Posted on June 3, 2021
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Lifespan Activity Time: 10 min
Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?
Student Response:Rule out bacterial meningitis, there was no immunizations to increase meningitis risk.
Model Note:Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no previous history of chronic infections. Although children with strep throat can present with fever and neck pain, they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.
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Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform? Tina Jones Neurological shadow health assessment Lifespan & Review Questions
Student Response:Differential diagnosis include stroke, dementia, electrolyte imbalance, dehydration, infection and drug toxicity. An Neurological assessment can rule out stroke and transient ischemic attack. Urinalysis should rule out uti.
Model Note:Differential diagnosis includes stroke, transient ischemic attack, dementia, infection, electrolyte imbalance, dehydration and drug toxicity. The provider should do a neurological assessment to rule out stroke and TIA. Visualization of mucous membranes and skin assessment for tenting is indicated to rule out dehydration. A urinalysis should be performed to rule out a urinary tract infection which is a common cause of confusion in the elderly. He should be asked questions about his medication intake and medical history in case he retains some memory. If he is completely disoriented, family members should be contacted, if possible, to gain more information. Tina Jones Neurological shadow health assessment Lifespan & Review Questions
Review Questions Activity Time: 6 min
To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested?
Correct:The patellar deep tendon reflex involves the sensory and motor nerve fibers associated with spinal segments L2, L3, and L4. Location of abnormal reflexes may be helpful in identifying neurological pathologies of the spine.
- Achilles
- Biceps
- Patellar (Correct Response)
- Triceps
Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening?
Correct:Autonomic dysreflexia is the sudden increase in blood pressure caused by dysregulation of sympathetic and parasympathetic nervous systems reacting to a noxious stimulus below the site of spinal injury. Other symptoms include bradycardia, anxiety, blurred vision, headache, flushing, and sweating Tina Jones Neurological shadow health assessment Lifespan & Review Questions. The noxious stimulus (pulling of the Foley catheter) should be alleviated to resolve the condition.
- Odynophagia
- Febrile reaction
- Idiopathic spinal reaction
- Autonomic dysreflexia (Correct Response)
Which of the following is not a common symptom of Parkinson’s disease?
Correct:Parkinson’s disease is characterized by tremors at rest, bradykinesia, cogwheel rigidity, postural instability, festination, lack of facial expression, reduced arm swing, autonomic and neuroendocrine dysfunctions, and a variety of psychological issues such as depression, anxiety, and sleep disturbances.
- Lack of facial expression
- Festination
- Cogwheel rigidity
- Intention tremors (Correct Response)
Name at least three ways to assess cerebellar function during a physical exam.
Student Response:Test cerebellar function by assessing gait and instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements Tina Jones Neurological shadow health assessment Lifespan & Review Questions
Model Note:The cerebellum is responsible for smooth and accurate coordination of voluntary movements. You can test cerebellar function by assessing gait and by instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements, and Romberg tests.
If Tina had a fever and photophobia, you would have had to test for meningitis. Describe how you would have tested for the Kernig’s sign.
Student Response:flex the knee and hip when the patient is supine,at a right angle with the flexed knee. Straighten the leg at knee.
Model Note:The test for Kernig’s sign is used to identify meningeal irritation. To perform the test, flex the leg at the knee and hip when the patient is supine, making a right angle with the flexed knee. Then attempt to straighten the leg at the knee. Resistance and pain in the lower back constitute a positive Kernig’s sign, indicating meningeal irritation.
Suppose you assessed pain sensation over Tina’s left foot, and noticed that she had decreased sensation. How would you have proceeded with your exam?
Student Response:Assess bilateral sensations from feet and up the legs since the client is at risk of diabetic nephropathy.
Model Note:Because Tina is at risk for diabetic neuropathy, it is important to assess bilateral sensations starting at her feet and proceeding up the legs. Sensation tests should include sharp and dull touch, light touch, vibration, temperature, point location, and positioning of joints. Superficial and deep tendon reflexes of the feet, ankles, and knees should also be assessed to determine the extent of her neuropathy. Tina Jones Neurological shadow health assessment Lifespan & Review Questions
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