lesions i.e whether the lesion is symmetric or asymmetric. The type of lesions is distinguished by accurate examination.

The neurological examination involves assessment of mental status, behaviour, posture, gait, cranial nerve functions, postural reactions , pain and perception , muscle tone and mass , spinal reflexes.

3. The most likely diagnosis for possible risk factors include testings like imaging testing, MRI scan, x-ray, blood test etc.

Pathophysiology is included in risk factors such as chronic obstructive pulmonary disease, dyspnea, asthma, rwstruve lung disease, hypoxia, cardiovascular disease, endothelial injury, arterial injury etc.

All the risk factors were examined accordingly and perfect diagnosis is given to patient based on the results or outputs of the tests that are done to the patient.

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