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Family History
Hypertension –Maternal and Paternal Side
Psychosocial History
Housewife with 2 kids
PHYSICAL EXAMINATION
Patient is a female, mesomorph, conscious, responsive, cooperative,
afebrile and not in cardio-respiratory distress with the following vital
signs:
•BP – 130/90 mmHg
•HR – 94bpm
•RR- 21 cpm
•Temp. – 36.5 C
PHYSICAL EXAMINATION
PERTINENT FINDINGS:
HEENT: Normocephalic, anicteric sclerae, pupils equally reactive to
light and accommodation
Flattening of forehead and nasolabial fold, left.
Poor eyelid closure OS
Auricles symmetrical, no discharges, slight tenderness left posterior
auricular area, no erythema
Pinkish nasal mucosa, nasal septum at midline, no masses, no polyps
OTHER SYSTEM ORGANS WERE UNREMARKABLE
NEUROLOGIC EXAMINATION
Awake, conscious oriented
CN I No anosmia
CN II Pupils 2-3mm in diameter, equally reactive to light and accommodation
CN III, IV, VI Full EOM
CN V with corneal reflex
CN VII Facial paralysis left
CN VIII Responds to verbal stimuli
NEUROLOGIC EXAMINATION
CN IX, X Good gag reflex
CN XI able to shrug shoulders
CN XII unable to protrude tongue, midline
Motor 5/5 in all extremities
Sensory 100% in all extremities
DTR +2 in all extremities
(-) Babinski
LABORATORIES
COMPLETE BLOOD COUNT
BLOOD CHEMISTRY
URINALYSIS
ELECTROLYTES
SALIENT FEATURES
Female
42 y.o.
Posterior Auricular Pain
Facial paralysis, left
Poor eyelid closure OS
No body weakness
No slurring of speech
No change in sensorium
DIFFERENTIAL DIAGNOSIS
NUCLEAR (PERIPHERAL)
Disease Cause Distinguishing Factors
Lyme Disease Spirochet Borrelia burgdorferi History of tick exposure, rash or
arthralgias; exposure to endemic
areas
Otitis Media Bacterial pathogens Gradual onset; ear pain, fever and
conductive hearing loss
Ramsay Hunt Syndrome Herpes zoster virus Pronounced prodrome of pain,
vesicular eruption in ear canal or
pharynx
GBS Autoimmune response More often bilateral
Tumor Cholesteatoma, parotid gland Gradual onset
DIFFERENTIAL DIAGNOSIS
SUPRANUCLEAR (CENTRAL)