CNS PE

Question 1

Describe the causes of Meningeal irritation? What condition(s) does it indicate? (2 pts)

Answer 1

1. Movement of SC/SNs against meninges
2. MCC: Meningitis; could also be SAH, Neoplasms of brain & SC, & extensive stroke (affecting area adjacent to the space w/CSF)

Question 2

What is Meningitis TRIAD?

Answer 2

Neck stiffness + Fever + Altered mental status

Question 3

What are the 2 Signs tested for Meningeal Irritation? Describe them.

Answer 3

1. Brudzniski’s sign: you FLEX the NECK (using both hands on the occipital lobe); (+) sign = flexion of knee (to less traction of the meninges)
2. Kernig’s sign: you FLEX the KNEE then EXTEND the LEG w/knee FIXED in position; (+) sign = flexion of the other knee/muscle spasms in the hamstrings of the same leg/ generalized/specific pain (radiculopathy = in leg & lower back)

Question 4

What is the FIRST STEP of any PE?

Answer 4

WIPPE
Wash your hands
Introduce yourself
“Hello, my name is _________ & I am a ______ yr medical student & I have been asked to examine your ______ would that be okay?”
Patient confirmation & Permission
Position
Exposure