MedBugs: SAQ #68

Case: LL Weakness

A 25-year-old overseas student presented to ED with 4/7 history of lower limb weakness, She is otherwise well with no regular medications or allergies. Vital signs all within normal range.

1. Complete table below providing (2) distinguishing clinical feautres UMN and LMN weakness. 4 marks

The RN looking after that patient reports a case of Guillain Barre Syndrome on a recent shift.

2. List (2) key features on history or exam which would suggest GBS and its Miller-Fisher variant. 4 marks

On further assessment, you discover the patient has been engaging in regular daily ‘nanging’ (nitrous oxide) ~180 bulbs daily for the last 6-8wks. He demonstrates some mild sensory changes with markedly gait disturbance. You are concerned for nitrous oxide toxicity.

3. What KEY investigations would you order? Provide justification. 4 marks

4. What is the treatment for N2O toxicity 3 marks

You note this patient is walks with tandem gait requiring 2 assists.

5. What would be the likely disposition? 1 mark

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