Neurology for MRCP PACES

We saw a very interesting case when teaching for PACES
After the initial examination and presentation of findings we went through the case again one step at a time with analysis to demonstrate how examination and interpretation should be done.
We initially looked at the dimensions of the lower limb and then looked at the skin (ACES for PACES page 417)
At this point we noted that the patient had trophic changes in the skin (loss of hair, callosities)
Immediately we thought that this could indicate a peripheral neuropathy.
Next we looked at the muscle mass and noted wasting of the muscles of both lower limbs. This made us think of a lower motor neurone lesion and reinforced our initial suspicion of a peripheral neuropathy. ACES for PACES page 443
Tone was difficult to examine in this patient as he kept tightening up his limbs.
Muscle power was decreased especially in the distal muscles again in keeping with a lower motor neurone lesion and peripheral neuropathy (ACES for PACES page 452)
Reflexes were diminished even with reinforcement again in keeping with our initial suspicion (ACES for PACES page 453)
Coordination was difficult to assess as the patient had weakness of his lower limbs
Sensation was diminished especially in the lower part of his limbs (stocking distribution) again in keeping with our initial suspicion (ACES for PACES page 455)
The diagnosis of a peripheral neuropathy had been made clinically the next step was to think about the causes of peripheral neuropathy
This was a distal symmetrical polyneuropathy which could be due to a number of causes (ACES for PACES page 434-435)