Rosen's Correlations Flashcards
What is Occam’s Razor?
Among competing hypotheses, the one with the fewest assumptions should be selected.
Basically, the simplest solution is best. Find the unifying lesion.
What does a B12 deficiency affect?
Posterior and lateral columns in the spinal cord
For each time course, identify the appropriate lesion: Seconds-Minutes Hours-Days Weeks-Months Months-Years
Vascular
Infection
Neoplasm
Degenerative (demyelinating)
CN V examination
open mouth, lesion causes less opening on affected side
CN VII examination
observation of face, taste
CN VIII examination
Acoustic via Weber test
Vestibular via caloric/rotational stimuli or Baraney test
CN IX examination
gag reflex
CN X examination
palatal and pharyngeal paralysis
CN XI examination
SCM and trapezius muscles
CN XII examination
tongue deviation to side of LMN lesion and atrophy
\+/- for UMN lesion: Weakness Atrophy Spasticity Reflexes Pathological reflexes Fasciculations
Weakness: +
Atrophy: - (maybe some atrophy of disuse)
Spasticity: + (initial flaccid, becomes spastic)
Reflexes: +
Pathological reflexes: + (Babinski)
Fasciculations: -
\+/- for LMN lesion: Weakness Atrophy Spasticity Reflexes Pathological reflexes Fasciculations
Weakness: + Atrophy: + Spasticity: - (flaccid weakness) Reflexes: - Pathological reflexes: - Fasciculations: + (only when anterior horn cell is involved)
Some questions to ask during a neurological history:
- Most important thing: timeline of current illness (started, what illness was like)
- Other problems? (diabetes, thyroid disease)
- What makes it worse/better? (particularly good for headaches)
- Hypertension, heart disease, diabetes, lung disease (he always checks for)
- Neurological problems in family?
- Smoking, medications, recreational drugs
Some physical examination points:
- Evaluating walking when they don’t know (before/after)
- Facial expressions
- People often gesture with hands (absence of hand gestures, only using one hand, etc.)
- Oriented to time, place, person (work it into conversation, or wait a few minutes into conversation)
- Memory test – 3 cities (ask 5 minutes later; grade out of 3)
- President, VP, previous president – general knowledge/awareness
- Get idea of patient affect, appearance
How to test for receptive aphasia?
Doing series of tasks that don’t require words, getting progressively harder (opening/closing eyes/mouth, show left hand, put left hand on nose, put left hand on right ear)
