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Questions and Answers
Which of these is a characteristic of progressive diseases?
Which of these is a characteristic of progressive diseases?
What is meant by 'BOV' within the head and neck symptoms?
What is meant by 'BOV' within the head and neck symptoms?
Which of the following is NOT a typical respiratory symptom listed?
Which of the following is NOT a typical respiratory symptom listed?
Which symptom is most indicative of cardiac issues?
Which symptom is most indicative of cardiac issues?
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What is one defining feature related to the 'Fluctuating Severity Profile'?
What is one defining feature related to the 'Fluctuating Severity Profile'?
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Which gastrointestinal issue is associated with the listed symptoms?
Which gastrointestinal issue is associated with the listed symptoms?
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What does 'Paroxysmal nocturnal dyspnea' refer to?
What does 'Paroxysmal nocturnal dyspnea' refer to?
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What is a common generalized symptom associated with various diseases?
What is a common generalized symptom associated with various diseases?
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Which of the following best describes the 'vertigo' category of dizziness?
Which of the following best describes the 'vertigo' category of dizziness?
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If a patient describes their dizziness as a 'near-syncope,' what sensation are they most likely experiencing?
If a patient describes their dizziness as a 'near-syncope,' what sensation are they most likely experiencing?
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Which category of dizziness is most likely associated with mood or anxiety disorders?
Which category of dizziness is most likely associated with mood or anxiety disorders?
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What does the term course of dizziness refer to when taking a patient's history?
What does the term course of dizziness refer to when taking a patient's history?
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Which symptom is characterized by dark stools resulting from the presence of blood?
Which symptom is characterized by dark stools resulting from the presence of blood?
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When asking about the onset of dizziness, what information is the doctor trying to collect?
When asking about the onset of dizziness, what information is the doctor trying to collect?
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What term describes the presence of bright red blood in the stool?
What term describes the presence of bright red blood in the stool?
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A patient with disequilibrium is most likely to experience which of the following?
A patient with disequilibrium is most likely to experience which of the following?
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Which of the following is NOT typically associated with endocrine system symptoms?
Which of the following is NOT typically associated with endocrine system symptoms?
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Which question would be most helpful when establishing the duration of a patient's dizziness?
Which question would be most helpful when establishing the duration of a patient's dizziness?
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Which symptom involves difficulty or pain during urination?
Which symptom involves difficulty or pain during urination?
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A partially shaded shape on a medical chart indicates what condition?
A partially shaded shape on a medical chart indicates what condition?
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When a doctor asks the patient 'Ano pong ginagawa niyo nung nagsimula ito?', what aspect of the dizziness is the doctor trying to determine?
When a doctor asks the patient 'Ano pong ginagawa niyo nung nagsimula ito?', what aspect of the dizziness is the doctor trying to determine?
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What does a question mark inside a shape on a medical chart typically signify?
What does a question mark inside a shape on a medical chart typically signify?
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What does a horizontal line directly connecting two shapes in a medical chart indicate?
What does a horizontal line directly connecting two shapes in a medical chart indicate?
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Which of these is a symptom of a progressive, step-wise disease?
Which of these is a symptom of a progressive, step-wise disease?
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When taking a neurological history, which of the following is the MOST important reason to inquire about a patient's educational attainment?
When taking a neurological history, which of the following is the MOST important reason to inquire about a patient's educational attainment?
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In a neurological history, what does the term 'baseline level' refer to with regard to a patient?
In a neurological history, what does the term 'baseline level' refer to with regard to a patient?
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Why is it important to ask about a patient’s residence or province during a neurological history?
Why is it important to ask about a patient’s residence or province during a neurological history?
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If a patient is unable to provide their medical history, what is the recommended course of action?
If a patient is unable to provide their medical history, what is the recommended course of action?
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Which of the following is NOT a common neurological complaint that should be asked about during a history?
Which of the following is NOT a common neurological complaint that should be asked about during a history?
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Why is it important to be systematic when taking a patient's neurological history?
Why is it important to be systematic when taking a patient's neurological history?
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What does quantifying the reliability of information from a patient typically involve?
What does quantifying the reliability of information from a patient typically involve?
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Which of the following is NOT typically included in the general data section during a neurological history?
Which of the following is NOT typically included in the general data section during a neurological history?
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During a neurological examination, which action is considered inappropriate when interacting with a patient?
During a neurological examination, which action is considered inappropriate when interacting with a patient?
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What is the primary goal of the first level of questioning when assessing a patient for a potential lesion?
What is the primary goal of the first level of questioning when assessing a patient for a potential lesion?
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When introducing yourself to a patient for a neurological examination, which action is MOST important?
When introducing yourself to a patient for a neurological examination, which action is MOST important?
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Which strategy should be avoided when questioning a patient during a neurological examination?
Which strategy should be avoided when questioning a patient during a neurological examination?
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Why is it important to avoid using 'why' questions when talking to a patient?
Why is it important to avoid using 'why' questions when talking to a patient?
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A patient is talking a lot and is going off topic about the problem they are seeking help with, which of the following is the BEST course of action?
A patient is talking a lot and is going off topic about the problem they are seeking help with, which of the following is the BEST course of action?
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In what order should a neurological examination proceed? In other words, which of these would be the third to be assessed?
In what order should a neurological examination proceed? In other words, which of these would be the third to be assessed?
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When a clinician states, 'I'm here to get you cured...', what mistake has been made?
When a clinician states, 'I'm here to get you cured...', what mistake has been made?
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What does a clinician's knowledge of neuroanatomy and neurological examinations primarily help them achieve during the assessment?
What does a clinician's knowledge of neuroanatomy and neurological examinations primarily help them achieve during the assessment?
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What should be done before starting a neurological examination?
What should be done before starting a neurological examination?
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What indicates the offspring of mating in a pedigree chart?
What indicates the offspring of mating in a pedigree chart?
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In which type of inheritance does the disease never skip generations?
In which type of inheritance does the disease never skip generations?
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What is an example of an Autosomal Dominant disease?
What is an example of an Autosomal Dominant disease?
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Which of the following is NOT a common type of inheritance discussed?
Which of the following is NOT a common type of inheritance discussed?
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What key symptom should be inquired about in men related to the genitourinary system?
What key symptom should be inquired about in men related to the genitourinary system?
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What might loss of weight and appetite suggest in a systemic inquiry?
What might loss of weight and appetite suggest in a systemic inquiry?
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Which organ system includes inquiries regarding respiratory issues?
Which organ system includes inquiries regarding respiratory issues?
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What aspect is emphasized as a priority during patient history gathering?
What aspect is emphasized as a priority during patient history gathering?
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Study Notes
Neurological History Taking
- Neurological history taking is the most crucial and productive part of neurological assessment.
- It provides the most information about the nature and location of a lesion.
- Often, a diagnosis can be made from the history alone (over 80% of cases), supplemented by physical examination (7%), and further investigations (7%).
- History taking helps determine the appropriate physical exam and investigations.
Purpose of Neurological History Taking
- Screening tool to detect underlying abnormalities, even if not expected.
- Investigative tool to determine the presence, nature, and extent of neurological abnormalities in patients with complaints.
- Guides the neurological exam to address specific questions/hypotheses generated from the history.
Guidelines for Neurological History Taking
- Be friendly and relaxed during the interview.
- Use patient-preferred language.
- Balance open-ended and closed-ended questions.
- Allow patients to narrate their experiences without interruption.
- Clarify symptoms and their time course and severity.
- Explore how neurological complaints affect daily life.
- Understand how experiences and emotions influence the complaints.
Components of Neurological History
- General Data: Name, Age, Handedness, marital status, occupation, education, religion, residence, etc.
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Chief Complaint: Patient's most concerning problem, often the most severe symptom.
- Focuses on the anatomy and etiology.
- Includes the temporal aspect (when it started) and severity.
- Consider risk factors and other causes.
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History of Present Illness (HPI): Comprehensive history of the current problem, starting when the problem began.
- Detailed chronological description of all symptoms.
- Detail pertinent negative information.
- Address related medical problems (e.g., hypertension with stroke).
- Review of Systems (ROS): Checklist questioning all body systems for related/additional symptoms.
- Past Medical History (PMH): Past illnesses, injuries, surgeries, medications, and allergies.
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Family Medical History (FMH): Familial diseases, including inheritance patterns.
- Includes individuals affected, those who have the disease or are carriers, and their relationships.
- Inheritance patterns (Autosomal dominant, autosomal recessive, X-linked recessive, mitochondrial).
Neurological Examination Tools
- Reflex hammer
- Tuning fork (256 Hz)
- Penlight
- Pocket vision card
- Cotton or tissue paper
- Wooden tongue depressor
- Opaque containers (coffee, nicotine, sugar, salt)
- Stethoscope
- Ophthalmoscope
- Personal safety/hygiene kit (during pandemic, as needed)
Throughout the Encounter:
- Maintain an attentive position (lean forward slightly).
- Maintain eye contact (look at the forehead if difficult).
- Minimize distractions.
- Allow the patient to express their points without interruption, then follow up on clarification.
- Do not interrupt or talk over the patient, redirect if necessary.
- Be well-rested and present. Make the environment comfortable and appropriate.
- Be professional and respectful.
Other Things to Remember
- Be presentable and professional in appearance.
- Provide comfort and respect the patient's privacy.
- Observe appropriate body language.
- Employ infection control techniques.
Heuristics and Cognitive Biases
- Uncommon presentations of common diseases are more frequent than common presentations of uncommon diseases.
- Use Occam's Razor (simplest explanation is often best).
- Be aware of anchoring, confirmation bias, framing effect, premature closure, and search satisfying.
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Description
This quiz covers the critical aspects of neurological history taking, emphasizing its significance in the assessment process. You will explore guidelines for effective interviewing, the purpose of gathering neurological history, and how it influences diagnosis and examination strategies. Test your understanding of this vital component of neurological assessment.
