Hillcrest Case 6 H&P Essay

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

Moreover, now I learn most specific radiological techniques for different condition especially associated to spine. I learn importance of MRI and CT scan in different spinal pathological condition. To improved knowledge regarding types of MRI or CT scan method will most appropriate to condition, for instance, in the disc herniation condition, MRI will provide most appropriate result for soft tissue injury but in other cases CT myelogram is second choice techniques. Discography, is second last choice, before spinal surgery or fusion. I used to seen a 57 year old male patient with lower back pain, patient have improvement in pain with modality and strengthening exercises techniques but suddenly one day he was lifting trash pot and feel severe pain with radiating symptoms and feeling less sensation around inner thigh. Next day he came to me and complaining of this symptoms which are indicates for referral and further investigation. Afterwards, MRI reports revealed prolapsed intervertebral disc (PIVD-extrusion) at level lumbar 3 and 4 (L3-L4). I also learn certain condition (spinal stenosis), physical examination will helpful to detect pathological condition and which always should be confirmed by diagnostic imaging method and requirement for referral to appropriate

She presents with severe episodes of back pain and sometime extension in the lower extremity .Her problem started when she fell off a horse when she was 10 or 11 age . This pain aggravate during movement and walking . Additional she complains of often epigastric pain , probably combined with intake of different food components.

MRI scan of the lumbar spine with contrast dated 7/17/2015 showed compression of the descending left L5 nerve root at L5-S1 on the basis of a 6.1mm left paracentral disc extrusion and compression of the descending left L4 nerve root at L3-L4 on the basis of a 6mm left-sided pre-foraminal and foraminal disc extrusion.

DOI: 11/13/2014. Patient is a 32-year old male technician who sustained injury at the time he was breaking loose a pulser component, he felt a sharp pain to his right side, low back buttocks and right leg. The patient was subsequently diagnosed with lumbar degenerative disc disease, radiculopathy and, lumbar spinal stenosis. Per MRI of lumbar spine without contrast dated 12/23/14 revealed at L4-5 there is disc space height loss, disc bulging and facet degenerative change; at L5-S1 there is posterior disc bulging resulting in mild narrowing of the central canal, and; at T11 to T12 there is posterior disc bulging resulting in mild narrowing of the central canal. As per focused history and physical dated 3/17/15, patient is presented to the office

She weighs 159 pounds, oxygen saturation is 97% in room air. Patient is sitting comfortably in no apparent distress. Eyes: Pupils are equal, regular, reacting to light with intact extraocular movements. Oropharynx is normal. Ears: Normal, external auditory canal, and tympanic membrane. Neck: Supple. Chest: Clear to auscultation. Left thumb mild tenderness. Good range of motion.

Lumbar intervertebral disc prolapse most commonly occurs at L4 or L5. Disc prolapse involving at much higher level may be associated with a negative straight leg raising test instead there may be a positive femoral stretch test which is tested by making the patient prone and knee of the patient is made to flex with one hand of the examiner at the popliteal fossa, will cause pain radiating along the anterior aspect of the thigh, for which a high lesion should be suspected .In addition, these lesions may occur with a more diffuse neurological complaint without significant localizing neurological signs. Often the neurological signs associated with disc disease vary over time.

DOI: 8/1/2014. Patient is a 46-year-old female relationships manager who incurred injury to her back from a horse at a camp site. As per OMNI, she was initially diagnosed with lumbar strain, thoracic strain, contusion at the low back and muscle spasm.

DOI: 9/11/2001. Patient is a 47-year-old female correspondence reader who sustained a work-related injury while evacuating when she was pushed and fell in chaos due to an event. Per OMNI, she was diagnosed with herniated lumbar disc. It was noted that the patient has had

She had to take a neurological examination in which, she had absent abdominal reflexes with brisk tendon jerks and bilateral extensor plantar responses. Blood investigations

Clinical examination revealed that the patient is a 62-year-old male, sitting in a wheelchair. Range of motion at the level of both upper extremities is limited, but the left is markedly more involved. He is not able to raise his arm in forward flexion and abduction past 30-40 degrees without shoulder hiking on the left. He is able to touch his face and bring his hands behind his neck. With regards to the lower extremities, he is able to hip flex, knee extend, plantar flex and dorsiflex with mild weakness on the left when compared to the right. Reflexes were absent in the upper extremities. Present at the knees but absent at the ankles bilaterally. No upper motor neuron track signs were noted. The straight leg raising maneuver in sitting was

Diagnoses include degeneration of lumbar intervertebral disc, lumbar radiculopathy, osteoarthritis of spinal facet joint, sacroiliitis, chronic depression, chronic posttraumatic stress disorder, chronic anxiety, bradycardia and osteoarthritis of knee.

This patient notes three weeks of increasing back pain. No recent trauma. His pain has gradually gotten worse and she notes three weeks of no bowel movements with continued diffuse abdominal pain and hurts when she moves. She has not had vomiting today, though she has had some anorexia and some minor nausea. No dysuria or frequency. She notes pain with motion and she notes that she has great difficulty walking, she had to be assisted to get showered. She notes no loss of ability to move or sensation. She has not been incontinent.

Patients had suffered back pain for varying durations (4-15 years) prior to SMT. Within 24 hours of undergoing SMT, all experienced acute aggravation of pain, leaving them unable to walk, stand, sit, or lie down normally. Herniation results in diminished lower extremity control and abnormal tendon reflexes; as such, four individuals suffered from neurological issues. Patient history determined that no individual had experienced back trauma or surgery, and further investigation found that all patients had a disc fragment within the spinal canal. In cases regarding herniation, surgical intervention is required; hernia and pain symptoms were alleviated post-surgery in all 10 patients. It was determined that SMT could exacerbate pre-existing symptoms, and certain vertebrae were found to be more susceptible to herniation (L4–L5 disc herniation observed in seven individuals). Five potential predictive factors regarding age and previous symptoms were identified, which may help identify future patients at-risk of lumbar disk herniation from SMT.