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Cervical Conundrum

Physical Examination

BP: 106/73

Pulse: 87

Respirations: 24/minute

Temperature: 35.8°C

Weight: 63.7kg

HEENT: within normal limits. Neck supple, no lymphadenopathy; tongue protrudes midline, with evidence of fasciculations; tongue sensation decreased; uvula deviated slightly to right; palate midline; gag absent.

Heart/Lungs: clear to auscultation, regular rate and rhythm without murmur

Eyes: pupils 3/3 round, briskly reactive to light and accommodation. EOM intact. No evidence of diplopia. Horizontal nystagmus on far right lateral gaze.

Ears: hearing subjectively decreased to finger rub on right. Pinna, canal and TM within normal limits.

Abdomen: diffusely tender to palpation. No masses or bruit noted. Bowel sounds hypoactive.

Extremities: right arm and hand cool to touch, and diffusely numb to light touch. Left arm within normal limits. Evidence of amputation of several digits of the right hand. Evidence of clubbing and previous fingernail bed infection of the left fingers. Diffuse numbness throughout the right lower extremity. Right leg and foot cool to touch.

Sensory: sensation to light touch and pinprick was decreased diffusely throughout the right upper and lower extremity. Proprioception was absent on right upper and lower extremities. Decreased sensation to light touch right V1, V2 and V3.

Motor:

• Right: Deltoid 4/5, biceps 4+/5, triceps 4/5, handgrip 4/5
• Left: Deltoid 5/5, biceps 5/5, triceps 5/5, handgrip 5/5
• Motor strength: 5/5 in the lower extremities