Raynaud’s phenomenon
Catriona is 37 years old, and she has one child. She is a new patient in dire need for medical interventions. She has scheduled an appointment to improve her posture exercises that will reduce shoulder aches. After she woke up in the morning today, she describes that she experienced a strange feeling on her left face because she felt numbness. Consequently, her tongue was fizzing and tingling. She thought that she had slept in a strong position on her pillow during the night. She suspected such a cause because she experienced mild headaches when she was reading her book before she slept. Such feelings gave her fright after waking up, thus rushing to the bathroom to examine her face in the mirror. She used her hands to feel the sensation on her face while looking on her face in the mirror. She thought her face was normal, although she could not fathom the causes of the uneasiness. She explains that she felt her hands when she touched her face. She continuously touched her face to feel the touch after she drove her child at school. Moreover, she explains that she is experiencing difficulties in communication because words were hampered, and they could not come out, and if she speaks, she experiences problems.
Past medical history
Importance of past medical history help in knowing the risk associated with hereditary diseases and disorders. It provided information about Catriona and her close family friends. The risk of heart disease and diabetes are genetically inherited. However, it is not a guarantee that family friend or relative suffers from the same chronic illness because further examinations are recorded in the hospital for diagnostic. However, it will assist in providing lifestyle guidelines such as increasing exercises
Second, questions on past medical history help in keeping track of medications. It is recommended to provide relevant information for efficient medical intervention. For example, Catriona has not recorded her past medications that revealed she had no past medical history.
It is crucial to provide records of medications both in hospital and over-the-counter prescriptions such as painkillers. Third, it assists in helping family members who are vulnerable at risk of disease. Family members are alerted in case of a predisposing factor. For example, Catriona has mild disorders such as fizzling and tingling of the tongue. After examination, if found with contagious or chronic disease, it will be easier to protect the family members. Some questions asked include, describe your past medical history? Have you been to medicines in the last week? Do you have hereditary disorders in the family? Have you undergone blood screening? Have you taken antihistamine drugs? Which medical interventions do you use when your skin becomes numb
Family medical history
Family medical history is vital to the doctor in various ways. It involves a record of three family generations of relatives. Families have some familiar characters such as genes, environment, and lifestyle. By so doing, the information is used to provide medical interventions of the family (JohnHopkins, 2015). Disclosure of particular disorder trait in the family, it makes it easy to predict the future risk to the members of the family and future generations. It helps to determine the higher-than-usual chance of a common disorder in a family such as a stroke, particular cancer, heart disease, diabetes, and hypertension. Such factors are a result of lifestyle choices, environmental conditions, and genetic factors.
Additionally, it helps in examining rare conditions caused by a mutation in a single gene such as cystic fibrosis and sickle cell disease. Besides, a person with no family medical history may be at risk of developing the disorder such as Catriona, who did not provide any family medical history (Alana Biggers, 2019). It helps recommendations for screening, such as mammography and colonoscopy of cancer diseases. Questions asked to patients include, are there health problems within your family? Do you have allergic conditions in your family? Is there anyone in your family that had fizzing and tingling of the tongue? Did anyone in your family had arthritis? Did you had hypertension in the previous years?
Patient systems
In examining cardiovascular, digital vasospasm was induced by hand immersion, Catriona had low baseline carbon monoxide diffusing capacity that showed induced decrease in size of the pulmonary capillary bed, thus required further diagnosis. The lymphatic exam showed that Catriona’s epidermis had a mean thickness of 65.2 um. It revealed that Catriona had the infection in one year. GIT examination revealed that her esophagus had heartburn and dysphagia. Besides, she had diarrhea, constipation, and bloating in the stomach and difficulty in swallowing symptoms associated with the disease. Integument system showed diminishing blood flow that caused numbness of the skin. Cranial nerve examination revealed discoloration of the hands and weakness of limbs. Musculoskeletal system exam showed that she had a vasoconstriction response to cold temperatures and emotional stress, especially on the digits (Medicine, 2016).
Exams
Exams to be conducted include capillaroscopy that is used to distinguish between primary and secondary Raynaud’s and cold stimulation test.
Cranial N test
The test involves several stages in testing all 12 nerves in one station. Step one consists of assembling the equipment; Step 2 includes the washing of hands; Step 3 requires the testing of the olfactory and optic nerve. Visual inattention is tested by the patient moving both fingers. Step 4, the color vision is tested and visual reflexes. Step 5 fundoscopy is conducted on both eyes. In step 6, the oculomotor nerve, Trochlear nerve, and Abducent Nerve are involved in the movement of the eye. Step 7 Trigeminal nerve is used in the supply of the face and motor supply of the muscles. All nerves are tested to identify any disorder.
Finding
Cranial nerves and fundi were clinically normal. However, respiratory muscles needed ventilator support. Trigeminal neuralgia was identified as the disorder in Catriona of sensory nucleus that led to headaches, which last for a few seconds.
Neurological test
Neurological tests involve conducting several tests such as laboratory screening tests, genetic testing, computed tomography (CT scan) that uses X-rays, and magnetic resonance imaging (MRI). However, positron emission tomography examines brain activity and, finally, single-photon emission computed tomography. Those tests are used to assess motor and sensory skills, hearing and speech, vision, coordination, and balance. For example, Catriona had difficulty in speaking, sensory problems, and coordination problems that could be identified through neurological examination.
Findings
The symptoms revealed by the exam showed that connective tissue disease had started to develop, which led to the onset of bilateral facial numbness with pain or without paresthesia. The diagnosis further required imaging to validate the results of the exam. It also causes tingling and fizzing of the tongue due to disorder of the connective tissue disorder.
Pathophysiological
Catriona body parts may have intense vasospasm, which may result in color change under severe conditions. She experienced three-phase vasoconstriction, cyanosis, and rapid blood reflow that led to numbness. Affected parts were those susceptible to cold injury that affected ischemic and face (professional, 2019). Vascular tone is affected due to vasoconstriction of endothelial cells, muscular layer, and neuronal stimulation. Catriona experienced numbness on the face, toes, and fingers. Additionally, she experienced numbness on her face.
Differential diagnostic
Canker Sore
They are sores that appear around the tongue and on the gums. However, its cause is not definite, although it may be attributed to injury in the mouth and inadequate nutrition. Once infected, it causes speech problems, fizzing, and tangling of the tongue. The application of benzocaine or Kanka helps to control the disease.
Hypocalcemia
It is caused by a low level of calcium in the body. Symptoms include muscle twitches, tingling around mouth, fingers and toes, dizziness, and seizure. A simple blood test diagnoses it. It is controlled by taking calcium supplements.
Diagnostic imaging
Catriona required the IRT test to help in proper diagnosis in detecting temperature changes that effective connective tissue. Rheumatology clinic will help to examine the cause of the fizzing and tingling of the tongue. IRT provides an overall assessment of blood circulation in small blood vessels.
In conclusion, disease diagnostic helps to determine disease and provide necessary interventions required in for the patient. Similarly, past medical history and family medical history assist in detecting risks associated with a particular family.