Lecture 1- Introduction Flashcards Preview

CHI303- Clinical Science And Diagnosis > Lecture 1- Introduction > Flashcards

Flashcards in Lecture 1- Introduction Deck (16):
1

MAIN CHIEF COMPLAINT

- try to describe the nature of the problem in a word or phrase
- find out if your understanding of the complaint is the same as the patients
- clearly outline area of complaint

2

HISTORY OF PRESENTING ILLNESS

-SOCRATES
-S: clearly delineate
-C: neurological complaints are typically not just pain
-A: if pain is main complaint ask about other common neurological complaints. If neuro complaints in the MC, ask about pain. Ask about fever is there is any suspicion of infection

3

NEUROPATHIC PAIN

- results from direct injury if nerves
* compression
* stretching
* severing
-terminology related to NP
* dysesthesia: abnormal sensation in response to stimulus
* hyperesthesia: increased sensitivity to touch
* hyperalgesia: increased sensitivity to pain
* allodynia: perception of innocuous stimulus as painful

4

PAST MEDICAL HISTORY

- enquire about chronic illnesses such as hypertension and diabetes
- medications: are these essential to enquire about with neuro complaints
- vaccinations: meningococcal meningitis
- diet:
*B1 deficiency (causes alcoholic polyneuropathy)
*Excessive B6 (causes polyneuropathy)
*B12 deficiency (causes malabsorption and pernicious anaemia which lead to corticospinal and posterior column degeneration and dementia)

5

PSYCHOSOCIAL HISTORY

- Alcohol abuse
* withdrawal seizures
* polyneuropathy

6

FAMILY HISTORY

Severe neurological symptoms are inherited:
* Huntington disease (autosomal dominant)
* Wilson's disease (autosomal recessive)
* Duchenne muscular dystrophy (x-linked recessive)
* Some motor neuron diseases (can be autosomal dominant, recessive or x-linked)

7

REVIEW OF SYSTEMS
(Neurological questions)

- difficulty with memory, mood and attention
- seizures or loss of consciousness
- episodes of dizziness or vertigo
- difficulty with or slurred speech
- numbness, weakness or pins and needles
- tics or tremors

8

REVIEW OF SYSTEMS

- screening questions for diabtes under endocrine if your concerned:
* polydipsia
* polyuria
* nocturial
- screening for risk of a potential stroke under CVS
* chest pain
* palpitations
* SOB
* Orthopnea
* stroke

9

COMMON NEUROLOGIC MAIN COMPLAINTS

- confusion
- dizziness
- weakness
- numbness
( patients may describe their complaint as being a "spell", this signifies that the condition is episodic)

10

LOCALISING THE LESION: GENERAL PRINCIPLES

- one lesion being most likely, not multiple
- hemispheric lesions (one cortex)
- brainstem lesions ( crossed deficit: one side of body and other side of face)
- spinal cord lesion (bilaterally below)
- diabetic polyneuropathy (bilateral, symmetric, glove and stocking distribution)
- myopathy (bilateral, symmetric, proximal weakness in large muscle groups)

11

FOCUSSED EXAMINATION: OBSERVATION

Observe the patients for any visible neurological deficits e.g tics and tremors

12

FOCUSSED EXAMINATION: MENTAL STATUS EXAM

- level of consciousness
- establish if cognitive function is normal
- the standardised mini mental state exam

13

FOCUSSED EXAMINATION: VITAL SIGNS

- temperature: elevation in encephalitis, meningitis or myelitis
- respiratory rate: Cheyenne-stroke breathing ( alternating respiration patterns of deeper, shallower with possible periods of apnoea, seen in severe CVA (brainstem), encephalitis, raised ICP)
- blood pressure (chronic hypertension is risk factor for stroke, acute hypertension seen in ischemic stroke and Subchondral haemorrhage)


14

FOCUSSED EXAMINATION: HEENT

- HEENT:
*check for ptosis( drooping of eyelid, lesion of levator palpebrae), *physiologic anisociria (1mm difference in sides),
*accomodation/near response
*pupillary dilation

15

FOCUSSED EXAMINATION: NECK

- test for meningeal irritation
- Kernot sign: resistance to passive knee extension while hip flexed
- Brudzinski sign: involuntary hip and knee flexion accompanying passive neck flexion

16

PATIENT IDENTIFYING DATA: AGE!!!

Middle-aged:
- epilepsy
- multiple sclerosis
- Huntington disease
Older age:
- Alzheimer disease
- Parkinson disease
- Brain tumours
- Stroke