MeTHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE
MEDICAL FACULTY
LESSON № 5 (PRACTICAL – 6 HOURS)
Theme:
1. Autonomic nervous system (peripheral and segment parts, hypothalamus, limbic-reticular system). The symptom of lesion on different levels.
2. Special Clinical Examinations of Neurological Patients (Electromyography, Echo-Electroencephalography, Electroencephalography, CT-scan, Pneumocephalography, Cerebral Angiography, Roentgenography, Reoencephalography, MRI).
Aim: Students should be able to determine independently signs of lesion Autonomic nervous system, to localize the pathological process (focus) on different topical levels. Students should be able to formulate and to explain the topical diagnosis. Students should be able to analyze the result of the special methods of examination and use it.
Professional orientation of students: The autonomic nervous system is a purely efferent system of nerve fibers with ganglia and plexuses outside the central nervous system innervating the blood vessels, heart, viscera, glands, and smooth muscles throughout the body. The vegetative disturbance have own specific clinical signs. Contemporary medicine uses many special methods for the examinatioeurological patients. They can help to set the pathogenesis of disease, to detected the localize of the lesion, to make the diagnosis. The doctor of all specialties must be able to analyze the result of the special methods of examination and use it.
Methodology of Practical Class (9:00-12:00).
Algorithm of students’ communication with patients with pathology in subject (communication skills):
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Find a contact with a patient, try to gain his/her confidence
5. Correct inquest, listening to the patient’s explanation.
6. Conversation accomplishment.
Physical methods of examination
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Find a contact with a patient, try to gain his/her confidence
5. Explain to the patient the nessessity of the examination and its aim, get his/her informed consent
6. Explain to the patient examination details, its safety and possible sensations
7. Prepare for the examination (clean, warm hands, ets.)
8. Explain to the patient results of his/her tests correctly and accesibly
9. Conversation accomplishment.
Informing about the results of examination
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Interpretation of test results
5. Calm a patient in the case of precense of pathological changes, inform about the following actions
6. Assure in positive changes and favourable prognosis at implementation of all of the medical recommendations
7.Conversation accomplishment
Work 1.
Autonomic nervous system (peripheral and segment parts, hypothalamus, limbic-reticular system). The symptom of lesion on different levels.
I step. Aim: To determine presence of signs of vegetative system lesion. For this purpose it is necessary:
The scheme of diagnostic search of vegetative disorders:
I. To gather an anamnesis and to examine patient’ status.
II. At the analysis of the complaints of the patient to find out presence of attributes of a lesion of a vegetative system:
a. activity of inner organs (attacks of tachy- and bradycardia, breath, dyspeptic disturbance after meals, abdominal spastic pain, diarrhea, frequent and abundant urination),
b. activity of cardiovascular system (attacks of a skin pallor and hyperemia, high and low of blood pressure),
c. activity of the sweating, sebaceous glands and lacrimal organs (salivation, hyperhidrosis, dry skin, eyewatering, xeroftalmia),
d. activity of pelvic (urogenital) organs (ischuria /retention of urine/, incontinence of urine and feces),
e. trophic disturbance (hyperkeratosis, skin lesion, peeling of the skin, fissures of skin, pustules, skin edema, hyperpigmentation, alopecia, hemiatrophia, osteoarthropathia),
f. disturbance of height and substances exchange (low and high height, increasing of weight, cachexia, acromegalia),
g. disturbance of sleep, thermoregulation, memory, emotions and tendencies.
II step. Aim: To determine part of vegetative nerve system (sympathetic, parasympathetic) lesion. Make a conclusion about presence of pathology of sympathetic or parasympathetic part of vegetative nervous system.
III step. Aim: To find level of lesion vegetative nervous system.
IV step. Aim: To make topical diagnosis of a pathological process level localization in vegetative nervous system. In topical diagnosis it is necessary to point main vegetative signs (syndromes), the character of vegetative pathology.
Work 2.
Special Clinical Examinations of Neurological Patients (Electromyography, Echo-Electroencephalography, Electroencephalography, CT-scan, Pneumocephalography, Cerebral Angiography, Roentgenography, Reoencephalography, MRI).
Step II. Aim: To estimate the parameters of the electrophysiological and the roentgenologic methods of examination of neurological patients. Students must know the normal parameters of the electrophysiological and the roentgenologic methods.
Step III. Aim: To make topical and clinical diagnosis. For this aim it’s necessary to use algorithm of differential diagnosis, which is in methodological indication for students.
Individual Students Program.
You should be subjects prepared for the practical lesson using the existing textbooks and lectures. Special attention should be paid to the following:
Theme 1 Autonomic nervous system (peripheral and segment parts, hypothalamus, limbic-reticular system). The symptom of lesion on different levels.
1. Knowledge of anatomical structures and function of the autonomic nervous system.
2. To study specific methods of examination autonomic nervous system:
a) history taking;
b) examination of patient’s status;
c) vascular responses of the skin (local, reflection);
d) activity of the sweating, sebaceous glands and lacrimal organs (salivation, hyperhidrosis, dry skin, eyewatering, xeroftalmia);
e) disturbance of thermoregulation.
3. The signs of lesion of sympathetic part of autonomic nervous system:
a) sympathy-adrenal attacks
b) damage of sympathetic fibers in structure of peripheral nerves, plexus and roots, superior cervical ganglion, Celiac ganglion, sympathetic (thoracic-lumbar) outflow, side horns of spinal cord.
4. The signs of lesion of parasympathetic part of autonomic nervous system:
a) vago-insular attacks;
b) lesion of S3-S5 segments of spinal cord;
c) disturbance of pelvic (urogenital) organs (ischuria /retention of urine/, incontinence of urine and feces) by central and peripheral types;
d) the lesion of superior and inferior salivatory nuclei of medulla oblongata;
e) the lesion of Edinger-Westphal nuclei of midbrain.
5. Hypothalamic syndromes:
a) visceral-vegetative-vascular attacks
b) diencephalic epilepsy
c) temperature disturbance
d) disturbance of sleep and vivacity
e) endocrinal disturbances
f) neuro-myogenic disturbances
g) trophic disturbances
h) pseudoneurastenic signs
6. Lesion of limbic-reticular complex:
7. The lesion of frontal, temporal and parietal lobes.
Theme 2. Special Clinical Examinations of Neurological Patients (Electromyography, Echo-Electroencephalography, Electroencephalography, CT-scan, Pneumocephalography, Cerebral Angiography, Roentgenography, Reoencephalography, MRI) .
To study the parameters of the electrophysiological methods:
a) electromyography,
b) echo – electroencephalography,
c) electroencephalography.
To study the roentgenologic methods of examination:
a) roentgenography of the scull;
b) roentgenography of the spinal column;
c) computerized transaxial tomography – CT-scan;
d) pneumocephalography;
e) cerebral angiography.
To can estimate the parameters of the electrophysiological and the roentgenologic methods of examination neurological patients with;
a) cerebrovascular disease;
b) tumors;
c) trauma;
d) abscesses;
e) myopathy;
f) amyotrophic lateral sclerosis;
Seminar discussion of theoretical issues (12:30-14.00).
Test evaluation and situational tasks.
Tests.
1. Clinical features of sympathy-adrenal attack.
2. Clinical features of vago-insular attack.
3. Enumerate hypothalamic syndromes.
4. Name symptoms of lesion of limbic-reticular complex.
5. Describe autonomic-trophic disorders in case of lateral horns of spinal cord lesion.
6. Describe the irritation symptoms of sympathetic nerve of vertebral artery.
7. Enumerate hypothalamic realizing-factors.
8. Enumerate hypothalamic inhibits factors.
9. Special methods for determination of autonomic attacks.
10. Special methods for determination of urinary retention.
11. The lesion of what structures are in case of urinary retention?
12. The lesion of what structures are in case of micturition?
13. The lesion of what structures are in case of occasional incontinence?
14. Name the rate and amplitude of the normal EEG activity?
15. Name the rate and amplitude of the abnormal EEG activity?
16. Describe EEG from patients with convulsive seizure.
17. Name the type of electromyography and give them characteristics.
18. Give the characteristics of normal and abnormal Echo-EG.
19. Name the roentgenologic sings of ostheochondrosis.
20. What signs can we find in the CT-scan in patient with hemorrhage?
21. What signs can we find in the CT-scan in patient with ischemic stroke?
Real-life situations to be solved:
1. Specific methods of examination of autonomic nervous system.
2. The signs of lesion of sympathetic part of autonomic nervous system.
3. The signs of lesion of parasympathetic part of autonomic nervous system.
4. Hypothalamic syndromes.
5. Lesion of limbic-reticular complex.
6. The paroxysmal and permanent disturbance of autonomic functions.
7. Electrophysiological methods of examination of neurological patients
8. Roentgenologic methods of examination of neurological patients.
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.
Student should know:
1. Anatomical structures and function of the autonomic nervous system
2. Specific methods of examination autonomic nervous system
3. Signs of lesion of sympathetic part of autonomic nervous system
4. Signs of lesion of parasympathetic part of autonomic nervous system
5. Hypothalamic syndromes
6. Parameters of the electrophysiological methods
Student should be able to:
1. To localize processes within certain anatomic structures of medulla oblongata, autonomic nervous system.
2. To estimate the parameters of the electrophysiological and the roentgenologic methods of examination of neurological patients.
3. To put topical diagnosis and to explain it.
Independent work of students (14:15-15:00).
References:
А – Basic:
1. Basic Neurology. Second edition. John
2. Clinical examinations ieurology – Mayo clinic and Mayo foundation.- 4-th edition.- W.B. Saunders Company, Philadelphia, London, Toronto.- 1976.
3. WEB-site of tdmu.
Material for practical classes
В – Additional:
3. Neurology for the house officer.- 3-th edition.-Howard L. Weiner, MD and Lawrence P. Levitt, MD,- Williams &Wilkins.- Baltimore.- London.- 1980.
4. Van Allen’s Pictorial Manual of Neurologic Tests.- Robert L. Rodnitzky.- Third edition.-Year Book Medical Publishers, inc. Chicago London Boca Raton. – 1981.
Methodical instruction has been worked out by: dotsent N.R. Sokhor
Methodical instruction was discussed and adopted at the Department sitting
27.06.2013 . Minute № 10
Methodical instruction was adopted and reviewed at the Department sitting
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