A 60-year-old man is brought to the ER by ambulance because of slurred speech and left side weakness. His wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms. He is right handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50. He currently is unable to move his left arm and leg. He had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes. Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes. He is taking a baby aspirin a day an ACE inhibitor, and statin as well. He does have a history of alcohol use and smoking in the past but stopped after his heart attack. His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, o2 sat is 97% on room air. Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side. The neck is supple, there is no jugular vein distension, and there are no bruits. The lungs are clear heart sounds regular without murmurs, and abdomen is normal. The limbs are not well perfused distally. The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick. He shows loss of awareness and attention with respect to objects or stimuli on his left side. He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well. There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation. He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.1) What are two questions you would ask this patient?2) Identify the subjective data for this patient.3) Identify the objective data for this patient.
4)What is the likely diagnosis?

The potential question which can be asked is when he first noticed left-side weakness. The subjective data of the patient include previous medical history.

The objective data of the patient include his blood pressure, pulse, temperature oxygen levels, and some other vitals. This patient is most likely suffering from an ischemic stroke that has targeted the right middle cerebral artery

1. Two questions you could ask this patient are:

"When did you first notice the slurred speech and left side weakness?"

"Have you experienced any other symptoms leading up to this event, such as headaches or dizziness?"

2. Subjective data for this patient:

Slurred speech and left-side weakness were noticed by the wife.

The previous episode of amaurosis fugax (temporary blindness) in the right eye was one month ago.

Bilateral leg pain during a walk three months ago.

History of coronary artery disease, hypertension, hypercholesterolemia, and a previous heart attack.

History of alcohol use and smoking in the past, but stopped after the heart attack.

3. Objective data for this patient:

Blood pressure: 195/118 mmHg

Pulse: 106 beats per minute

Respiratory rate: 18 breaths per minute

Temperature: 99.8°F

Oxygen saturation: 97% on room air

Pupils equal and reactive

Inability to voluntarily turn eyes toward the left side

Limbs not well perfused distally

Mild weakness on the left side of the face

Left-sided homonymous hemianopsia (loss of vision on the left side of both eyes)

Left-sided arm and leg paralysis

Hyperreflexia (exaggerated reflexes)

Upgoing left great toe (Babinski sign)

4. This patient is most likely suffering from an ischemic stroke that has targeted the right middle cerebral artery. Speaking slurredly, having left-sided weakness, having left-sided homonymous hemianopsia, and being unable to swivel one's gaze to the left are all stroke symptoms.

A vascular event like a stroke is more likely in patients with a history of hypertension, hypercholesterolemia, and prior heart attacks.

To know more about ischemic stroke:

https://brainly.com/question/31765404

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