Problem solving - neurology Flashcards
Recall problem based clinical reasoning
- define problem
2, define system - define location
- define lesion
How to define the problem with collapse?
seizures of syncope?
Define ‘can’t eat properly’?
inability to prehend or swallow food
Define ‘vomits’
vomiting or regurgitation
Define ‘wees a lot’
polyuric or pollakiuric
What is the 6 finger rule?
- localisation
- signalment
- onset
- progression
- symmetry
- pain
Localisation - hydrocephalus
brain
Localisation - cerebellar abiotropy
cerebleeulm
Localisation - atlanto-axial subluxation
upper cervical spinal cord
Localisation - caudal cervical spondylomyelopathy
caudal cervical spinal cor
Localisatio - spinal nephroblastoma (uncommon)
spinal cord (thoracic - lumbar?_
Localisation - myasthenia gravis (MG)
NMJ
Localisation -muscular dystrophy
mm bed
Localisation -vincristine neuropathy
peripheral nn
Outlien localisation -lesion distribution - 3
- FOCAL: neoplasia, IVDH, congenital malformation
- MULTIFOCAL: inflammatory, infection, multifocal neoplasia: lymphoma
- DIFFUSE: neurodegenerative, metabolic
What are the different onsets of (neuro) diseases
- per-acute
- acute
- sub-acute
- chronic
- acute on chronic
What are the different classifications of ‘progression’ of (neuro) diseases?
- improving
- static
- deteriorating
- waxing and waning
- episodic
- paroxysmal
Are there pain receptors in the spinal cord?
No
List the 8 parts to the neuro exam
- mentation
- posture
- gait
- postural reactions
- spinal reflexes
- cranial nerves
- palpation
- nociception
What should you do if you suspect a focal lesion?
imaging
What should you do if you suspect infection/ inflammation?
Minimum database- CBC, biochem, UA
What are teh most important aspects of patient hx in neuro cases? 3
- signalment
- onset
- progression
What are the most important things to determine on physical and neuro exam?
- localisation
- symmetry
- presence of pain
Then choose diagnostic tests based on remaining ddx (the true rule outs)
What is the ddx based on? 6
- localisation
- signalment
- onset
- progression
- symmetry
- pain