Take your shoes off for a minute. Can you feel the soft fluffy carpet under your feet? Or the cool smooth tiles? Or the grain of he floor boards? When was the last time you walked through the grass with bare feet? Taking these times to nourish your tactile senses is really enjoyable and calming. If you’ve had a bad day, just take a few minutes to give it a go.
This article is about Neurology.
One of the most common forms of neurological complaints I’ve seen is the good ole “sciatica”. A patient will present with burning pain radiating from their buttock down their leg. This is always a very distressing and debilitating pain for patients. I know my Grandfather had this pain and it literally floored him for several weeks – he would just lie on the lounge room floor in a beanbag with his favourite Labrador by his side. The factors that determine urgency of assessment are all the red flags of back pain – fever, saddle parasthesia, IV drug use, etc. If these aren’t present, then it’s not recommended to do imaging for the first 4-6 weeks as this condition can typically resolve with simple analgesia. If imaging is required, then MRI is the investigation of choice. Having a good arsenal of pain relief options for the patient is also helpful!
I once had a patient present for a whooping cough vaccine. His grand-daughter was soon to be born and his wife sent him in for the vaccination. He was 45 years old and hadn’t been to the doctor for anything more than a sprained ankle in the last 20 years. I took the opportunity to invite him back for a 45-49 year old health assessment (707). As part of this assessment I noted an irregular pulse, and ECG confirmed atrial fibrillation. This started a journey of investigation and management with the hope of reducing his risk of cerebrovascular accident – all by taking the time to reach over and feel his pulse. Never underestimate the value of reaching across the space between you and your patient.
If a patient reports a “funny turn” don’t forget to complete a complete neurological assessment. I had a patient come to see me to follow up on some results of a CT brain ordered by another GP. The patient originally presented after feeling a bit off after a “funny turn” the previous day. The other GP ordered a CT brain out of thoroughness, but failed to complete a neurological examination. The CT returned showing that the patient had indeed had a stroke, and further examination revealed a very clear homonymous hemianopia. A well practiced cranial nerve examination can be quick and simple.
Be kind to yourself, and nourish your tactile sensations.
Dr Andrew Harris
Director of Amadeus Education.
Did you know?
According to BEACH data, 4.2% of all encounters in General Practice were specifically related to the neurological system. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)
These are the common presenting complaints that should be covered for this topic:
- Amnesia, total or partial (https://bit.ly/2CmOBUe)
- Arm and hand pain (excluding fractures) (https://bit.ly/2Hov9Mm)
- Confusion, acute in adults (https://bit.ly/2MeZ8Fk)
- Diplopia (https://bit.ly/2DdSVqt)
- Dizziness/vertigo (https://bit.ly/2stf3H2) (BEACH)
- Dysphagia (https://bit.ly/2ssCLDg)
- Fits, faints and funny turns (https://bit.ly/2QSg6dm)
- Headache (https://bit.ly/2RzyNrP) (BEACH)
- Leg pain (https://bit.ly/2RRyDuZ)
- Leg ulcers (https://bit.ly/2VXUIHl)
- Paraesthesia and numbness (https://bit.ly/2AMSu4K)
- Tremor (https://bit.ly/2CpLfQp)
These are the common conditions that should be reviewed for this topic:
Headache – including migraine, tension, cervicogenic, cluster, subarachnoid haemorrhage.
Cerebrovascular disease – including stroke, TIA
Tremor – including Parkinson’s disease, Huntington’s disease
Restless leg syndrome
Motor neuron disease
Guillain Barre syndrome
Myelopathy including polymyositis, dermatomyositis, muscular dystrophy
Carpal tunnel syndrome
These are the medications and doses that should be learned for the exam:
These are some important mnemonics relevant to this topic:
- ABCD2 score (TIA) (https://bit.ly/2IqxrLF)
- Canadian C-spine rule (cervical spine fracture risk) (https://bit.ly/2GVtqMS)
- CHADS2 score (atrial fibrillation stroke risk) (https://bit.ly/2E2Iwgz)
- CHA2DS2-VASc score (atrial fibrillation stroke risk) (https://bit.ly/2xII7KP)
- GCS (Glasgow coma scale) (https://bit.ly/2CY4xdQ)
Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):
- Neurology, August 2018
- Dizziness, July 2011
- Pain management, November 2011
- Fitness to drive, January 2012
- Neurology, August 2013
- Head pain, August 2014
Focus on clinical skills:
Here is a brief focus on some OSCE preparation topics related to this topic:
- Parkinson’s disease assessment
- Glasgow coma scale
- Gait assessment
- Neurological examination playlist by GP Synergy: https://bit.ly/2Dhn0VW
Focus on medicolegal:
Here is a brief focus on the medicolegal issues covered in Australian Family Physician:
- Using interpreters: A guide for GPs. AFP, April 2010. (https://bit.ly/2sA1rtR)
- Failure to use an interpreter. April 2010. (https://bit.ly/2Do5Bva)
Copyright © 2021 Andrew Harris