Today will be the Physical Examination section

Physical Examination
Madam XXX’s physical examination shows signs of peripheral neuropathy.
I say this because on her palmar and dorsum of her hands and on her lower limbs from knew down bilaterally, she has decreased pin prick sensation and a loss of vibration sensation. Her proprioception was lost in her lower limbs but was intact in her upper limbs. Also she showed dry skin on her hands and feet which might suggest an autonomic involvement.
She feels pain when she touches her own hand and it is worst on the pulp of her fingers.
Her tone was normal on all four limbs. She had brisk biceps, triceps and knee reflexes and absent Supinator and ankle reflex. Plantar reflexes could not be elicited.
Her power was weak at about 4 for her proximal muscles and 3+ for her distal muscles in both her upper and lower limbs. Although it should be noted there seemed to be variable effort on testing and that her power of her lower limbs were inconsistently weak as compared to her ability to walk.
She showed no cerebellar signs and was Romberg positive. She was able to walk although she was somewhat atypically unsteady.
Other neurological and abdominal examination revealed no abnormalities.
There were no dermatological signs suggesting any autoimmune disease.
She did not show any signs suggesting endocrine disorders of the thyroid and diabetes.
Other systems examined were also normal.

Sumamry
In summary, Madam XXX shows signs of glove and stocking painful peripheral neuropathy affecting pain, vibration, proprioception and possibly autonomic functions of her limbs bilaterally. Her power was weak but seemed to be effort related.