Adele Spencer iHuman Case Study

Adele Spencer is a 65-year-old female presenting with visual disturbances, fatigue, and neurological symptoms that have persisted and progressively worsened, accompanied by right upper extremity weakness and sensory changes.

In this comprehensive guide, we’ll walk you through how to approach her case, from initial history-taking through physical examination to the final diagnosis of Multiple Sclerosis (MS). You’ll learn the key clinical reasoning steps for adult neurological patients, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this complex neurodegenerative case simulation.

Adele Spencer iHuman Case Overview (Doorway Information)

Patient Overview: Adele Spencer is a 65-year-old female presenting with chief complaint of visual disturbances that have been occurring with associated fatigue and neurological symptoms. She describes experiencing progressive visual changes, particularly affecting her left eye, which has resulted in decreased visual acuity and color perception difficulties. The patient also reports significant fatigue and right upper extremity weakness that has impacted her daily activities.

Key Background Information:

• Age/Gender: 65-year-old female
• Chief Complaint: Visual disturbances and fatigue
• Duration: Progressive symptoms over several weeks to months
• Pain Characteristics: Visual changes with left eye predominance, general fatigue
• Associated Symptoms: Right upper extremity weakness, sensory changes, diplopia
• Significant History: History of asthma, hypertension, and osteoporosis
• Recent Changes: Progressive neurological symptoms with functional decline
• Risk Factors: Age, female gender, potential autoimmune predisposition
• Neurological Symptoms: Progressive weakness and sensory deficits

The patient appears alert and cooperative during assessment, with notable neurological findings including left optic disc changes and right-sided motor weakness. Her presentation is consistent with demyelinating disease, particularly Multiple Sclerosis, making this an excellent case for learning systematic adult neurological assessment and differential diagnosis skills for complex autoimmune conditions.

Adele Spencer (65 y/o female) – Visual Disturbances and Neurological Symptoms Assessment

• CC: Visual disturbances and fatigue
• MSAP: Progressive visual impairment with left eye predominance, associated with right upper extremity weakness, sensory changes, and significant fatigue
• Associated symptoms: Diplopia, color vision changes, motor weakness, sensory deficits
• History: Previous medical conditions including asthma, hypertension, osteoporosis
• High-risk factors: Female gender, middle age, potential genetic predisposition

History Questions:

• How can I help you today, Ms. Spencer?
• When did you first notice changes in your vision?
• Can you describe what the visual disturbances are like? (blurring, double vision, color changes)
• Which eye seems more affected, or is it both eyes?
• Have you experienced any pain behind your eyes or with eye movement?
• Have you noticed any changes in color perception or contrast sensitivity?
• Tell me about the fatigue you’ve been experiencing
• When did you first notice weakness in your right arm?
• Have you experienced any numbness or tingling sensations?
• Are there times when your symptoms seem better or worse?
• Have you had any difficulty with coordination or balance?
• Have you noticed any changes in your walking or gait?
• Do you have any bladder or bowel control issues?
• Tell me about your current medications for asthma, hypertension, and osteoporosis
• Have you had any recent infections or stressful life events?
• Is there any family history of autoimmune diseases or neurological conditions?
• Have you experienced any muscle spasms or stiffness?
• Any difficulty with speech or swallowing?
• Have you had any cognitive changes or memory problems?
• Any heat sensitivity or worsening symptoms in warm weather?

Physical Exam:

• Vitals: temperature, pulse, blood pressure, respirations, oxygen saturation
• General appearance: alertness, cooperation with exam, overall functional status
• HEENT examination:
  • Visual acuity testing both eyes
  • Pupillary response and symmetry
  • Ophthalmoscopic examination for optic disc changes
  • Visual field testing
  • Extraocular muscle testing
• Neurological examination:
  • Cranial nerve assessment (all 12 cranial nerves)
  • Motor strength testing (upper and lower extremities)
  • Sensory testing (light touch, vibration, position sense)
  • Deep tendon reflexes
  • Coordination testing (finger-to-nose, heel-to-shin)
  • Gait assessment and balance testing
  • Plantar reflexes (Babinski sign)
• Cardiovascular examination: heart sounds, peripheral pulses
• Respiratory examination: lung sounds, respiratory effort
• Musculoskeletal: range of motion, joint stability

Assessment Note: A.S. is a 65-year-old female presenting with progressive visual disturbances predominantly affecting the left eye, associated with right upper extremity weakness and sensory changes. Physical exam notable for left optic disc pallor and edema, dilated pupil on left, decreased left eye acuity, slow left pupillary response, right upper extremity weakness, and right upper extremity diminished sensation. Recent onset of neurological symptoms in a middle-aged female with characteristic pattern of CNS involvement.

Diagnostic Testing: Brain MRI, cervical spine MRI, and cerebrospinal fluid analysis Diagnosis: Multiple Sclerosis (MS)

Plan:

• Neurological consultation for MS management
• MRI imaging of brain and cervical spine
• Cerebrospinal fluid analysis
• Ophthalmology referral for comprehensive eye evaluation
• Physical therapy evaluation and treatment
• Patient education about MS diagnosis and management
• Disease-modifying therapy consideration
• Symptom management and supportive care

Adele Spencer SOAP Note

Patient: Adele Spencer

Subjective Data

CC: 65-year-old female presents with visual disturbances and fatigue

HPI: 65-year-old female presents with chief complaint of progressive visual disturbances that began several weeks to months ago and have gradually worsened. The patient reports that the visual changes primarily affect her left eye, with decreased visual acuity and difficulties with color perception. She describes the visual problems as intermittent blurring and occasional double vision, particularly when fatigued. The patient also reports significant fatigue that is more pronounced than her usual tiredness and seems to worsen throughout the day.

The patient has developed right upper extremity weakness that has progressively worsened, making daily activities more challenging. She reports decreased sensation in her right arm and hand, describing it as numbness and tingling. The weakness is more noticeable with fine motor tasks and lifting objects. She denies any recent trauma or injury that could explain these symptoms.

Medications: Current medications for management of asthma, hypertension, and osteoporosis as previously prescribed

Allergies: (medication, environmental, food) No known drug, food, or environmental allergies reported

PMH: History of asthma, hypertension, and osteoporosis. Otherwise generally healthy adult with routine healthcare maintenance.

Family History: No significant family history of neurological disorders or autoimmune conditions reported. Family history may include cardiovascular disease and diabetes.

Social History: Retired professional living independently. Non-smoker, occasional alcohol use. Maintains active social connections and previously engaged in regular physical activities.

Review of Systems: Notable for visual disturbances, fatigue, right upper extremity weakness and sensory changes. Denies fever, headache, nausea, vomiting, or other systemic symptoms.

Objective Data

ROS: (Perform an appropriate ROS based on the C/C and HPI; documented in i-Human assignment; performed in final focused exam)

General: Alert, cooperative 65-year-old female appearing stated age. No acute distress noted during examination. Mild fatigue apparent during prolonged assessment.

HEENT: Left optic disc pallor and edema noted on ophthalmoscopic examination. Dilated pupil on left with slow pupillary response. Decreased left eye visual acuity compared to baseline. Right eye examination within normal limits.

Neurological: Right upper extremity weakness evident on motor testing. Right upper extremity diminished sensation to light touch and vibration. Cranial nerve examination reveals abnormalities consistent with optic nerve involvement. Deep tendon reflexes may be hyperactive. Plantar/Babinski reflex testing performed.

Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops. Blood pressure consistent with known hypertension, well-controlled.

Respiratory: Clear lung sounds bilaterally, no respiratory distress. Consistent with well-controlled asthma.

Musculoskeletal: Range of motion appropriate for age with considerations for osteoporosis. Gait assessment may reveal subtle abnormalities.

Vital Signs: Temperature: 98.4°F, Pulse: 76, BP: 138/82, Respirations: 18, Oxygen Saturation: 98% on room air

Assessment

General: Well-appearing 65-year-old female with progressive neurological symptoms consistent with demyelinating disease.

HEENT: Significant findings include left optic nerve involvement with disc changes and visual acuity reduction.

Neurological: Multiple neurological abnormalities including optic nerve dysfunction, motor weakness, and sensory deficits in a pattern consistent with Multiple Sclerosis.

Cardiovascular: Stable, well-controlled hypertension.

Respiratory: Well-controlled asthma without acute exacerbation.

Diagnostic Testing: Brain MRI and cervical spine MRI recommended to evaluate for demyelinating lesions. Cerebrospinal fluid analysis to support MS diagnosis.

Differential Diagnoses

Multiple Sclerosis (MS): The patient presents with classic symptoms of Multiple Sclerosis including visual disturbances with optic nerve involvement, progressive neurological deficits affecting motor and sensory function, and the characteristic relapsing-remitting pattern. The age and gender demographics, along with the clinical presentation of CNS lesions separated in time and space, strongly support this diagnosis.

Brain Neoplasm: Central nervous system tumors could cause similar neurological symptoms and visual disturbances. However, the pattern of symptoms and examination findings are more consistent with demyelinating disease. Brain MRI would help differentiate between tumor and demyelinating lesions.

Peripheral Neuropathy: Diabetic or other causes of peripheral neuropathy could explain some sensory symptoms. However, the combination of central visual symptoms with motor and sensory deficits suggests central nervous system involvement rather than peripheral nerve disease.

Vasculitis: Systemic vasculitis affecting the CNS could present with similar multi-focal neurological symptoms. Laboratory testing including ANCA levels would help evaluate for vasculitic causes.

Myelitis: Inflammatory conditions affecting the spinal cord could explain motor and sensory symptoms. Cervical spine MRI would evaluate for myelitis, though the visual symptoms suggest more widespread CNS involvement.

Most Likely Diagnosis: Multiple Sclerosis (MS) evidenced by the combination of visual disturbances with optic nerve involvement, progressive motor and sensory deficits, and the characteristic pattern of CNS lesions in a middle-aged female.

Plan

Health Promotion: (appropriate screening, disease prevention, and health promotion according to the patient’s age, gender, and identified risk factors)

✓ Adult Health Maintenance – Continue routine adult health maintenance including age-appropriate screenings, immunizations, and preventive care.

✓ Chronic Disease Management – Ongoing management of asthma, hypertension, and osteoporosis with regular monitoring and medication optimization.

✓ MS Education – Comprehensive education about Multiple Sclerosis, including disease course, treatment options, and lifestyle modifications.

✓ Fall Prevention – Given neurological symptoms and osteoporosis, implement fall prevention strategies and home safety assessment.

Screening

✓ Neurological Monitoring – Regular assessment of neurological function and disease progression with standardized disability scales.

✓ Visual Function – Ongoing ophthalmological monitoring for disease-related visual changes and complications.

✓ Bone Health – Given osteoporosis and potential mobility limitations, regular bone density monitoring and fracture prevention.

Immunizations

✓ Adult Immunizations – Ensure up-to-date status on routine adult vaccines including influenza, pneumococcal, and COVID-19.

✓ Live Vaccine Considerations – If disease-modifying therapies are initiated, consider timing and contraindications for live vaccines.

Complete Step-by-Step Guide to Writing the Adele Spencer iHuman Case Study

Completing the Adele Spencer iHuman case requires a systematic approach focused on adult neurological assessment and autoimmune conditions. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, take a moment to review the doorway information and formulate your initial clinical approach.

Key Information to Note:

• 65-year-old female with visual disturbances
• Progressive neurological symptoms
• Consider demyelinating diseases, especially Multiple Sclerosis

Initial Clinical Mindset: Approach this case with autoimmune neurological conditions as your primary consideration. The age, gender, and symptom pattern immediately suggest potential Multiple Sclerosis, making this a high-priority assessment requiring systematic neurological evaluation.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the foundation of your diagnosis. Use the OLDCARTS method systematically while keeping adult neurological considerations in mind:

Onset: Ask about when symptoms started and any precipitating factors

• Key points to elicit: Progressive onset over weeks to months

Location: Determine the exact location and distribution of symptoms

• Target response: Left eye predominantly, right upper extremity

Duration: How long episodes last and pattern of symptoms

• Important detail: Progressive worsening with possible fluctuations

Character: Detailed description of visual and neurological symptoms

• Critical descriptors: Visual blurring, double vision, weakness, sensory changes

Aggravating factors: What makes symptoms worse

• Essential findings: Fatigue, heat, stress

Relieving factors: What provides relief

• Key response: Rest, cool environments

Timing: Pattern and frequency

• Important pattern: May show relapsing-remitting course

Severity: Impact on daily activities and function

• Typical response: Significant functional impairment affecting activities of daily living

Associated Symptoms:

• Ask specifically about: other neurological symptoms, bladder dysfunction, cognitive changes
• Key findings: Motor weakness, sensory deficits, visual disturbances

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to neurological and visual systems:

Neurological:

• Motor function and coordination
• Sensory changes and paresthesias
• Balance and gait disturbances
• Cognitive changes or memory problems

Visual:

• Visual acuity changes
• Color vision disturbances
• Visual field defects
• Eye pain or discomfort

General:

• Fatigue patterns and severity
• Heat sensitivity
• Mood changes or depression

Genitourinary:

• Bladder control issues
• Urinary frequency or urgency

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

• Previous neurological episodes or symptoms
• History of autoimmune conditions
• Current management of asthma, hypertension, osteoporosis
• Recent infections or immunizations

Social History:

• Occupational history and current functional status
• Support systems and living arrangements
• Smoking and alcohol history
• Exercise and activity level

Family History:

• Autoimmune diseases in family members
• Neurological conditions including MS
• Other chronic medical conditions

Step 5: Physical Examination Strategy

Perform a comprehensive adult-focused neurological exam:

Vital Signs:

• Expected findings: May be within normal limits or reflect underlying conditions

Visual System:

• Critical component: Complete ophthalmological assessment
• Look for: Optic disc changes, pupillary abnormalities, visual field defects

Neurological Examination:

• Comprehensive cranial nerve testing
• Motor strength assessment (systematic testing of all muscle groups)
• Sensory testing (multiple modalities)
• Coordination and cerebellar function
• Reflexes including pathological reflexes

Additional Key Exams:

• Gait assessment and balance testing
• Cognitive screening if indicated
• Assessment of functional capacity

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Multiple Sclerosis

• Supporting evidence: Classic presentation with CNS lesions in space and time

Secondary Considerations:

• Brain Neoplasm: Could cause similar focal deficits
• Vasculitis: Systemic inflammatory condition affecting CNS
• Peripheral Neuropathy: For sensory symptoms, though CNS involvement makes this less likely

Step 7: Diagnostic Test Interpretation

Interpret provided test results to support your diagnosis:

Expected Key Findings:

• Brain MRI: Demyelinating lesions consistent with MS
• Cervical spine MRI: Additional lesions supporting diagnosis
• CSF analysis: Oligoclonal bands and elevated protein

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Multiple Sclerosis (MS)

Justification:

• Progressive neurological symptoms with CNS involvement
• Visual disturbances with optic nerve changes
• Motor and sensory deficits in characteristic pattern
• Demographics consistent with MS (middle-aged female)

MSAP Selection: Choose “Multiple Sclerosis” as your Most Significant Active Problem, as this represents the primary condition requiring immediate specialist referral and long-term management.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach:

Immediate Management:

• Neurology referral for MS specialist evaluation
• Ophthalmology consultation for visual complications
• Consider corticosteroids for acute relapses

Long-term Management:

• Disease-modifying therapy evaluation
• Physical therapy for motor deficits
• Occupational therapy for functional adaptation

Patient Education:

• MS disease education and prognosis
• Lifestyle modifications and trigger avoidance
• Support group resources and community connections

Follow-up Plan:

• Regular neurology follow-up for disease monitoring
• MRI surveillance for disease progression
• Symptomatic treatment adjustments

Step 10: Documentation and Submission Tips

Writing Your Summary:

• Create a concise 350-word summary explaining your clinical reasoning for adult neurological conditions
• Include how you arrived at the problem list with consideration of differential diagnoses
• Cite specific assessment findings and diagnostic test correlations
• Use professional medical terminology appropriate for adult neurology

Key Documentation Elements:

• Assessment Statement: Brief patient summary with key neurological findings
• Clinical Reasoning: Explain diagnostic thought process for demyelinating diseases
• Evidence Correlation: Link physical findings to diagnostic test results
• Management Rationale: Justify treatment choices and specialist referrals

Final Submission Checklist:

• ✓ Complete adult neurological history with systematic questioning
• ✓ Comprehensive physical exam including detailed neurological assessment
• ✓ Appropriate differential diagnoses with adult considerations
• ✓ Correct final diagnosis and MSAP
• ✓ Evidence-based management plan including specialist referrals
• ✓ Professional documentation with proper citations

Adele Spencer iHuman Case Summary

Grading Criteria

The Adele Spencer iHuman case will evaluate you across several critical domains to ensure comprehensive adult neurological assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points): You must ask targeted questions about neurological symptoms and functional impact to get full credit. Essential questions include: timing and progression of visual symptoms, character of neurological deficits, impact on activities of daily living, heat sensitivity, and bladder function. Don’t miss asking about: family history of autoimmune conditions, medication history, and functional status changes. The rubric specifically rewards students who ask about MS-specific symptoms and disease progression patterns.

(2) Physical Examination (High Weight): Focus your exam on systematic neurological assessment and visual function testing. Must-do components: complete cranial nerve examination, motor strength testing, sensory assessment, reflex testing, coordination testing, and gait evaluation. Pro tip: The rubric awards points for performing ophthalmoscopic examination and testing for pathological reflexes – key components that relate directly to MS diagnosis.

(3) Differential Diagnosis (Critical for Scoring): You need to propose at least 3 appropriate differentials with brief rationales. Expected differentials include: Multiple Sclerosis, brain neoplasm, peripheral neuropathy, vasculitis, and myelitis. Scoring secret: The rubric rewards students who can distinguish between central and peripheral nervous system causes based on examination findings and symptom patterns.

(4) Final Diagnosis & MSAP: You must correctly identify Multiple Sclerosis as your Most Significant Active Problem (MSAP). Justification is key – cite the progressive neurological symptoms, visual changes, and characteristic examination findings as supporting evidence.

(5) Management Plan (Heavily Weighted): The rubric expects comprehensive management including: appropriate specialist referrals, diagnostic testing recommendations, symptomatic treatment considerations, and patient education. High-scoring responses mention: neurology consultation, MRI imaging, disease-modifying therapy consideration, and rehabilitation services.

(6) Patient Communication: Demonstrate appropriate communication for adult patients with chronic conditions. Bonus points for: explaining the diagnosis in understandable terms, discussing prognosis and treatment options, addressing patient concerns, and providing resources for ongoing support.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Adele Spencer

Situation: 65-year-old female presenting with progressive visual disturbances and neurological deficits consistent with demyelinating disease.

Background: Significant risk factors including female gender and middle age. Progressive onset of left eye visual changes with associated right upper extremity motor and sensory deficits. Past medical history significant for well-controlled chronic conditions.

Assessment: Physical examination notable for left optic disc pallor and edema, decreased visual acuity, right upper extremity weakness, and diminished sensation consistent with Multiple Sclerosis.

Primary Diagnosis: Multiple Sclerosis (MS)

Recommendation:

• Immediate neurology referral for MS specialist evaluation and treatment planning
• Brain and cervical spine MRI to evaluate extent of demyelinating lesions
• CSF analysis to support diagnosis with oligoclonal band testing
• Ophthalmology consultation for comprehensive visual assessment
• Physical therapy evaluation for motor deficits and functional optimization
• Patient education regarding MS diagnosis, treatment options, and support resources

Patient and Family Education Provided: Explained Multiple Sclerosis diagnosis and disease course, discussed treatment options including disease-modifying therapies, emphasized importance of specialist follow-up, and provided information about MS support groups and resources for ongoing management.

Conclusion

By following this comprehensive approach to the Adele Spencer case, you’ll demonstrate the adult neurological assessment skills that iHuman evaluates. Remember, success in adult neurology cases requires understanding disease progression patterns: gather detailed history about symptom evolution, perform systematic neurological examination, consider autoimmune and degenerative conditions in your differentials, and develop specialist-centered management plans. The key is treating each iHuman simulation as you would a real adult patient encounter – be thorough, consider the complexity of adult medical conditions, and always prioritize patient education and specialist coordination. With this guide, you’re well-prepared to excel in this challenging but important adult neurology case simulation.

Frequently Asked Questions

Q1: What is the correct diagnosis for Adele Spencer’s neurological symptoms?

Adele Spencer’s primary diagnosis is Multiple Sclerosis (MS). The key distinguishing features that point to MS include the progressive visual disturbances with optic nerve involvement, motor and sensory deficits affecting multiple CNS locations, and the characteristic pattern of symptoms in a middle-aged female. Students often struggle between MS and brain tumors, but remember that MS typically shows lesions separated in time and space, whereas tumors usually cause more focal, progressive deficits.

Q2: What are the critical physical exam components I need to perform to score well?

Essential physical exam elements include comprehensive neurological assessment with cranial nerve testing, motor strength evaluation, sensory testing, reflex assessment, and coordination testing. Many students miss points by inadequately performing the ophthalmoscopic examination, which is crucial for identifying optic disc changes and visual system involvement. Don’t forget to test for pathological reflexes like Babinski sign and assess gait and balance function.

Q3: How do I pass the Adele Spencer case and meet the 70% requirement?

You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough history-taking using systematic neurological questioning, complete all recommended physical exam components with attention to adult considerations, propose appropriate differential diagnoses (including MS, brain neoplasm, and other neurological conditions), and develop a comprehensive management plan that includes specialist referrals and patient education. The key is being systematic and remembering that adult neurology cases require specialist-centered care approaches.

Q4: What management interventions should I include in my treatment plan?

The comprehensive management plan should address both immediate diagnostic needs and long-term disease management. Include neurology referral for MS specialist evaluation, appropriate imaging studies (brain and cervical spine MRI), CSF analysis for definitive diagnosis, ophthalmology consultation for visual complications, physical therapy for motor deficits, patient education about MS and treatment options, and consideration of disease-modifying therapies. Students often forget to address the psychosocial aspects and support resources, which are crucial components for managing chronic neurological conditions and can impact your overall score.