neurological examination

this is not easy!

while most of you know the sequence [what was the PALS pneumonic? - TOPCAR??], there are real variations in technique, and without good technique signs are missed

this applies to doctors (like me) not just medical students

the chap we saw was wasted proximally, with low/normal tone & symmetrical weakness 4/5 of hip & knee flexion

he had +++ reflexes at the knee & ankle with upgoing plantars

we did not really test sensation properly - he seemed to have intact JPS

he was wobbly on heel-toe walking & his heel-shin co-ordination was poor, although this may be due to his reduced power
_ _ _

in my non-expert mind this does not fit together neatly!

if he has stiff then this would fit better with a UMN/cord lesion, although the pattern of weakness is not typical

he has a proximal myopathy, but classically reflexes are reduced

i will wait to see what happens!
_ _ _

in the meantime i will try to have a look at one of my favourite textbooks (by john patten)

[this really is a work of art - some incredible drawings]

another very good (short) book is by geraint fuller

2 websites:

1) from the university of utah has a great collection of videos (normal & abnormal)
2) associated with an excellent neuroanatomy book by hal blumenfeld

the link to the karim meeran vodcasts is here


Salaam

sabih

homework this week

izzy - causes secondary hypertension

adam - ECG learning resource

leena - (patho)physiology of angioedema

amanda - still waiting for a good resource for learning ABGs and a quick lesson on how to not kill someone with a sickle chest crisis

a 28 year old west african with acute renal failure

a very interesting case this morning - thanks saaid

things to learn:

1. features of anaphylaxis
2. features of angioedema
3. what is C1-esterase inhibitor deficiency
4. emergency management of acute renal failure (how did we know it was acute?)
5. investigation of acute renal failure
6. ECG signs of hypo- & hyper-kalaemia
7. indications for urgent dialysis
8. causes of low Na
9. causes of low K
10. causes of low platelets
11. causes secondary hypertension
12. clinical features of aortic dissection (benton episode - anyone know? also of note is that gerard houllier had an acute dissection in 2001)

things i learnt:

- 1 patient can teach us a lot of things
- following up patients is crucial, if we never put together the whole story, ie one with and 'end' we never really understand things
- those algorithms about what to do if x happens are only good up to a point, what you/i need is awareness of those algorithms + experience of applying them to real people

questions:

- if he had not had a reaction to a medication would he be dead now? [are we sure it was drug-related?]
- if he came into casualty tomorrow & you were the house officer, would you know how to treat him?

resources:

- davdisons cases has a good case about C1-esterase inhibitor deficiency

anyone find anything else?