Neurological History Taking Essentials
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Questions and Answers

Which of these is a characteristic of progressive diseases?

  • Fluctuating severity profile
  • Sudden onset with rapid resolution
  • Primarily affecting respiratory functions
  • Gradual worsening over time (correct)

What is meant by 'BOV' within the head and neck symptoms?

  • Bronchial Obstructive Volume
  • Brief Ocular Vertigo
  • Blurred or double vision (correct)
  • Bilateral Ocular Vision

Which of the following is NOT a typical respiratory symptom listed?

  • Cough
  • Pleuritic chest pain
  • Colds
  • Orthopnea (correct)

Which symptom is most indicative of cardiac issues?

<p>Edema (D)</p> Signup and view all the answers

What is one defining feature related to the 'Fluctuating Severity Profile'?

<p>Variable intensity of symptoms (C)</p> Signup and view all the answers

Which gastrointestinal issue is associated with the listed symptoms?

<p>Diarrhea (C)</p> Signup and view all the answers

What does 'Paroxysmal nocturnal dyspnea' refer to?

<p>Difficulty breathing that occurs while sleeping (D)</p> Signup and view all the answers

What is a common generalized symptom associated with various diseases?

<p>Unintentional weight changes (C)</p> Signup and view all the answers

Which of the following best describes the 'vertigo' category of dizziness?

<p>A physical sensation of movement, either of oneself or the surroundings. (B)</p> Signup and view all the answers

If a patient describes their dizziness as a 'near-syncope,' what sensation are they most likely experiencing?

<p>A feeling of faintness with possible blacking out. (A)</p> Signup and view all the answers

Which category of dizziness is most likely associated with mood or anxiety disorders?

<p>Ill-defined light-headedness (D)</p> Signup and view all the answers

What does the term course of dizziness refer to when taking a patient's history?

<p>Whether the dizziness is improving, worsening, or staying the same. (B)</p> Signup and view all the answers

Which symptom is characterized by dark stools resulting from the presence of blood?

<p>Melena (B)</p> Signup and view all the answers

When asking about the onset of dizziness, what information is the doctor trying to collect?

<p>Whether the dizziness is acute, subacute, or chronic and how it started. (D)</p> Signup and view all the answers

What term describes the presence of bright red blood in the stool?

<p>Hematochezia (B)</p> Signup and view all the answers

A patient with disequilibrium is most likely to experience which of the following?

<p>Difficulty maintaining balance. (A)</p> Signup and view all the answers

Which of the following is NOT typically associated with endocrine system symptoms?

<p>Skin lesions (A)</p> Signup and view all the answers

Which question would be most helpful when establishing the duration of a patient's dizziness?

<p>How long does each episode of dizziness last? (D)</p> Signup and view all the answers

Which symptom involves difficulty or pain during urination?

<p>Dysuria (B)</p> Signup and view all the answers

A partially shaded shape on a medical chart indicates what condition?

<p>Known carrier of diseased allele (B)</p> Signup and view all the answers

When a doctor asks the patient 'Ano pong ginagawa niyo nung nagsimula ito?', what aspect of the dizziness is the doctor trying to determine?

<p>The setting in which the dizziness occurred. (A)</p> Signup and view all the answers

What does a question mark inside a shape on a medical chart typically signify?

<p>Possibly affected person (B)</p> Signup and view all the answers

What does a horizontal line directly connecting two shapes in a medical chart indicate?

<p>Mating (A)</p> Signup and view all the answers

Which of these is a symptom of a progressive, step-wise disease?

<p>Multi-infarct dementia (A)</p> Signup and view all the answers

When taking a neurological history, which of the following is the MOST important reason to inquire about a patient's educational attainment?

<p>It influences how some scoring systems in neurological assessments are interpreted. (D)</p> Signup and view all the answers

In a neurological history, what does the term 'baseline level' refer to with regard to a patient?

<p>The patient's level of function prior to the onset of their symptoms. (A)</p> Signup and view all the answers

Why is it important to ask about a patient’s residence or province during a neurological history?

<p>Certain neurological diseases are more prevalent in specific regions. (C)</p> Signup and view all the answers

If a patient is unable to provide their medical history, what is the recommended course of action?

<p>Identify an informant who can provide the history in place of the patient. (A)</p> Signup and view all the answers

Which of the following is NOT a common neurological complaint that should be asked about during a history?

<p>Heart palpitations (C)</p> Signup and view all the answers

Why is it important to be systematic when taking a patient's neurological history?

<p>To avoid missing pertinent information. (C)</p> Signup and view all the answers

What does quantifying the reliability of information from a patient typically involve?

<p>Assigning a percentage to represent how truthful the provided info is. (C)</p> Signup and view all the answers

Which of the following is NOT typically included in the general data section during a neurological history?

<p>History of present illness (D)</p> Signup and view all the answers

During a neurological examination, which action is considered inappropriate when interacting with a patient?

<p>Providing false reassurance to the patient. (A)</p> Signup and view all the answers

What is the primary goal of the first level of questioning when assessing a patient for a potential lesion?

<p>To differentiate between normal and abnormal findings. (B)</p> Signup and view all the answers

When introducing yourself to a patient for a neurological examination, which action is MOST important?

<p>Stating your intention and ensuring the patient is comfortable. (D)</p> Signup and view all the answers

Which strategy should be avoided when questioning a patient during a neurological examination?

<p>Using leading or biased language that affects their answers. (C)</p> Signup and view all the answers

Why is it important to avoid using 'why' questions when talking to a patient?

<p>'Why' questions can create a judgment and may cause the patient to feel defensive. (B)</p> Signup and view all the answers

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?

<p>Politely redirect them to the topic at hand. (C)</p> Signup and view all the answers

In what order should a neurological examination proceed? In other words, which of these would be the third to be assessed?

<p>Motor examination (A)</p> Signup and view all the answers

When a clinician states, 'I'm here to get you cured...', what mistake has been made?

<p>The clinician is providing false reassurance. (C)</p> Signup and view all the answers

What does a clinician's knowledge of neuroanatomy and neurological examinations primarily help them achieve during the assessment?

<p>To localize the lesion within the brain and nervous system. (B)</p> Signup and view all the answers

What should be done before starting a neurological examination?

<p>To make sure the clinician is well-fed and rested. (A)</p> Signup and view all the answers

What indicates the offspring of mating in a pedigree chart?

<p>Vertical lines (D)</p> Signup and view all the answers

In which type of inheritance does the disease never skip generations?

<p>Autosomal Dominant (C)</p> Signup and view all the answers

What is an example of an Autosomal Dominant disease?

<p>Huntington disease (C)</p> Signup and view all the answers

Which of the following is NOT a common type of inheritance discussed?

<p>Y-linked (A)</p> Signup and view all the answers

What key symptom should be inquired about in men related to the genitourinary system?

<p>Erectile dysfunction (C)</p> Signup and view all the answers

What might loss of weight and appetite suggest in a systemic inquiry?

<p>Malignancy (C)</p> Signup and view all the answers

Which organ system includes inquiries regarding respiratory issues?

<p>Respiratory (A)</p> Signup and view all the answers

What aspect is emphasized as a priority during patient history gathering?

<p>Systemic inquiry (B)</p> Signup and view all the answers

Flashcards

Identifying a Lesion

The initial step in a neurological examination focuses on identifying potential neurological problems.

Localization of the Lesion

This level aims to pinpoint the exact location of the neurological issue within the brain or nervous system.

Identifying the Nature of the Lesion

This level involves diagnosing the specific neurological condition causing the identified lesion.

Treatment Options for the Lesion

The final level focuses on determining potential treatment options for the diagnosed neurological condition.

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Onset of Symptoms

Describes how a symptom begins, including its suddenness or gradual onset.

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Vertigo

A feeling of spinning or whirling, often accompanied by a sense of losing balance.

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Mental Status Examination

Mental status examination assesses the patient's cognitive functions, including memory, attention, language, and mood.

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Near-syncope

A feeling of faintness or lightheadedness that is not caused by true dizziness or vertigo.

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Cranial Nerve Examination

Examination of cranial nerves involves testing each of the twelve cranial nerves to assess their function.

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Motor Examination

Motor examination evaluates muscle strength, tone, coordination, and gait.

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Disequilibrium

Difficulty maintaining balance or walking steadily.

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Course of Symptoms

Describes the pattern of a symptom over time, such as its progression, improvement, or recurrence.

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Sensory Examination

Sensory examination assesses different sensory modalities, including touch, pain, temperature, and vibration.

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Meningeal Examination

Meningeal examination checks for signs of inflammation of the meninges, the membranes surrounding the brain and spinal cord.

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Duration of Symptoms

The length of time a symptom lasts.

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Place of Symptoms

Describes the location of a symptom on the body.

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Autonomic Testing

Autonomic testing assesses the function of the autonomic nervous system, which controls involuntary functions.

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Setting of Symptoms

The context or activity in which a symptom began.

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Systematic Approach to Neurological History

Gathering information systematically and avoiding shortcuts ensures a comprehensive understanding of the patient's neurological condition.

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Baseline Level

The patient's ability to perform activities of daily living at the same level they could before the onset of neurological symptoms.

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History of Present Illness

Information about the patient's current medical problem that prompted them to seek medical attention. It should be a detailed account of the symptoms, including onset, progression, and associated factors.

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General Data in Neurological History

Details about the patient, such as their age, occupation, education level, and handedness, can provide valuable insights for understanding their neurological history.

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Occupation in Neurological History

The patient's occupation is important because some neurological conditions are associated with specific occupations.

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Handedness in Neurological History

Understanding a patient's handedness (left or right) is relevant in neurological assessment as some conditions affect the dominant side.

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Residence/Province in Neurological History

Some neurological diseases are more prevalent in certain regions due to environmental or genetic factors.

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Reliability of Informant

Evaluating the accuracy of the information provided by the patient is essential, especially if there are discrepancies or doubts about their reliability.

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Progressive diseases

Diseases that worsen over time, leading to a decline in health and function.

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Examples of progressive diseases

Examples of progressive diseases include Alzheimer's, Parkinson's, and ALS.

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Fluctuating Severity Profile

A symptom pattern characterized by periods of worsening symptoms followed by periods of improvement or stability.

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Fever

A common symptom of many diseases, characterized by a sudden rise in body temperature.

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Unintentional Weight Changes

A significant change in weight, either unintentional gain or loss, can be a symptom of various diseases.

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Generalized Malaise

A general feeling of being unwell or run down, often accompanied by fatigue and low energy.

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Orthopnea

A symptom characterized by difficulty breathing when lying down, often requiring the individual to sit up or stand.

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Paroxysmal Nocturnal Dyspnea

Sudden episodes of shortness of breath that occur during sleep, often causing the individual to wake up gasping for air.

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Multi-infarct Dementia

A neurological condition where damage to brain tissue due to multiple small strokes leads to gradual cognitive decline.

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Melena

Dark, tarry stools indicating the presence of blood in the digestive system.

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Hematochezia

Bright red blood in the stools, suggesting bleeding in the lower part of the digestive tract.

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Palpitations

Rapid heartbeat, often experienced as fluttering or pounding in the chest.

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Polydipsia

Increased thirst, often a symptom of dehydration or underlying medical conditions.

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Polyuria

Excessive urination, often a sign of fluid imbalances or kidney issues.

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Joint Pains and Swelling

Pain, swelling, or stiffness in the joints, commonly associated with inflammatory conditions.

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Vertical Lines in Pedigrees

In a pedigree, a vertical line indicates a direct descendant. This line connects a parent to their child and shows the lineage. Think of it as a family tree where each generation descends vertically.

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Chief Complaint

The main reason someone seeks medical help is called the chief complaint. This is the primary problem they are experiencing and is considered the most important symptom.

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Minor Complaint

A minor complaint is an additional symptom that isn't as significant as the chief complaint. It might be related to the main problem, but it's not the primary reason for the visit.

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Autosomal Dominant Inheritance

Autosomal Dominant inheritance means that a single copy of the faulty gene is enough to cause the disease. This means that if you inherit one copy from a parent, you will have the condition.

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Autosomal Dominant & Gender

In Autosomal Dominant inheritance, the disease can be passed on to offspring regardless of gender. Both males and females have an equal chance of inheriting the condition.

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Autosomal Dominant & Generations

The disease doesn't skip generations in Autosomal Dominant inheritance. If a parent has the disease, one of their children is likely to have it as well.

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Systemic Inquiry

A systemic inquiry explores multiple organ systems to help diagnose illnesses. It looks beyond the chief complaint to understand a patient's overall health.

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Paraneoplastic Syndrome

A paraneoplastic syndrome is a condition that occurs as a result of cancer. It's not the cancer itself but a side effect that can cause different symptoms in the body.

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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.
  • 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.
  • 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.
  • 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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Related Documents

OS 202 Neurological History Taking PDF

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.

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