T6, Wk5, Day 356, Wednesday

Had Phys Dx II, Dx Imag II and our Phys Dx II Lab Practical today. I was really hoping to get testing on the posterior lung examination but got hit with the breast exam instead. I muddled through alright but didn't have near as much practice with the breast exams as I did with the lung exams.

Tomorrow we've got two hours of Neurology followed by two hours of EENT then 3 hours of Chiropractic Clinical Reasoning (CCR). In CCR we start by giving a regional exam to our patient and we've got 20 minutes to complete it then switch Dr. / patient roles. After the first 40 minutes we're given a case study to evaluate. The case evaluation part is kind of like the TV show House MD. The neat part is these are actual cases from one of our teachers. The first week kind of sucked because we had a patient w/ a metastatic cancer but, last week it was a much nicer (and easier to evaluate) muscle strain.

Neurology is all case based also. The first hour of that class starts out by going over a couple cases and we have to figure out where the neurological lesion is located. That might not be a bad thing to review right now. We start at the top of the head, with the cerebral cortex and work our way down. For each segment of the neurological system we may have sensory and motor symptoms.

A quick look at todays pic may help when going through this neurological list. We're basically starting at the top of the head. Numbers 1 to 4 deal with things in the head and upper neck region. #5 is the Spinal cord, then we have the roots (#6) of the nerves that project from the spinal cord. Those nerves that spread out to all areas of the body are known as the peripheral nerves (#7). The neuromuscular junction (#8) is simply where a nerve attaches to a muscle and #9, myopathy refers to the muscle itself.

1. Cortex - complex sensory loss, asterognosis/agraphesthesia, visual spatial loss (neglect) difficulty localizing - motor loss involves weakness or paralysis, spasticity with increased tendon reflexes and little, if any muscular atrophy.
2. Subcortical (thalamus or Basal Ganglion) - thalamus deficits include sensory losses of primary sensory modalities, possible visual disturbances, spontaneous painful sensations. Motor loses involve the basal ganglion and include dyskinesias, abnormal posturing (dystonia) possible hemiparesis.
3. Cerebellum - sensory losses include clumsiness and incoordination. Motor signs & symptoms include ataxia, intention tremors, dysmetria, hypotonia, dysdiadochokinesia ...
4. Brainstem - sensory changes seen in cranial nerves and long tracts. Motor changes seen in cranial nerve territories and may be LMN or UMN signs. Long tracts involvementwith UMN signs.
5. Spinal Cord - well demarcated level below which there is decreased sensory perception. Sensory signs include spastic weakness with increased DTR's and dysautonomia. Acute injury has flaccid paralysis with decreased DTR's.
6. Nerve Root (radiculopathy) - sensory = dermatomal loss of sensation, asymmetric distribution that may be distal or proximal. Motor = flaccid weakness, decreased DTR's, presence of fasciculations.
7. Peripheral Nerve - Sensory = territorial distribution of sensory loss, usually distal asymmetric loss. Motor = flaccid weakness, decreased DTR's presence of fasciculations
8. Neuromuscular junction - absence of sensory changes. Motor signs include weakness that may be patchy in distribution, weakness noticed worse with exercise or later in the day, normal or reduced tone and DTR's
9. Myopathy - absence of sensory changes. Motor signs include proximal weakness, usually symmetric, absence of atrophy or fasciculations, normal DTRs and mass until late in disease, absence of sphincter disturbances.

DTR stands for Deep Tendon Reflex.