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A 65 years old female presents with constant, left-sided burning, stinging pain. The pain began following a fracture of her left wrist 6 years ago, at which point she developed a burning pain over the radial aspect of her wrist and shooting pains into her palm. Within days the pain had spread to the left side left leg, left foot, and groin. She is now in constant pain and barely uses her left arm. On examination, allodynia and hyperalgesia are present over the left side, most severe in the upper extremity. Pin, touch, vibratory, and proprioceptive sensations are decreased on the left side. There is dystonic posturing of the arm with contractures at the fingers, wrist, elbow, and shoulder. There is left-sided bluish discoloration below the mid-arm, shiny and swollen skin of the hand and fingers, and excessively thin nails. What potential sequelae do you need to be concerned about?

December 26, 2020 7:30 am Published by

Impaired social and occupational functioning

A 65 years old female presents with constant, left-sided burning, stinging pain. The pain began following a fracture of her left wrist 6 years ago, at which point she developed a burning pain over the radial aspect of her wrist and shooting pains into her palm. Within days the pain had spread to the left side left leg, left foot, and groin. She is now in constant pain and barely uses her left arm. On examination, allodynia and hyperalgesia are present over the left side, most severe in the upper extremity. Pin, touch, vibratory, and proprioceptive sensations are decreased on the left side. There is dystonic posturing of the arm with contractures at the fingers, wrist, elbow, and shoulder. There is left-sided bluish discoloration below the mid-arm, shiny and swollen skin of the hand and fingers, and excessively thin nails. What are the most important differential diagnoses?

December 26, 2020 7:29 am Published by

Of the relevant differential diagnoses, it is important to rule out Dejerine Roussy syndrome, fibromyalgia, thrombophlebitis and gout.

A 65 years old female presents with constant, left-sided burning, stinging pain. The pain began following a fracture of her left wrist 6 years ago, at which point she developed a burning pain over the radial aspect of her wrist and shooting pains into her palm. Within days the pain had spread to the left side left leg, left foot, and groin. She is now in constant pain and barely uses her left arm. On examination, allodynia and hyperalgesia are present over the left side, most severe in the upper extremity. Pin, touch, vibratory, and proprioceptive sensations are decreased on the left side. There is dystonic posturing of the arm with contractures at the fingers, wrist, elbow, and shoulder. There is left-sided bluish discoloration below the mid-arm, shiny and swollen skin of the hand and fingers, and excessively thin nails. What is the most likely diagnosis?

December 26, 2020 7:28 am Published by

Complex regional pain syndrome

The mother of a 4 months old infant reports that he has had 3 to 4 days of constipation. She states that the baby has had difficulty feeding over the past 24 hours and is unable to suck and swallow. She is also worried that he feels limp in her arms and appears to have a very weak cry. What are the most important differential diagnoses?

December 26, 2020 7:27 am Published by

Of the relevant differential diagnoses, it is important to rule out congenital muscular dystrophy, spinal muscular atrophy, and hypothyroidism.

A 5 years old boy presents with frequent unusual episodes for the past 3 months. The unusual episodes consist of sudden activity arrest with staring and minimal eyelid flutter for 10 to 20 seconds occurring multiple times per day. The patient is unresponsive to voice or tactile stimulation during the episodes. He is able to immediately resume activities without any recollection of the event once the episode finishes. His teachers have noted that he stares off in class repeatedly and does not seem to be remembering instructions and classroom material. He also no significant past medical history. What potential sequelae do you need to be concerned about?

December 26, 2020 7:25 am Published by

Increased likelihood of accidents, status epilepticus and self harm

A 5 years old boy presents with frequent unusual episodes for the past 3 months. The unusual episodes consist of sudden activity arrest with staring and minimal eyelid flutter for 10 to 20 seconds occurring multiple times per day. The patient is unresponsive to voice or tactile stimulation during the episodes. He is able to immediately resume activities without any recollection of the event once the episode finishes. His teachers have noted that he stares off in class repeatedly and does not seem to be remembering instructions and classroom material. He also no significant past medical history. What are the most important differential diagnoses?

December 26, 2020 7:25 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, transient ischemic attack, narcolepsy and cataplexy.

A 5 years old boy presents with frequent unusual episodes for the past 3 months. The unusual episodes consist of sudden activity arrest with staring and minimal eyelid flutter for 10 to 20 seconds occurring multiple times per day. The patient is unresponsive to voice or tactile stimulation during the episodes. He is able to immediately resume activities without any recollection of the event once the episode finishes. His teachers have noted that he stares off in class repeatedly and does not seem to be remembering instructions and classroom material. He also no significant past medical history. What is the most likely diagnosis?

December 26, 2020 7:24 am Published by

Absent seizures