Tuesday, January 26, 2010

Neuro Exam

At our institution we spend 2 weeks on Neurology. During this 2 weeks they have a pretty stringent list of things to be done in addition to things we already have to do for Internal Medicine at the same time. One of those requirements is a witnessed neurological exam to be graded by your attending or 4th year neuro resident.

My group has known that we were having ours today for a week, but it's still nerve wracking. We were expecting to do the exam on a patient or on each other but our attending had a different idea.

He took us into an examination room and had us do an entire simulated patient encounter with him, as well as the full neuro exam - on him. They say you should be able to do one in 5 minutes, but I think it took all 3 of us at least 15 minutes a piece. It was a bit scary but I really enjoyed 2 parts of it:

1 - asking him to smile because I had not yet witnessed it. Just as I expected, he wasn't very good at it...

2- the Babinski reflex :) Let me explain. To see if a patient has a Babinski reflex you have to apply a painful stimulus to the bottom of the foot and see if the big toe goes up or down. Upgoing toe is Babinski + and abnormal. Downgoing toe is normal. So to elicit this reflex you have to take an object (the pointier, the better) and starting at the heel drag it very deeply and painfully up to the pinky toe and then around to the big toe. My other 2 classmates were pretty gentle with him, but I really let him have it. He had downgoing toe before I even got to halfway down his foot.

3 more days of Neuro - on call tomorrow, so they'll be a long 3 days...

RUNNING LOG
I've run 5.58 miles since last time I posted. Only 288.16 miles to go this year. I'd better get on it!

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