sar
Forum Guru
Topics: 22
Posts: 639
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Hi
If there is a pt e c/o weakness of arm and leg
Do we need to examine MMS, all CN 2-12, motor, sensory, reflexes of UE and LE.
For CN 2, do we need to do ophthalmic exam, and visulaacuity e snellens chart too? It is taking a lot of time.
In what sequence should we do cns exam. After examining all CN 2-12, expose upper part of body and check for sensory, motor, and reflexes, and then cover upper part of body and go to LE and check sens, motor and reflexes. Or
After all CN, then sens of UE and LE, then motor of UE and LE and then reflexes of UE and LE and then gait, cerebellar tests, and meningeal tests.
Also auscultate heart and lungs...
Isnt it too much???
do we need to do UE exam in lying position or sitting position.
Thanks
Sar.
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| dacis
Forum Junior
Topics: 1
Posts: 75
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I don't know if there are PT. with hemiparesis on CS exam .
Use your common sense in examining PT.- you will not have enough time to do complete exam . Try to do the most important and relevant things first .
If you do have PT. with hemiparesis examine :
- CN2-12 and pretend to do quick eye exam with ophthalmoscope ,
- generally in Cs exam you don't need to undress the PT. to do the neuro exam ( unless the complaint is backpain ) ;
-Check the muscle tone , strength , DTRs , sensation in UE , then LE ,
-If necessary do the finger - nose test , Romberg ,
- gait .
- Meningeal tests ( only one for the exam ) only if you suspect meningitis or subarachniodal hemorrhage .
-MMSE if there are any c/o memory problems
If you suspect stroke , auscultate carotids and heart .
You can examine UE whith the PT. sitting or lying . If Pt can not sit then examine him while he is lying down . Otherwise it will be easier and quicker for you to do most of the exam whith the Pt sitting .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks a lot Dacis for replying my queries in detail. Are you done with your CS?
Many points are cleared from your reply, i have another question if you please can answer it:
For CN 2, these are the exam given in uw and osce:
Visual acuity with snellens chart, visualization by confrontation, pupillary light reflex and optic fundi by opthalmoscope.
For a pt (described above) should i do all of these test or just a quick opthalmoscopic exam? If i do visual acuity, can i check it just by showing him my fingers and ask him "how many fingers do you see"?
If I do all the exams quickly and superficially and pretend that i am doing all exams, wouldnt i miss any finding that he was pretending to have???
Another question is about Telephone encounter:
We obviously cant write the PE, but we have to write the history. Do we need to write d/d and workup for it?.
Thanks for taking time!
Good luck,
Sar.
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| dacis
Forum Junior
Topics: 1
Posts: 75
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I took my CS ar the beginning of november , still waiting for results .
For the Pt described above I would not examine visual acuity with the Snellens chart .
Do the ophthalmoscopic exam - when you turn the ophthalmoscope on use it as a flashlight first and examine pupillary reflexes by shining the light from ophthalmoscope into each eye , then do the fundus oculi exam .
If Pt has hemiparesis you should examine his visual fields by confrontation .
Remember to tell Pt everything you are doing - examining . That way Pt knows what you are looking for and will tell or show you the " finding " .
For the telephone encounter you do have to write d/d and work up plan . The first thing on the work up plan should be - physical exam of child .
You have to convince the mother or child's caregiver to bring child in for evaluation and necessary treatment .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks again Dacis for replying! I really appreciate it.
Your answer has cleared my confusion.
Although i have many more questions, but i dont want to bother you again and again.
Best of luck for your CS result!
sar
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| sar
Forum Guru
Topics: 22
Posts: 639
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Hi dacis,
I have some more questions if you could please answer!
How we explain the patient about different d/d's in laymans language.
eg: how would you explain that you are considering thrombangitis obliterans or pelvic inflammatory disease or wegeners granulomatosis or PAN or many many others???
How we explain about the need of rectal, pelvic and breast exam, should we tell them "you need rectal exam, and we will do it later" is it correct?
Are axillary nodes, femoral nodes exam allowed?
Can we take our own pencil torch, and wrist watch inside the exam room. Is hammer already available in exam room?
Only few people reply on this CS forum, i am asking you because you replied my questions.
Thanks
Sar.
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| dacis
Forum Junior
Topics: 1
Posts: 75
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Yes , you can tell the Pt. that you will need to do pelvic, rectal or breast exam later and ask the SP if that would be OK with her/him .
You can examine all peripheral lymphnodes including axillar and femoral - just use the appropriate Pt draping - expose just the area you are examining and cover up the rest .
As far as I know SPs usually have some " common " diseases . I don't think ( but I might be wrong ) that you will have SP with Wegeners granulomatosis ( tell that the PT has inflammation of blood vessels ) or PAN .Regarding trombangiitis obliterans - tell Pt that some of his blood vessels are clogged up . PID - inflammation or infection in pelvis or lower part of the belly .
Leave your torch light at home .Yuo will not be allowed to take it with you to the exam area . There is a reflex hammer in the room . You can wear a wrist watch - but not a digital one - no beeping or any other sound signals . Don't waste your time by looking at your watch .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks a lot Dacis!
All of the questions are cleared now.
Yesterday was a good day, many of the members got their passing result.
May you get your passing result soon!
Best wishes,
Sar.
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| SilatK
Forum Guru
Topics: 42
Posts: 584
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What would be the sequence for a complete neuro exam? Anyone recomends any?
How about for lower extremities(neuro)?
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