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Old 04-19-2012
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Hammer and Otoscope Neurologic Cases Taking Time

hello - hope everyone's preparation going well. I have my exam next week and been practicing FA, Kaplan and UW cases .. agreed Kaplan cases are little complex but at times I feel I am really struggling with time on CNS cases .. either history takes time or the physical .. I am trying hard to finish history in 8 min and physical in 7 .. hows everyone coping with it ?

I would appreciate if someone who has already taken exam can shed some light. I am not seeking case details but just hows SP interaction and do they seem to be cooperative ..

thanks in advance
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Old 04-19-2012
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Most of the times you won't be doing a complete comprehensive neurological examination even in CNS cases.

Practice doing it quickly, do not go into details. For example, elbow, knee, and ankle reflexes are enough, and you don't need to keep repeating it to get response, just a quick light tap is enough, the SPs are good in telling an exaggerated response if they want.

You can do the cranial nerves really quickly (maybe 2 minutes) you just need to keep practicing it.

Do not use the pin prick, just the end of your hammer for sensation and again do it quickly, if there's sensation distally then you don't need to work yourself all the way up proximallly.

If the case is irrelevant, you don't need to do vibration, position sense, and the plantar response.

If the case is irrelevant, you don't need to do visual field.

If the case is irrelevant, you don't need to do Rinne and Weber.

If the case is irrelevant, you don't need to do finger-nose, heel-shin testing.

If the case is irrelevant, you don't need to do detailed cerebellar exam.

This issue has also been discussed here
Full Neurological Examination in CS cases?

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