Generalized Weakness

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of generalized weakness

Onset was ‍gradualsudden, started ‍whileafter ‍

Severity is ‍mildmoderatesevere and impact on daily activities is ‍minimal

Pattern ‍constantintermittent



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍muscle pain

‍joint pain

‍shortness of breath

‍dizziness

‍palpitations

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍difficulty swallowing

‍speech changes

‍vision changes

‍bowel or bladder changes

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍night sweats

‍rash

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍cognitive impairment

‍mood changes



Contributing factors:

‍recent illness

‍prolonged bed rest

‍poor nutrition

‍dehydration

‍excessive alcohol

‍drug use

‍high stress

‍lack of sleep

no history of: ‍neurological disease, ‍cardiac disease, ‍pulmonary disease

no use of: ‍muscle relaxants, ‍antihypertensive drugs, ‍diuretics, ‍psychotropic medication, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Weakness due to deconditioning ‍likelysuspectedpossible

DDx: deconditioning, electrolyte imbalance, anemia, thyroid disease, diabetes mellitus, adrenal insufficiency, neuromuscular disorders (e.g., myasthenia gravis, muscular dystrophy), COPD, heart failure, chronic kidney disease, liver disease, infection, rheumatologic conditions, malignancy, medication side effect, vitamin D deficiency, vitamin B12 deficiency, neurological conditions (e.g., multiple sclerosis, Parkinson's disease), depression, chronic fatigue syndrome, fibromyalgia, sleep apnea, long Covid





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍TSH, ‍free T4, ‍cortisol AM, ‍ACTH, ‍vitamin B12, ‍ferritin, ‍iron studies, ‍CRP, ‍ESR, ‍ANA, ‍rheumatoid factor, ‍CK, ‍parathyroid hormone, ‍calcium, ‍phosphate, ‍magnesium, ‍vitamin D

- Urinalysis

- ECG

- Chest X-ray

- CT scan of the chest/abdomen/pelvis

- MRI of the brain and spinal cord

- EMG and nerve conduction studies

Treatments:

- ‍IV fluids

- ‍Physical therapy

- Occupational therapy

- Dietary counseling

Further care:

- Follow-up in ‍ ‍daysweeksmonths

- Return if weakness worsens or if new symptoms develop such as difficulty breathing, swallowing difficulties, or profound fatigue