Download MBBS Final Year Central Nervous System CVS Notes Notes

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) Central Nervous System CVS Notes Handwritten Notes

This post was last modified on 11 August 2021

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MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities

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CENTRAL NERVOUS SYSTEM

INTRODUCTION

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Name
Age
Sex
Handedness
Resident of

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Education
Occupation
Informant
Reliability

CHIEF COMPLAINTS

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Xxxxxx – Onset and course
Yyyyyy – onset and course
Zzzzzzz – onset and course

H/O PRESENT ILLNESS

LOC/Seizure
1. Onset
2. Activity at the time of incident
3. Preceded by
  1. Chest pain/Palpitationsweating/nausea/ vomiting/
  2. headache/giddiness/presyncope/visual disturbance.
4. Associated with
  1. Involuntary movt/Tonic/clonic/focal/generalized
  2. Rolling up of eyes/stare/tongue bite/grunting noise
  3. Sphincter incontinence/abnormal breathing pattern
5. Lasted for (Duration)
6. Recovered after – Spont/treatment
7. Post recovery – drowsiness/confusion/weakness
8. Number of episodes
9. Sensorium in between episodes
10. Last episode
11. Any injury sustained.
Disorientation
1. To T/P/P
2. Episodic or continuous
3. Orientation between the episodes
4. Any abnormal behavior
5. Recovery
Speech disturbance
1. Onset
2. Comprehension
3. Any spontaneous speech/word outflow
4. Slurring
5. Reading/writing/repetition
6. Progression
7. Any stress during speaking
8. Tightness/looseness in tongue
9. Paraphasias
Cranial Nerves
1. Smell to commonly used items soap/shampoo/toothpaste
2. Decreased visual acuity Color vision Color desaturation Scotoma/Field defect
3. IV and VI
  1. Double vision
    1. Monoocular/binocular
    2. On primary gaze or evoked gaze
    3. Horizontal/vertical
    4. Disappears by (Closing eye)
  2. Pain in eyes on movements
  3. Ptosis – Fatiguability/diurnal variation
  4. Features of Horners syndrome
4. Same as above
5. Decreased/abnormal sensations over face, difficulty in mastication.
6. Same as above
7. Deviation of angle of mouth Facial asymmetry Drooling of saliva Difficulty in closing eyes Difficulty in speaking Taste impairment
8. Hearing impairement Giddiness Vertigo Tinnitus H/O CSOM
9. And X Dysphagia – solid/liquid/both Dysphonia Dysarthria Nasal regurgitation Hoarseness of voice/Nasal twang
10. Same as above
11. Neck movements Shrugging of shoulders
12. Ability to make the bolus of food Ability to maneuver the food bolus inside the mouth Tongue deviation Dysarthria
Motor
1. Weakness (UMN)
  1. Reaching overhead objects/taking comb to the head
  2. Lifting a bucket of water/breaking the chapaties
  3. Holding a glass of water/writing task in detail
  4. Holding the pen/grasping the comb
  5. Difficulty in getting up from a chair/squatting position
  6. Climbing up/down the stairs/gripping the chappals
  7. Chappals slips away with/without the knowledge
  8. Getting up from lying down position/Turns in the bed
  9. Lifting the head off the bed
  10. Breathlessness/ptosis/facial weakness/chewing
2. Dexterity
  1. Buttoning/unbuttoning the shirt/ Breaking the chapaties
  2. Tie the nada of payjama/shoe lace
  3. Negotiating the foot into the chappal
  4. Also ask about
  1. Proximal/distal
  2. Symmetrical/asymmetrical
  3. Spasticity/wasting – which is more?
  4. Onset and progression of the weakness
  5. Present status.
3. Weakness (LMN)
  1. Looseness/fasciculations/wasting
  2. Which is earlier – weakness or wasting
  3. Proximal/distal
  4. Symmetrical/asymmetrical
  5. Periodicity/diurnal variation, fatiguability
  6. Selectivity of muscles
  7. Onset/course/progression
4. Cerebellar
  1. Smearing of face/target oriented activities
  2. Tremors/Gait/Speech/Vertigo/Looseness of limbs
  3. Difficulty in reaching the objects
  4. Incoordination during picking up water/during drinking.
5. EPS
  1. Tremors at rest/Stiffness/expressionless face
  2. Bradykinesia – during bath/dressing etc.
  3. Sleep/Memory/Handwriting/Hypophonia/Gait
  4. Difficulty in walking narrow paths (Pedestrian strip)
6. Gait
  1. Broad based/Narrow base
  2. Speed/Antalgic gait/Freezing/Parkinsons gait features
  3. Recurrent falls/Buckling........./Climbing up/down
  4. Difficulty in walking in dark/Pain while walking
  5. Stiffness/crossing of legs
Sensory
1. Onset/progression/present status
2. Posterior column
  1. Unable to feel clothes over the body
  2. Difficulty in walking in the dark/wash basin (Sink) sign
  3. Slipping of slippers without knowledge
  4. Cotton wool sensations over the feet
  5. Band like sensation/Encasement of limbs
  6. Pins and needles/numbness/tingling/paraesthesias
  7. Lhermittes phenomenon/water flowing underneath the feet
3. Spinothalamic
  1. Hot and cold water during bath
  2. Burning/shooting/pricking pain
  3. Funicular pain/sensory level
  4. Root pain is a sharp shooting pain in a particular n dermatomal pattern which increases on coughing/sneezing. It is recurrent and more severe.
4. Cortical sensations
  1. Ability to feel the coins in the pocket
  2. Feel wallet in the pocket
Autonomic
1. Bladder
  1. Urgency/urge incontinence/frequency/hesitancy
  2. Precipitancy/Retention (Painful/less & aware/unaware)
  3. Overflow incontinence/incomplete evacuation
  4. Dribbling of urine/loss of social inhibition
  5. Postural giddiness/presyncope/erectile dysfunction
2. Bowel – Frequency/consistency/continence
3. Faintness/palpitations
4. Abnormal sweating/Decreased lacrimation
5. Horners syndrome
6. Gastroparesis/nausea/vomiting/diarrhea

ETIOLOGICAL HISTORY

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Headache (Mnemonic – OLD CAARTS)
1. Onset/location/duration/diurnal variation/Ch...
2. Associated with(Nausea/vomiting/photophobia/ phonophobia/ abnormal behavior/LOC/blurring of vision
3. Red flag signs
4. Preceded by aura
5. Aggravated by/relieved by/timing/severity/
6. Frequency (No of episodes in a day)/abnormal sweating
7. Pain anywhere in the body
Injury/RTA/Trauma to the neck
Abnormal behavior/nausea/vomiting

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Fever/chest pain/palpitations/cough/ dyspnea/hemoptysis
Bowel symptoms/Jaundice
Oliguria/dysuria/hematuria/high colored urine
Joint pain/rash/photosensitivity/oral ulcers /hair fall/seizures
Dog bite/animal bite/vaccination/injection

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Alternative drugs/well water drinking/insecticides exposure
Carrying weight in head for long/neck pain for long
Skin lesions/Nodules
Hypo/hyper thyroidism symptoms
Blood transfusion

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PAST HISTORY

DM/TB/HTN/Hansens/CAD/BA
Similar illness in the past
Animal bite/vaccination/injection in the past
Blood transfusion/jaundice

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Major surgery

PERSONAL HISTORY

Veg/Non veg/Well water drinking/food habits
Smoking/Tobacco/Alcohol/Substance abuse
Marriage/Children

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High Risk behavior

MENSTRUAL HISTORY

Menarche/Cycles/Menopause
LMP/Post menopausal bleed
any surgery

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OCCUPATIONAL HISTORY

Nature/duration/intensity of exposure
H/O exposure to dye/paint/glasswares/med eqpts/jwellery
Plumbing/farming/insecticides
Vibrating eqpts/repeated trauma

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FAMILY HISTORY

Pedigree charting of possible genetic disease
h/O similar illness in the family

TREATMENT HISTORY

SUMMARY at the end of history and four tier diagnosis

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Functional
Physiological
Anatomical
Etioloical 1, 2, 3, 4....

GENERAL EXAMINATION

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Conscious/oriented/cooperative/comfortably lying.........
Ht/Wt/BMI/Arm length/upper segment/lower segment/neck:ht ratio.
Pulse Rate/rhythm/volume/character/peripheral pulses/R-R & R-F Delay/pulse deficit/vessel wall/carotid bruit/shudder
BP mm Hg/Rt Arm supine/No significant postural fall
RR – rate/rhythm/type

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P/I/C/C/L/E/JVP
Neurocutaneous markers
Nerve thickening
Vitamin deficiencies
Xanthoma/xanthelasma/arcus senilis

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Congenital anomalies – arms/foot/chest/gums/teeth/hair change
acanthoma nigricans/scars/sinus
Features of hypo/hyper thyroidism
acromegaly/marfans features
Angioma/cutaneous angiomata/rash/petechiae/purpurae/ecchym.

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Bed sores/genital ulcers
Peripheral stigmata of TB/HIV

SYSTEMIC EXAMINATION

CVS
1. Apical Impulse/chest wall symmetry/anomalies
2. S1/S2/S3/S4/murmur/pericardial rub/knock
RS
1. Chest wall symmetry
2. Air entry/Breath sounds/adventitious sounds/pleural rub
P/A
1. Distended/all quadrants moves equally with the respiration
2. Soft/Non tender/organomegaly/free fluid/bowel sounds
3. Hernial sites/peripheral signs of liver failure

CNS EXAMINATION

HMF
1. consciousness
2. oriented to T/P/P
3. Registration
4. attention/calculation
5. Recall
6. Language-Speech (Mnemonic – CNS R3)
  1. Comprehension
  2. Naming
  3. Spontaneous speed
  4. Reading
  5. Writing
  6. Repetition
7. Language – Dysarthria
  1. UMN/Pseudobulbar – “British constitution"
  2. Bulbar - Pa Ta Ka
  3. Cerebellar – Rashtrapaty Amritsar se Hyderabad gaye
Cranial Nerves
| Coffe powder/soap/shampoo/tooth paste
|| Acuity/Color/field/pupils/RAPD/Fundus.
III/IV & VI
- Position of the eye at primary gaze
- Conjugate eye movements
  1. convergence/divergence/saccades/pursuits
- Individual eye movements
- Nystagmus
V
- Facial sensations touch/pain/temp/vibration
- Muscles of mastication- clench the teeth
- Movements of mandible
- Corneal reflex
- Jaw reflex
VII
- Wrinkling of forehead
- Frowning of eyebrows/eyelid closure
- Bells phenomenon/facial expression/nasolabial fold
- Angle of mouth deviation/buccinators
- Taste sensation ant 2/3rd – sugar/vinegar/salt
- Parotid swelling/tenderness
- Herpes zoster in EAM
VIII
- Rinnes/webers/ABC/Ear examination
IX & X
- Uvular position
- On saying "AH” uvula/palatal/post phar. wall movement
- Gag reflex
- Ask to repeat “Yellow Lorry”.
- Tongue muscles fasciculations/flaccidity.
- NMJ – Fatiguability/Nasal voice.
Motor system examination
1. Position/attitude of limbs
2. Bulk (wasting/hypertrophy)
3. Tone
  1. Spasticity – clasp knife
  2. Rigidity – cog wheel/lead pipe
  3. Flaccidity
  4. Fasciculations
4. Power
  1. Shoulder – Abduction/adduction/flexion/extension (5/5)
  2. Elbow – Flexion/extension (5/5)
  3. Wrist – Dorsiflexion/Palmar flexion (5/5)
  4. Hand grip – Percentage (25/50/75), Myotonia (+/-)
  5. Individual muscles of hand – Normal or weak.
  6. -------
  7. Hip - Abduction/adduction/flexion/extension (5/5)
  8. Knee - Flexion/extension (5/5)
  9. Ankle – Dorsiflexion/Plantar flexion (5/5)
  10. EDP muscle wasting – Present/not
  11. Truncal weakness – Percentage (25/50/75)
  12. Neck muscle weakness - Percentage (25/50/75) (Flexion/extension/lateral flexion)
5. DTR
  1. Biceps/triceps/supinator/knee/ankle
  2. Clonus (+/-)
  3. Myotonia (+/-)
  4. Pseudomyotonic reflex
6. Superficial Reflexes
  1. Plantar
  2. Abdominal
  3. Cremastric
  4. Perianal reflex
7. Whartenburg sign
8. Koffman sign
9. Release reflexes
  1. palmo mental
  2. Glabellar tap
  3. Rooting reflex
  4. Suckling reflex
  5. Grasping reflex
10. Coordination – UL/LL
Sensory System Examination
1. Superficial sensations
  1. First test pin prick sensation
  2. Touch
2. Deep sensations
  1. Pain
  2. Temperature – Cold (Tuning fork) and warm
3. Combined
  1. Vibration
    - Forehead/Mastoid/Sternum/Vertebral spine
    - Clavicle/Elbow/wrist
    - ASIS/PSIS/Tibial tuberosity/ankle
  2. Joint position Great toe/index finger
4. Cortical sensations
  I all the peripheral sensations are intact, then, check for cortical sensations.
5. Lhermittes phenomenon
6. Rhombergs sign
7. determine pattern of sensory loss
  1. Symmetrical/asymmetrical
  2. Glove stocking/Patchy
  3. Root level

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Cerebellum
1. Nystagmus
  1. Primary gaze
  2. evoked gaze
  3. Horizontal/vertical/torsional
  4. Fatiguable/not
2. Intention tremor
3. Rebound phenomenon (Holmes)
4. Dysmetria (these tests to be done with eyes open and then eyes Closed and initially slow & then rapid)
  1. Finger nose test
  2. Finger nose finger
  3. Knee shin dragging test
    - First tap the knee with heel to r/o sensory loss
    - Then excursion along skin of the tibia (Cerebellar – broken movements) (Sensory – waving of heel here & there)
  4. Finger toe test
5. Past pointing
6. Alternating movements
  1. Draw a circle in air with finger/toe
  2. Alternatively pat the foot steadily on the ground
  3. Pronation – supination (Disdiadochokinesia)
  4. Alternating opening and fisting of both hands
  5. Screwing like movements
  6. Door knob opening like movements
  7. Opposition of thumb and fingers
  8. Tap out simple rhythm with finger.
7. Speech
8. Hypotonia
9. Pendular knee jerk
10. Titubation
11. Gait and how the patient stands
12. Drift
  1. Cerebellar – Upward
  2. Pyramidal – Down and pronated
  3. Parietal lesion – Upward and wavy
Gait

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EPS
1. Rigidity
2. Tremor
3. Mask like face
4. Gait
5. Micrographia
6. Hypophonia
7. Hypomimia
ANS

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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities

This post was last modified on 11 August 2021

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Download MBBS Final Year Central Nervous System CVS Notes Notes

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