Neuroendocrine Scenario

Mrs Askew is a 43 year old woman who presents with a six month history of pain, tingling and numbness in the left thumb and first finger. The symptoms are described as nagging but generally not severe. Mrs Askew has noticed that she has broken a number of objects by dropping them, and finds that cutting hard objects with a knife is difficult. She admits that the tingling and pain does wake her up at night on occasions.

On examination, a clinician finds that Mrs Askew has reduced pin-prick, temperature and light touch sensation on the anterior aspect of her left thumb and first finger when compared to the right, and there is some reduction in the thenar bulk on the left compared to the right.
Mrs Askew is referred for specialist neurological assessment.

1- list each neural dysfunction sign and symptom that is evident in the scenario (e.g. paralysis is a neural dysfunction sign).
2- for each sign or symptom that you list, indicate the words in the scenario that are directly related.
your answer should be in the following format:
name of the sign: quote from text.
if Mrs askew has no neurological dysfunction, other than what is described in the scenario, which of the following would be indicated ( you can chose more than one – you will lose marks for incorrect choices.)
Question 2 options:
A- the dysfunction is somatic only.
B- the dysfunction is in the sensory neurons only.
C- the dysfunction is in the motor neurons only.
D- the dysfunction involves both sensory and motor pathways in the spinal cord.
E- the dysfunction is in the peripheral nervous system only.

In the scenario, an electrical conductance test along the ulnar nerve will:
A- help localise the spinal segments involved in the dysfunction.
B- assist in diagnosing the cause of the apparent neural lesion.
C- assist in locating the site of the apparent neural lesion.
D- be of little use in diagnosing or localising the apparent lesion.

Explain your choice of answer for question 3.
( NO MORE THAN 100 WORDS )

Why would a change in the thenar bulk be a significant finding?
1- What do you think is the cause of Mrs Askews signs and symptoms?
2- Explain why you have made this choice?
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