PARKIN SON

PARKIN SON:
PARKING TREMOR=AT REST
\D2 70% + /Ach

DRUGS=BALSAM:
B ROMO-CRIPTINE
A MANTADINE
L-DOPA
S ELEGILINE
A NTI-M USCARINIC

1. L-DOPA+
CARBI-DOPA-->
PERIPH. INHIBITOR
SE:CHOREA, ON/OFF

2. SELEGILINE
DEPRENYL
MAO-B INHIBITOR DD.MAOI

3. BROMO-CRIPTINE
D-AGONIST~DOPAMINE
ERGOT-->LACTATN STOP

4.ANTI-Ach=M-BLOCKER
BENZ-ATROPINE

5.AMANTADINE-->FLU

COX-SACK-IE V

COX-SACK-IE V:
A-->h
A ND, FOOT & MOUTH
A NGINA (HERP)
A SEPTIC MG

B-->
B ARRE-GUILAIN

SPHINGO-LIPID SYNTHESIS

SPHINGO-LIPID SYNTHESIS:
AA SERINE+
FFA PALMITATE=
SPINGO-SINE+
FFA--> CERAMIDE:

DISEASE--> GRAY MATTER ONLY-->
IN NEURONES

Gal STAYS-->FABRY
XR 50y
META-CHROMATIC
LEUCO-DYSTROPHY

NO-MAN
P ICKs
P HOSPHATE
his nose with
hiSPHINGer
SPHINGomyelin

+MONO-SACCARIDE
G lu-CEREBROSIDE
G AUSHER
G LUCO-CEREBRO-SIDase\

S STAYS--> KRABBE

+OLIGO-SACCHARIDE-->
GANGLIO-SIDE
TAY-
SA X
HE X OS-AMIN-IDASE A

LMN SIGNS

LMN SIGNS=everything
L OWERED
-MUSCLE MASS\
-TONE\=FLACCID DD. UMN
-DTR\
TOES-->DOWN\

Nervous System SUPPORTNG CELLS

NS SUPPORTNG CELLS:
A MOSE wonderful array
A STROCYTE = FRAME
M ICROGLIA = APC
O LIGODENDROGLIA~
S WANN
E PENDYMAL~
ENDOTHELIAL CELL

Muscular Dystrophy

D MD
D YSTROPHIN\
D NA
D LELETION 70%
D EATH< 25y
DD.
B ECKER
B ENIGN

MYOTOME DANCE

MYOTOME DANCE:
RECITE ALOUD
“1-2-3”+ PERFORM:
C5- ARM ABD.
C678-ADD.
ELBOW FLEX
C78- EXT.
C6-PRON & SUPIN
C67-WRIST FL & EXT
C78-FING. FLEX & EXT
T1- FING ABD & ADD
ULNAR NERVE
L123- FLEX HIP<--PSOAS L34-KNEE EXT L45-ANKLE DORSI-FLEX L IFT PED S12-ON TOES S TAND on T OES T IBIAL NERVE-->TIP

Dementia

Dementia

DE
MEM-TIA
MEM-ORY LOSS
DELI-RIUM
SENSO-RIUM CHANGE

SLEEP STAGES and WAVES

SLEEP STAGES+
WAVES:
OPEN EYES
b \ AMPLIT. /FREQ.
buden

0 CLOSE EYES
a \FREQ. /AMPLIT.
Awake
0 theta
1 DELTA
DEEP /AMPL.
\FREQ.
REM
b ~ OPEN EYES
b UDEN

SKIN RECEPTORS

sPAINo-THalaM
PAIN Therm.
S HARP TOUCH

P ACINIAN
P RESSURE DEEP

UMN SIGNS

UMN SIGNS=
Everything UP:
-TONE /SPASTC~ RIGID
C RAFT
C LASP KNIFE

-DTR /
-TOES/=BABINSKI

SEIZURE DDx: TIC SPASMS CONCLUDE

T U
I CP/
C ONGEN STURGE-WEBER

S TROKE
P AN
A LCOHOL Withdrawal
S LE
M G
S EVERE TRAUMA

METABOLIC
C a2\
O 2\
N a+\
C OCAINE
L F
U REMIA
D RUGS
E VALUATE Glu\ or /


DRUGS=
PCT B:

P HENO-THIAZN Schz
C OCAINE
T CA

B DZ W

ROMBERG
C LOSED EYES UN-SATBLE
C OLUMNS POST. or
C EREBELLUM

O PEN EYES UN-STABLE
O NLY CEREBELLUM

Tinnitus differential diagnosis: Q SALAMI mnemonic

Quinidine

Salicylates (aspirin)
Aminoglycoside antibiotics (ABx)

Labyrinthitis
Acoustic neuroma, CN VIII
Meniere’s disease
Increased blood pressure (BP) (HTN)

References:

Tinnitus: Patients do not have to ‘just live with it’. CCJM, 2011.

Tinnitus relief: Suggestions for patients. CCJM, 2011.
Noise Chart as It Relates to Hearing Damage and Hearing Loss http://goo.gl/tjZh1

RoS NERVOUS System: WW PROMS HINTS

W EAK-NESS
W ALKING/ COORDIN. PROBLEMS

P ARALYSIS
R OOM SPINNING
O THER DIZZY
M EMORY PROBLEMS
S TROKES

H EAD-ACHE
I NCONTINENCE
N UMB-NESS
T REMORS
S EIZURES Hx
S EE + HEAR-ING ?
S PEECH DIFFICULTIES

CPSS = FAS
LAPSS = ASS-NGA-GAG

NEUROLOGICAL Sx: HSV ERR

(presenting at PCP's office)

H EAD-ACHE 40%
COMMONEST COMPLNT
S TROKE, TIA
V ERTIGO 20%

E PILEPSY 10%
R IGIDITY+TREMOR
PARKINSON 4%
R EPEATED EPISODES
MS 3%

Nervous system examination mnemonic - NMS CD (and more)

 NMS CD:

Nerves - CN 2-12
Motor
Sensory - PP TT

Cerebellum + gait
DTR (deep tendon reflexes) - B-BAKAB KB

-----------

Hugh - MMSE - ORACLE. Note: Copyright vs. Open Access at the Bedside: MMSE form disappearing from textbooks, replaced by the Sweet 16 test - NEJM, 2011.
Speak/Undestand
Read/Write

Motor examination
STORM, BABy

-----------

DTR (deep tendon reflexes) examination - B-BAKAB KB mnemonic:

Biceps/triceps

Brachioradialis
Abdomen - MS
Knee
Ankle - Achilles

Babinski - Plantar

----------- 

Kernig
Brudzinski

-----------  

Sensory examination - PP TT mnemonic:

Pain - pin
Positon, vibrating fork

Touch - cotton ball
ToF

Numbers 1-9 - hand
Cortical sensation

-----------  

Cerebellum
Finger - nose
Shin - heel
Supination / pronation

Gait - Romberg

Closed eyes +
Columns posterior
Cerebellum

Open eyes +
Only cerebellum

-----------  

Physical examination of CNS

U/LMN symptoms

STORM BABy!:

Strength - ORGNFN
Tone
Other symptoms, e.g.FASCICUL
Reflexes (DTR)
Muscle mass

BABinski

LMN
Low all

UMN
Up - Babinski

-----------  

Muscle strength grade 0-5

ORGN FN:

5 OK
4 Resist
3 Gravity overcome
2 No gravity overcome
1 Flicker of movement
0 N O MOVEMENT

-----------  

Tone
Tetra - all 4 extremities

-----------  

DTR mnemonic - B-BAKAB KB

Published: 01/12/2003

HEAD-ACHE DDx: COMMON COMPLAINT

C LUSTER O2
O THER INDOMETHACIN
M IGRAINE 3 C
M USCLE TENSION headache
O CULAR GLAUCOMA,
REFR. ERROR
N EUR-ALGIA TRIGEMINAL

C ERV. SPONDYLOSIS
O A CERV. SPINE
M EDICATION NITRATE, Ca2
BLOCKER, MSG
P RESSURE/ BP
L P MG
A RHTRITIS TMJ
I CP/ TU, ICH BIH
N Phydro-cepalus
T EMPORAL ARTERITIS

B I HTN
B LIND-NESS

MIGRAINE 3 C
C LASSIC
C OLOR
A RRAY
A URA
1-LATERAL
DDx.
C OMMON BI-LATERAL

Cranial Nerves: OPEC GP TUFT

O CULAR - CALF
P ERRLA - 346
E OMI
C FC - 5

G AG - 9 10
P ALATE - Ah!

T ONGUE - 12
U UU! - HEAR-ING 8
F ACIAL N. - COWS
T RAPEZIES - STERNOM. 11

2=
CALF:

C ONFRONT.PERIPH.VIS. FIELDS
A CUIITY FIGURE
L IGHT REFLEX PERRLA
F UNDI ophtlalmo-scope

346 EOMI

5=
CFC:
C ORNEAL REFLEX
F ACE SENSATION
C LENCH TEETH
FEEL MUNCH mm

7=
COWS:
C LOSE your EYES
O PEN Dr TRIES
W RINKLE LOOK UP
S MILE!

8 WHISPER
9 10 Ah!
11
S HRUG
S HOULDERS
S IDE-WAYS HEAD

12 STICK OUT
TONGUE PROTRUSION

Diagnosing Meningitis: Don’t MISS

M eningeal symptoms, e.g. Kernig and Brudzinski
I CP increase
S eptic symptoms, e.g. fever, tachycardia
S pinal fluid changes


K ernig symptom
K nee bending


B ridzinski symtptom
B end the neck
B ack is rigid
B oth legs flex at the hips


DDx of Meningitis Causes = BAT:
B acterial
A septic, e.g. viral
T B

Nervous System Physical Exam: CNS MD

C erebellum and gait
N erves - CN 2-12
S ensory exam

M otor
D TR – deep tendon reflexes