Medical Concepts

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Internal Medicine

ICU Topics

Neurology

Neuro Exam Notes

Lumbar Puncture

Significant Clinical Trials

  • MR CLEAN
  • ESCAPE
  • EXTEND- IA
  • REVASCAT
  • SWIFT PRIME
  • THRACE
  • DEFUSE-3


Mental Status

Cranial Nerves

Cranial Nerve I Smell

Cranial Nerve II Visual acuity, fields, optic fundi, pupil size and reactivity

Cranial Nerves III, IV, VI (pupil size and reactivity), extraocular movements

Cranial Nerve V corneal reflex, facial sensation

Cranial Nerve VII strength of facial muscles, taste

Cranial Nerve VIII Hearing

Cranial Nerves IX, X, XI Articulation, palate movement, gag reflex

Cranial Nerve XII tongue movement

Motor system

The four questions of neurology:

What are the SYMPTOMS of neurologic disease

What are the SIGNS of neurologic disease

WHERE is the lesion

WHAT is the lesion

Stroke Labs

Signs of CNS Disorders

Psychogenic Neurologic Deficits

Headache

Migraine Cocktail

Psychiatry

Quantitative Psychiatry Topics

Schneiderian First Rank Symptoms

  • Auditory hallucinations
    • voice or voices repeating the subject's thoughts out loud
    • discussing the subject or arguing about him/her, referring to him/her in the third person
    • discussing the patient's thoughts as or before they occur
    • commentary on the subject's thoughts or behavior
  • Intrusion of unusual ideas or thoughts into the subject's mind as if by an external agency (Thought Insertion)
  • Experience that one's thoughts are shared or accessible to other people (Thought Broadcasting)
  • Experience of deprivation of thought as a result of removal by some person or influence (Thought Withdrawal)
  • Experience that actions, sensations, movements, emotions, or thoughts are generated by an outside agency taking over the will of the subject (Passivity Experiences)
  • Primary Delusions - fixed, false, idiosyncratic belief

The reliability of using first-rank symptoms for the diagnosis of schizophrenia has since been questioned, although the terms might still be used descriptively by mental health professionals who do not use them as diagnostic aids.

Individuals with dissociative identity disorder may experience first-rank symptoms more commonly than even patients with schizophrenia though patients with DID lack the negative symptoms of schizophrenia and normally do not mistake hallucinations for reality. Differentiating between dissociative identity disorder and psychotic disorders is not done by listing first-rank symptoms as these conditions have a considerable overlap yet a different overall clinical picture and treatment approach.


Withdrawal Management

Cocaine Withdrawal

Opioid Withdrawal

Benzodiazepine, Barbiturate, and Alcohol Withdrawal

Pharmacological Strategies for Detoxification

Perspectives

Disease

The patient’s clinical syndrome (signs, symptoms, and course) is understood as arising from structural or functional pathology within a specific organ or organ system (in this case the brain), with origins in a specific etiology, which in psychiatric disease is often unknown.

For example, the recognizable clinical syndrome of dementia due to Alzheimer disease may best be understood as developing from physical changes in the brain due to a specific, but at this time not fully known, etiology. Question asked by the clinician: "What disease, if any, does the patient have?" Dimensional

Within populations there are natural distributions of both physical and psychological attributes. This perspective presumes that an individual’s cognitive or temperamental endowments my increase his/her potential to react to a certain provocation with a particular pathologic response.

For example, individuals on the extremes of personality dimensions are classified as having personality disorders by the DSM. Question asked by clinician: "How can I best guide my patient toward success based on the kind of person he/she is?"

Behavior

This perspective is based on the concept that an individual’s psychological drives are shaped partly by conditioned learning and influence the choice of whether or not to engage in a particular behavior. This perspective refers to disorders of both innate (e.g., feeding, sexual) and acquired drives. For example, anorexia nervosa, paraphilia, alcoholism, self-cutting

Questions asked by clinician: "How can my patient’s troubles be explained by what he/she does, and how can I help him/her by changing what he/she does?"

Life story

This perspective uses the logic of narrative—a sequence of events within a particular setting leads to a specific outcome—to understand a patient’s psychiatric presentation. For example, loneliness and sadness with widowhood

Question asked by clinician: "How can I best understand my patient’s symptoms based on what he/she encountered?"