Proprioception
makes an image from the different joints and muscles in the brain, and the patient knows
which joints even if eyes are closed are in extension of flexion, contraction or relax.
Without proprioception, there is no balance, no awareness of limbs in space
and loss of fine touch and temperature sensation
sudden weakness, paralysis
wasting is sign of malignancy, if acute, difficulty in coordination
hyperreflexia, absencse of reflexes
resting tremor, action tremor
fascicilation, spasm
problem walking
neuropathy and neuralgia
prescribe gabapentin
parkinson, MS, autism, stroke, huntingtons, peripheral neuropathy from diabetes
peripheral neuropathy
diabetes mellitus, alcohol intoxication, vitamin b12 deficiency,
guillian barres
ascending paralysis with areflexia
spinal chord and neuromuscular
loss of sensation and movement below the injury level
myasthenia gravis, weakness in muscles decrease in number of receptors on post synaptic
receptor due to autoimmune reation, decrease number of acetylcholine receptors.
Elective cases, no need for emergency action, must refer to specialist or PCP.
Focal neurological deficit
[numbness in upper or lower extremity], parkinsons, vision or motor problem, may be
central or peripheral nervous system, refer to neurologist
fracture and dislocation cause sensory and motor problem for the patient.
Refer to orthopedic specialist.
Visual deficit, optic neuritis.
Refer to opthalmologist, first sign of multiple sclerosis, retina will have changes to the optic
nerve, inflamed, first sign of MS. Also may be referred to neurologist.
Autoimmune disorder cause motor problem
patient doesn’t speak
refer to psychologist?
Arm weakness sudden development, speech problem, patient at risk of stroke, facial drooping
if patient says severe pain, most severe pain I ever had, sudden development, headache, neck
stiffness, sub-arachnoid hemorrage, pain developed over just a few minutes
loss of alertness may be sign of stroke
after car accident, refer to 9-1-1
guillian barres, risk of involvement in respiratory muscles, respiratory arrest, refer to 9-1-1
taking history is very important, was onset abrupt or insidious,
physical examination detect neurological deficits, assessment of muscle strength,
thermal imaging may help us for detection of the stroke, obstruction of blood vessels
or bleeding in brain parenchyma.
In the case of a tumor, abnormal neurological finding, sometimes headache and seizure
detect by imaging as well as spinal damage
electro diagnosis help us, EMG for mysositis, polio,
nerve conductive studies help us for diagnosis multiple sclerosis
velocity will be down
check biochemical elements in the blood circulation
antibodies for autoimmune
blood culture, urinalysis for diagnosis of infectious disorder.
Routine health check, patient education,
Pyschological problem
mood problem
depression, bipolar, severe mood swing
depression for at least 2 weeks
manic attack lasts for about 1 day
lots of energy, talkative, will do risky actions, feeling of increase self esteem and grandiosity
schitzophrenia
auditory, visual hallucination, wrong beliefs or delusions, disorganized thinking
problem with thought content
aggressive action or self harm, withdrawal
anxiety
panic attack patient feels he must escape
chest pain, increases respiratory rate, sweating
lasts less than 10 minutes
different from ischemic heart disorder
worry about everything
palpitaiton, tremor, are somatic symptoms and generalized anxiety
PTSD following a disaster
lasts at least 6 months
acute stress disorder
lasts less and 1 month and there is no disaster
cognitive
confusion, meomry loss, disorientation
check ct scan and mri there are no abnormal neurologic finding
these problems are only as functional problems, there is no organic disorder
substance related disorder
risk of development of psychological problems
change in behavior, thoughts of suicide (depression, bipolar), homicidal idea, misperception
auditory or visual, delusional thought i.e. of grandeur, extreme agitation or panic attack, acute
confusional state (from bleeding i.e. hemorragic stroke),
depression, anhedonia, hallucination and delusion, high risk behavior and talkative,
schitzophrenia
negative sign like inability to integrate socially
positive sign like hallucination and delusional
negative sign much hard to treat not affected by medications
anxiety
refer to psychiatric
mood problems, behavior problems
refer to psychologist
dimentia, cognitive change
refer to neurologist
is an emergency if:
risk of suicide or homicide
severe agitatation or uncontrolled
unresponsive or catatonia
hallucination or delusion leading to dangerous situations
substance withdrawal
major depressive disrder
sleeps alot
no appeitite
depressed
functional problem with occupation, social activity
if bipolar
has all these symptoms plus manic attack, treatment will be different.
Schitzophrenia
PTSD
substance withdrawal
the physical dependency
rhinorrhea, itching, muscle pain, bone pain, headache, agitation
amnesia, acute confusional state, i.e. from alzheimer or alcoholism [wernicke’s disorder] or
following head injury, stroke
history, onset, duration, risk factors history of family, medications, lifestyle
mood problem, though problem
question 1: what is your name?
To manage them:
1. Stabilize the patient for his safety and that of his friends and family.
2. Psychiatric Evaluation
psychiatric specialist
if acute schizophrenia must be hospitalized, will not believe they have a problem and may resist
hospitalization
classic neuroleptics block dopamine receptors but do not work for negative effects of schizophrenia
like social withdrawal
for these must use clozapine,
prevention
public awareness
routine screening
counseling
SKIN PROBLEM
raised lumps from benign to lymphoma
if the following must refer: dermatologist or oncologist
rapid growth
irregular border, change in color or shape, new formation
bleeding
pain
chronic, recurring
refer to surgeon
if mole on the skin
excisional biopsy
basal cell carcinoma
squamous cell carcinoma
the basal one isnt as bad
melanoma
melanocyte carcinoma
is the most dangerous
cellulitis or abscess, red, swollen, fever, hypotension from septic shock
refer to 9-1-1 for inflammation in the dermis
facial lesion, involvement of eye, nose must refer to 9-1-1
if extensive edema on skin, redness, uticaria, wheezing and dyspnea
anaphalactic shock
proper diagnosis requires history taking, thorough assessment, biopsy
Vision
when eye lens is hard you can tell if there are refractive errors
in diabetes mellitus, there is diabetic retinopathy
opacity in eye lens or cataract
in glaucoma: blurry vision, eye pain
eye has rocky consistency
risk of damage to optic nerve
sudden visual loss
stroke
retinal detachment
diplopia
paralysis of extraoccular movement or cranial nerve
one eye sends an image and other eye sends another, because one eye is fixed
flutters and flashes
migraine aura, floaters, retinal detachment
severe eye pain
infection in the eye orbit
glaucoma
visual loss during the sunset
cannot correct with glasses
macular degeneration
glaucoma is it open or closed angle
cataracts affecting daily lifestyle
severe infection inflammation
eye trauma with structural changes
optic nerve, optic chiasma, refer to opthamologist
neurological deficit can develop visual loss, blurring
in stroke may have loss of coordination, facial weakness
severe eye pain
blurry vision, visual loss, nausea and vomiting, headache, acute angle glocoma or ocular
hypertension
headache
severe with vision loss is hemorrage and may lead to stroke
acute confusional state is common
injury to the eye
bleeding, visual loss, significant pain
flashes with floaters and shadow vision
retinal detachment
sudden flashes of light, curtain
acute angle glaucoma
halos around the lights
emergency referral
cerebrovascular accident
longer
transient ischemic attack
shorter
diagnosis:
history taking
snellen test to see how good their vision is reading letters from at least 6 meters away
while testing eye response to light
evaluate retinal and optic nerve
treatment
laser therapy, retinopexy, or vitrectomy
glaucoma
acetazolamide, beta blockers
must treat the blockage
stroke
thrombolytic medication to dissolve blood clot
save central nervous system cells
brought to ER in < 3 hours
cannot use if high blood pressure or if bleeding in the brain parenchyma
diabetic retinopathy