Question

Please figure out the right answer asap, Due today Need it fast 100 points for correct answer.

SCENARIO
Sophie is 15 years old and lives in Flint, Michigan. For several months, she complained of
earaches, but the doctors could not find anything wrong. Her parents noticed she had a
slight limp on her left side, but since she was a ballet dancer who practiced daily, they
thought she had just injured herself, which was common. In fact, she had a meniscus tear in
her left knee two years previously. Her limp got so bad that she had to give up ballet, but
after taking many X-rays and doing an MRI, doctors could not find anything wrong. Then her
parents noticed that she was slurring her speech, and she admitted that sometimes she
found herself drooling. Within a couple of months, she found herself getting short of
breath, even when she wasn’t exerting herself, and the muscles in her neck and shoulders
felt stiff.
CLUE #1 | SPEECH & HEARING SCIENCES
• Slurred speech
• Difficult mastication
• Difficulty swallowing
• Drooling
• Complains of ear pain
CLUE #2 | NURSING
• Vitals:
o BP 118/76; pulse 66 bpm
o Oral temperature 98.1 degrees Fahrenheit
o Pulmonary function tests: Forced vital capacity
▪ Result: 60% of normal

• General Symptoms presented to nursing staff:
o Shortness of breath
o Ear pain resolved

CLUE #3 | NUTRITION & EXERCISE PHYSIOLOGY
• Symptoms: weakness and numbness in left leg, stiff neck and shoulder muscles
o Recommended to see Physical Therapist
• History: Meniscus tear repair two years previously
• Recommend high protein diet
• Reflex testing
o Positive Babinski Reflex
• Hyperreflexia
o Positive crossed adductor reflex

CLUE #4 | MEDICINE
• Symptoms: left side weakness
• MRI of brain and spinal cord
o Results: Normal
• Blood sample drawn and sent to lab for comprehensive metabolic panel, CBC, thyroid
and parathyroid function, toxicology (heavy metal) screen, and Lyme serology.
o Results: mildly elevated CK (creatinine phosokinase)
o Results: AChRA negative
• Neuro-cognitive testing
o Results: normal with appropriate concern for symptoms presented
• Referral to neurologist
o Needle electromyography (EMG)
▪ Results: tongue fasciculations; fasciculations of muscles on the left side
of body with acute and chronic denervation

CLUE #5 | PHARMACY
• Family describes use of over the counter and homeopathic remedies
o Patient used ibuprofen and Tylenol for pain management, increase in Vitamin D,
Vitamin K, Magnesium symptoms
o Symptoms did not resolve
• After results from neuro visit
o Fill prescription for Riluzole

Answer 1

The symptoms described in the scenario are consistent with amyotrophic lateral sclerosis (ALS), a neurodegenerative disease that affects voluntary muscle movement. Various diagnostic clues from multiple medical specialties point towards ALS as a potential diagnosis. Further testing can confirm the diagnosis and treatment focuses on symptom management.

Step-by-step explanation:

The symptoms described in the scenario are consistent with a neurological condition known as amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. ALS is a progressive neurodegenerative disease that affects the nerve cells in the brain and spinal cord responsible for controlling voluntary muscle movement. Common symptoms of ALS include muscle weakness, slurred speech, difficulty swallowing, and muscle stiffness.

In the scenario, the patient experienced a progression of symptoms, starting with earaches and a slight limp, then progressing to slurred speech, drooling, shortness of breath, and stiff neck and shoulder muscles. The diagnostic clues from various medical specialties, such as speech and hearing sciences, nursing, nutrition and exercise physiology, medicine, and pharmacy, also point towards ALS as a potential diagnosis.

Further testing, such as an MRI of the brain and spinal cord, blood sample analysis, neuro-cognitive testing, and needle electromyography (EMG), can help confirm the diagnosis of ALS. Treatment for ALS focuses on managing symptoms and improving the patient's quality of life.