Barbara's Weakness

October 09, 2016 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
By Aayushi Pandya (4th year Medical Student)
Barbara Boss
30/03/1981 (35 years)
I have been feeling very tired over the past month or so and it is making me miserable. I just feel more and more worn out as the day progresses, with my arms getting weaker and less able to get jobs done at work. I’m also finding it difficult to work at my computer screen as my eyes feel very heavy and keep closing. I thought I might be coming down with something as I’m also finding it difficult to swallow my food. I don’t however have a sore throat or a high temperature.
Past Medical History
Drug History
Family History
Dad had a heart attack at 74 years. Mum and younger brother have Type 1 DM.
Social History
Smokes 15-20/day (15 years), drinks a glass of red wine with dinner daily, no recreational drug use. Single.
Introduction and consent

Name, age, occupation

Presenting complaint

History of Presenting Complaint (duration, onset, any triggers, progression, worse at a specific time of the day)

Previous episodes or recent illnesses

Any associated features (sensory loss, lower limb weakness, muscle twitching, breathing/swallowing difficulties, changes in vision/speech, motor difficulties)

Red flags: headache (worse on coughing/bending/with vomiting), loss of consciousness, trauma

Constitutional symptoms (fever, weight loss, malaise, loss of appetite)

Past Medical History

Family History

Drug History and allergies

Social History (smoking, alcohol, drugs)

Ideas e.g. “Was there anything you thought it might be?”

Concerns e.g. “What about it is worrying you in particular?”

Expectations e.g. “Is there anything in particular you’re hoping we could do for you?”

Summarises and thanks patient

Offer differentials (MG, LEMS, MND, MS) and appropriate follow up (motor examinations, nerve studies, tensilon test etc.)