Download MBBS Important Topics Central Nervous System CVS

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Important Topics Central Nervous System CVS for MBBS 1st Year Important Topics, MBBS 2nd Year Important Topics, MBBS 3rd Year Important Topics & MBBS Final Year Important Topics.

This post was last modified on 24 July 2021

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MBBS 2021 Important Topics and Materials for 1st Year, 2nd Year, 3rd Year and Final Year

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CENTRAL NERVOUS SYSTEM

INTRODUCTION

Name
Age

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Sex
Handedness
Resident of
Education
Occupation

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Informant
Reliability

CHIEF COMPLAINTS

XXXXXX – Onset and course
Yyyyyy - onset and course
Zzzzzzz – onset and course

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H/O PRESENT ILLNESS

LOC/Seizure
1. Onset
2. Activity at the time of incident
3. Preceded by
  1. Chest pain/Palpitations sweating/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
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  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
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  Taste impairment
8. Hearing impairment
  Giddiness
  Vertigo
  Tinnitus
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  H/O CSOM
9. And X
  Dysphagia – solid/liquid/both
  Dysphonia
  Dysarthria
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  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

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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 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

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

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Abnormal behavior/nausea/vomiting
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

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Dog bite/animal bite/vaccination/injection
Alternative drugs/well water drinking/insecticides exposure
Carrying weight in head for long/neck pain for long
Skin lesions/Nodules
Hypo/hyper thyroidism symptoms

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Blood transfusion

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
High Risk behavior

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MENSTRUAL HISTORY

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

OCCUPATIONAL HISTORY

Nature/duration/intensity of exposure
H/O exposure to dye/paint/glasswares/med eqpts/jwellery

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Plumbing/farming/insecticides
Vibrating eqpts/repeated trauma

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

Conscious/oriented/cooperative/comfortably lying.…………....

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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
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mm Hg/Rt Arm supine/No significant postural fall
RR – rate/rhythm/type
P/I/C/C/L/E/JVP
Neurocutaneous markers
Nerve thickening

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Vitamin deficiencies
Xanthoma/xanthelasma/arcus senilis
Congenital anomalies – arms/foot/chest/gums/teeth/hair change
acanthoma nigricans/scars/sinus
Features of hypo/hyper thyroidism

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acromegaly/marfans features
Angioma/cutaneous angiomata/rash/petechiae/purpurae/ecchym.
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

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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
  4. Ask to repeat “Yellow Lorry”.
  5. Tongue muscles fasciculations/flaccidity.
  6. NMJ – Fatiguability/Nasal voice.
Cranial Nerves
1. Coffe powder/soap/shampoo/tooth paste
2. Acuity/Color/field/pupils/RAPD/Fundus.
3. III/IV & VI
  Position of the eye at primary gaze
  Conjugate eye movements
  a. convergence/divergence/saccades/pursuits
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  Individual eye movements
  Nystagmus
4. V
  Facial sensations touch/pain/temp/vibration
  Muscles of mastication- clench the teeth
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  Movements of mandible
  Corneal reflex
  Jaw reflex
5. VII
  Wrinkling of forehead
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  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
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  Herpes zoster in EAM
6. VIII
  Rinnes/webers/ABC/Ear examination
7. IX & X
  Uvular position
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  On saying "AH" uvula/palatal/post phar. wall movement
  Gag reflex
  Taste on post 1/3rd of tongue
  Dysphonia/dysphagia testing (?)
8. XI
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  Shrugging of shoulders
  - Left/right turn of neck (SCM)
9. XII
  Tongue position in resting state/on protrusion
  Flaccidity/fasciculations/tremors/spasticity
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  Myotonia/movements/Deviation of tongue
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
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    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
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
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    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
EPS
1. Rigidity
2. Tremor
3. Mask like face
4. Gait
5. Micrographia
6. Hypophonia
7. Hypomimia

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This post was last modified on 24 July 2021

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CENTRAL NERVOUS SYSTEM

INTRODUCTION

CHIEF COMPLAINTS

H/O PRESENT ILLNESS

ETIOLOGICAL HISTORY

PAST HISTORY

PERSONAL HISTORY

MENSTRUAL HISTORY

OCCUPATIONAL HISTORY

FAMILY HISTORY

TREATMENT HISTORY

SUMMARY

GENERAL EXAMINATION

SYSTEMIC EXAMINATION

CNS EXAMINATION

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