By rray, 3 June, 2024 Do not dismiss sx not explained by or out of proportion to objective findings These are common even if etiology duration not fully understood 2
By rray, 3 June, 2024 Evaluate the overall trajectory of sx which often fluctuate and recur Support levels may change over time 6
By rray, 3 June, 2024 Evaluate the impact of sx on QOL even if individual sx alone may not warrant referral 6
By rray, 3 June, 2024 If muscle pain weakness tremor consider CK ANA LDH protein electrophoresis and immunofixation aldolase RF anticitrullinated peptide antibodies myasthenia gravis profile EMG NCS MRI to evaluate for myositis 1
By rray, 3 June, 2024 If neuropathy neuropathic pain consider CK ferritin HIV RPR serum protein electrophoresis w immunofixation methylmalonic acid EMG NCS MRI of spine if abnl EMG NCS 1
By rray, 3 June, 2024 Brain imaging Consider neuroimaging for new worsening focal neuro deficits cognitive sx 5
By rray, 3 June, 2024 Labs CBC w differential CMP B12 thiamine folate homocysteine 1 25 dihydroxy vit D HbA1c magnesium eGFR uACR LFTs TSH free T3 free T4 CRP ESR 1 5 if high risk consider syphilis and HIV testing 5
By rray, 3 June, 2024 Exam Perform complete neuro exam to identify focal deficits small loss of pin prick pain temp vs large loss of vibration position sense darr DTRs fiber neuropathies 1 screen for anxiety depression PTSD or other mental health dz if indicated 4