Neurology
Help!
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| Key point question | when did the patient last feel perfectly normal?
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| Light-headed? | Cardiovascular
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| off-balance | Cerebellar
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| History | the key is to get the progression of actual symptoms rather than a litany of diagnostic procedures and specialty evaluations
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| Past Medical History | Trauma, meningitis, encephalitis, polio, deformities, congenital anomalies, cardiovascular problems (htn, aneurysm, stroke), neuro disorders (stroke)
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| Family History | Hereditary disorders, alcoholism, mental retardation, seizure, headache, alzheimer's, learning disorders, weakness or gait disorders, medical/metabolic disorders (DM, thyroid, HTN)
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| Personal History | Environmental or occupational hazards (lead, arsenic, insecticides, chemical, heights, water), hand, eye, foot dominance, ability to care self, sleeping/eating habits, sexual contacts, alcohol and drugs
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| Review of Symptoms | Syncope, Seizures, Weakness of paralysis, Problems with sensation or coordination, tremors
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| Pain is a symptom of? | lesion in the PNS
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| Aphasia is a symptom of? | Lesion in the CNS
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| Coexistence of sensory loss and motor dysfunction in a limb implies | either a large lesion at the level of the cortex or a smaller lesion lower in the neuraxis
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| How do degenerative diseases progress? | Gradually
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| Which diseases occur more rapidly? | Vascular diseases (stroke, aneurysmal subarachnoid hemorrhage)
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| Common signs and symptoms | headache, dizziness, vertigo, weakness, numbness or loss of sensation, loss of consciousness, syncope, seizures, tremors or involuntary movements
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| Mental status observations | changes in attention, mood or speech, changes in insight, judgment, orientation or memory. Anxiety, panic, phobias, delirium, dementia
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| High indicators of location | focal weakness, sensory loss or pain, visual loss, language disturbance
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| Medium indicators of location | vertigo, dysarthria, clumsiness
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| Low indicators of location | fatigue, headache, insomnia, dizziness, anxiety/confusion
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| Cerebral Hemispheres signs: | unilateral weakness or sensory complaints, language dysfunction, spatial disorientation, hemivisual loss, flattening of affect or social dysinhibition, alteration of consciousness and alteration of memory.
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| Cerebellum signs: | expect limb clumsiness, unsteady gait or posture
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| Basal Ganglia signs: | expect slowness of voluntary movement and involuntary movement
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| Brainstem signs: | expect contralateral weakness or sensory complaints in the body, with ipsilateral weakness or sensory complaints in the face, double vision, vertigo, alteration of consciousness
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| Spinal cord Signs: | expect weakness and spasticity and anesthesia below a specified level, unsteadiness of gait, bilateral (can be asymmetric) weakness and sensory complaints in multiple contiguous radicular distributions.
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| General survey key point | symmetry, cause PNS or CNS?, Mental status, speech, cranial nerves, motor system, sensory system and reflexes
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| Head | Trauma, dysmorphism, bruits
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| Neck | tone, bruits, thyromegaly
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| Cardiovascular | rate, rhythm, murmurs, pulses, JVD
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| Pulmonary | Breathing pattern, signs of cyanosis
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| Abdomen | hepatosplenomegaly (liver dz causing toxic metabolites)
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| Back and extremities | Skeletal abnormalities, edema
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| Skin | Neurocutaneous or hepatic stigmata. Medussa veinage
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| PE Mental status exam | LOC, Attention (coherent stream of thought, serial 7s), Orientation (temporal, spatial), Memory (short-term and long-term), Language (naming, repitition, comprehension, fluency, reading, writing)
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| How do you evaluate visuospatial skills | clock drawing, figure copying
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| Maximum amount of points you can score on a mini-mental status exam? | 30pts
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| MMSE > or = 21 | Mild
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| MMSE 10-20 | Moderate
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| MMSE < or = 9 | Severe
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| Smell assesses | CN I
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| Extraocular movements and parasympathetic changes assess | CN III - oculomotor
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| Trochlear, motor: downward and inward eye movement | CN IV
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| Jaw clenching | CN V
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| Teeth, tongue, ear and facial skin | CN V
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| Gag reflex | CN IX
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| Peristalsis | CN X
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| Turn head, shrug shoulders, some phonation | CN XI - spinal accessory
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| Tongue movement for speech, sound articulation and swallowing | XII - hypoglossal
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| Diplopia | CN III, IV, VI
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| Decreased facial sensation | CN V
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| Deafness and Dizziness | CN VIII
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| Dysarthria and Dysphagia | CN IX, X, XII
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| Decreased strength in neck and shoulder | CN XI
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| What numerical scale is used to evaluate power of major muscle groups? | 0-5
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| Light touch tracts | Posterior Columns
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| Pain Tract | Spinothalamic tract
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| Temperature Tract | Spinothalamic tract
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| Joint position sense | Posterior column
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| Vibration | Posterior column
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| Graphesthesia | Write a number or a letter on their hand. Cortical sensory
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| Two-point discrimination | Posterior columns, cortical sensory
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| Double simultaneous stimulation | Touching both shoulders with fingers, cortical sensory
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| On what numerical scale are reflexes evaluated? | 0-4+
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| Myerson's | usually seen in Parkinson's. Inability to stop blinking in response to tapping the forehead, nasal bridge or maxilla
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| Snout | scratching upper lip induced a puckering movement
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| Jaw jerk | (if brisk) When mouth is partially open and muscles relaxed tapping the chin causes the jaw to close. (Reflex center midpons)
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| Palmomental | (if present) Vigorous scratching of thenar eminence causes ipsilateral contraction of the muscles of the chin.
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| Hoffman Sign | (if brisk) flexion and sudden release of the terminal phalanx of the middle finger results in reflex flexion of all the digits.
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| DTR's increased in | UMN involvement
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| DTR's decreased in | LMN involvement
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| Differential Dx | Genetic, neoplastic, vascular, infectious, degenerative, autoimmune, toxic/metabolic, other structural such as trauma, hydrodynamic, psychogenic, spinal cord injury
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| Top 15 for Primary Care | HA, Dizzy, Weakness, Seizures, Epilepsy, TIA, Stroke, tumors, pseudotumor cerebri (with young obese women, look in eye for swelling around optic disc), Dementia, MS, Injury, Neuralgias, Aneurysm, Parkinsons, Tremor, Tourette's, Bells Palsy
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Created by:
ltm12