Clinical case scenarios for coursework A
This document contains the clinical case scenarios for Coursework A. When preparing your coursework, it is essential to refer to the specific case scenario assigned to you, as detailed in the file BMS3646 CWA List of Students and Their Patient Cases 202425.pdf. Please note that your coursework will be considered invalid if it is based on a different patient case.
Note: All of the patient cases presented in this document were created for educational purposes and do not represent actual patients or their medical histories.
Case 1. Stroke
Mr JH is a 67?year?old man who was admitted to the Emergency Department.
On his physical examination during the admission, clinicians observed that Mr JH had weakness in his left?side limbs, facial drop. His blood pressure was 190/120 mmHg. JH showed left?sided facial drop and left?sided hemiplegia. An urgent CT scan of his brain revealed an acute infarct of the right periventricular white matter. Reference to his medical history revealed that he has uncontrolled type 2 diabetes mellitus, hypertension, and hyperlipidaemia. JH is a cigarette smoker (1 pack per day for 40 years) and moderate user of alcohol (3 to 4 beers daily).
Mr. JH was diagnosed with ischemic stroke and was admitted to the Intensive care unit (ICU). After staying in the ICU for 3 days, his blood pressure returned within the normal range and stabilised and he was transferred to the Neurology ward. On his admission there, the patient showed left?side hemiparesis, loss of sensation and absence of voluntary movements of his left?side limbs. After 6 weeks of treatment, no secondary complications were observed. He was discharged from the hospital and referred to the rehabilitation team. On his discharge, JH was unable to move his left arm and left leg and had no sensations on the left side of his body. His cardiac function was categorised as heart failure. He needs a wheelchair for his mobility.
Case 2. Amyotrophic Lateral Sclerosis
LA is a 55?year?old male who was admitted to the Neurology Department. Mr. LA explained to clinicians that initially he started to experience twitches and cramps in his left leg, but these sensations slowly spread to both legs. He also complained of limb weakness that started 18 months ago, initially in his left leg and the weakness slowly spread to all four limbs. Quick observation of his gait revealed that the patient experienced difficulty in walking due to severe stiffness in both lower limbs.
LA went through a full clinical examination and was referred for radiological and laboratory tests. Physical examination showed that his basic sensations were normal. The limb examination showed signs of muscle atrophy and weakness in all four limbs (both legs and both arms). Muscle atrophy was also presented in his neck and back. Based on these symptoms and the results from the neurological examination alongside brain MRI, EMG and laboratory test, LA was diagnosed with Amyotrophic Lateral Sclerosis (ALS). As the disease progresses, he experiences more muscle cramps and flaccidity. The muscle weakness of his lower limbs becomes more severe and he needs a wheelchair for his mobility and daily activities.
Case 3. Osteogenesis Imperfecta
JF is a 13?year?old boy who has been referred to the Orthopaedic department of the Paediatric hospital for assessment and finding the cause for his frequent leg & arm fractures over the last three years. Predominantly, his fractures resulted from falling down or overexertion. Most of the fractures happened in his forearms and lower legs. JF did not have a history of taking steroids that could affect bone metabolism.
The medical history of JF showed that he was born with a birth weight of 2.5kg. He started sitting unaided at eight months and walked alone at 18 months. Until the age of eight, his height and intellectual development were behind those of his peers. When he became 10 years old, JF started to have fractures caused by minor impacts. There was no family history of bone disease.
Physical examinations at the Paediatric hospital discovered slight protrusion of the eyes and blue sclera. A spinal curvature was also observed during sitting. X RAY confirmed fractures of both femoral bones and left distal radius bone. DNA testing revealed a COL1A2 gene mutation. clinical signs (recurrent fractures, blue sclera, etc.) and the results from radiological tests led to the diagnosis of osteogenesis imperfecta. Due to the numerous fractures, the patient is unable to walk and needs a wheelchair
Case 4. Duchene Muscular Dystrophy (DMD)
JA is a 6?year?old boy who was referred to the Paediatrics Orthopaedic Department by his general practice. His mother explained to clinicians that her child showed signs of clumsiness and experienced difficulty when climbing stairs. JA also complained about fatigue and muscle weakness, particularly in vigorous physical activities at school. His mother also explained that she has received multiple calls from his school to be notified about his falls. JA has expressed to her his frustration and embarrassment of being injured in front of his friends. Because of this, he feared that other children would avoid him to play together. His school reports showed that his intelligence level was generally behind his peers. He has two sisters who are all healthy. His parents also revealed that one of his uncles on his mother’s side had similar symptoms and died at a young age.
The examination at the hospital revealed that JA is well?appearing but obese. Physical assessment showed that he had difficulties in standing, walking, getting up from sitting position and jumping onto the examination table. The examinations also found a moderate scoliosis of his spine, deformity of both feet, waddling gait and calf hypertrophy. Lab results showed certain abnormalities. His blood test disclosed that his creatine kinase (CK) level was 40?fold higher than the normal limit. The Aldolase test indicated muscle degeneration. JA underwent quadriceps muscle biopsy, which revealed that his quantity of dystrophin is considerably lower than normal. Taking into account all these findings, JA was diagnosed with Duchene Muscular Dystrophy (DMD). As the disease progresses, he will need a wheelchair to support his mobility and daily tasks.
Case 5. Spinal Cord Injury at T3 level
Mr DK is a 20?year?old student who was admitted to the Hospital by ambulance. He hit badly his head into a sandbank while diving into the waves during his seaside holiday. His friend was first responder to the accident and called the ambulance. Few people who were nearby, took DK out of the water and positioned him to lie on his back. DK was conscious and had a weak cough. He had swallowed some water but was breathing independently. Paramedics arrived after 15 minutes. From the conversations with him, paramedics understood that he did not feel his arms and legs and had no sensations below his upper chest. His pupils were equal and reacted to light. Visual inspection did not show external injuries. His blood pressure was 110 / 70mmHg. His heart rate was 90 beats per minute and the respiratory rate was 20 breaths per minute.
During his initial assessment at the hospital, he looked pale, alert and able to respond to questions appropriately. He had no sensations below the level of the 3rd thoracic spine. There were no voluntary movements of his abdomen, pelvis, gluteus, legs and toes. The immediate total?body CT scanning revealed a thoracic spine fracture at T3 level. DK was admitted to the intensive care unit (ICU) and after a short stay there, he was transferred to the Neurosurgery Department. His general condition was stabilised after 8 weeks and he was referred to a specialist spinal injury centre for his rehabilitation management. He underwent further tests that confirmed the initial diagnosis of Spinal Cord Injury at T3 level. Before being discharged from the spinal injury rehabilitation centre, he was issued a referral to a wheelchair service department for prescribing and fitting a wheelchair for his mobility and daily activity. At the time of discharge, he presented spasms and exaggerated stretch reflexes of both his legs. He required a catheter connected to a urine bag for daily bladder management.
Case 6. Multiple Sclerosis
LB is a 25?year?old female who is living with her fianc and her 2?year?old son. Two years ago, she first experienced temporary blindness in one eye, combined with facial weakness, numbness and difficulty with speech (dysarthria). Since these symptoms continued for more than 24 hours, LB was referred to the hospital by her general practice for further testing. The results from her magnetic resonance imaging scan (MRI) revealed a lesion on her brainstem. Three months after the initial MRI scan, the patient started to experience extreme fatigue and balance problems. The subsequent MRI scan on spine and brain showed transverse myelitis at C7 spinal cord and multiple plaques in the brain. The results from her CSF lumbar puncture showed increased proteins and presence of oligo? clonal bands. LB was diagnosed with Multiple Sclerosis and treated in Neuro Rehab Unit for 2 months. Few weeks after she was discharged from the hospital, LB contracted Covid?19, her neurologic symptoms dramatically worsened. She complained of frequent fatigue and weakness in both legs and had several bad falls. She also abruptly developed urinary incontinence. LB experiences increased muscle weakness, severe fatigue, imbalance and needs a wheelchair for her mobility and carrying out daily activities.