When assessing a patient who complains of muscle weakness, the clinician should assess if there is specifically:

Question

A. Bilateral or unilateral muscle weakness
B. Proximal versus distal muscle weakness
C. Upper extremity and/or lower extremity weakness
D. All of the above

Answer 1

ANS: D
The history should include the type of weakness, whether it is proximal weakness, which might alert you to thyroid disease, malignancy, or adrenal dysfunction, or distal weakness, which would raise an index of suspicion for a neurological cause especially if it was accompanied by paresthesias. Ask the patient when and with what types of activities the weakness is most prominent and how much it interferes with activities of daily living. Inquire about changes in speech patterns or slurring that might indicate a neurological cause. Ask whether there are any cognitive or personality changes, which are often seen with adrenal dysfunction. The review of systems should include headache, cold or heat intolerance, change in appetite, weight gain or loss, nausea, vomiting or diarrhea, changes in balance or gait, numbness or paresthesia, diplopia or other vision changes, and difficulty with speech or swallowing.