We discussed video clip showing seven-year-old boy with history of being clumsy and falling. Findings on the video clip showed a normal gait but unsteady when walking on heel. Calf muscles looked prominent and Gower’s signs was positive.

There was some confusion as to what specific history points should be asked. Examination was less controversial and included looking at the tongue, reflexes and spine.

The differential diagnosis was fairly straight forward but we had a discussion whether the findings could be possibly consistent with poliomyelitis.

Learning points:

  • If the diagnosis is very clear then you need not make a long differential diagnosis list
  • Support your diagnosis with findings in history and clinical signs
  • Do not be ‘locked’ into your diagnosis – have a second option if asked.
  • When asking for what would you like to examine: inquire specific finding
  • Neurological case – Do NOT forget 5 Ss.

Add any point I may have missed or to add a comment.

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Anil Garg