وهسة ناسيها تمامًا ولله الحمد

Hyperreflexia & Myoclonus

تصحيح بالنسبة للـ pronator drift:

The patient is asked to hold both arms at 90 degree flexion and elbows fully extended at shoulder level in front of them, with the palms upwards (supinated), and hold the position. If they are unable to maintain the position and the arms pronate, the result is positive. Closing the eyes accentuates the effect, because the brain is deprived of visual information about the position of the body and must rely on proprioception.

باختصار: تبدي بـ supination وإذا صار أكو drift للـ pronation معناها الاختبار positive
And the patient has UMN lesion

When you see absent P-waves, you must check whether the rhythm is regular or irregular based on the QRS complex:-

- Irregular and normal QRS: most likely to be atrial fibrillation.

- Regular: if the QRS < 120 ms (narrow), then it's likely to be paroxysmal SVT.
If the QRS > 120 ms (wide) then it's probably VT.

JUST TO BE CLEAR: This is an oversimplification with a lot of buts and ifs.
For example, some paroxysmal SVTs can present with wide QRS if they're associated with pre-existing LBBB.

In AF, the P-wave is either absent or it's replaced by rapid, variable, irregular and low-amplitude oscillating fibrillatory waves.

Also, the diagnosis of VT is defined as: tachycardia (>100-120 bpm), and the rhythm originates below the bundle of His (in the ventricles, therefore it is a ventricular rhythm).

Usually, you can tell if the rhythm is sinus or ventricular by observing the P-wave & the QRS complex. If QRS is wide and P-waves are absent or dissociated from the QRS (not every P-wave is followed by QRS) then it's most likely to be ventricular rhythm.

A wide QRS happens in VT because the rhythm originates in the ventricles and this makes the depolarization of the ventricles slower and takes a longer time (indicated by wide QRS > 120 ms)

Atrial fibrillation

Paroxysmal SVT

She has her diagnosis on her shirt😂🍻

The official line in medicine is that the physical exam is important. But what you quickly pick up in the “hidden curriculum”—the values and beliefs of medicine as it’s practiced—is that the physical exam is mostly a waste of time. On rounds in the hospital, as a student or intern, you might proudly describe a murmur you picked up on exam, but it doesn’t take long to realize that it’s only the report of the “echo” (shorthand for echocardiogram —an ultrasound of the heart) that anyone pays attention to. And because the physical exam is not valued, you soon learn not to pay attention to it and all further learning stops—replaced by the kind of learning you know those who are in charge will value. What did the newest high-tech test say? What is the most current research on a particular therapy? These are the questions physicians are now being trained to ask—not the more traditional questions, such as, What did you see when you looked at the patient? What did you feel? What did you hear?

- Every patient tells a story

Neurological lesions above the red nucleus (intercollicular line in the midbrain) tend to cause decortication and lesions below, decerebration.

Decorticate vs decerebrate posturing

There are at least 3 tracts and 1 nucleus that have the name "arcuate" in them.

As for "Lemniscus," you have 2 of them.

Arcuate fasciculus: connects Broca's with Wernicke's area.

Internal Arcuate tract: connects the dorsal column nuclei with the thalamus.

Anterior/posterior External Arcuate tract: connects the dorsal column nuclei with the pons & the cerebellum.

Arcuate nucleus: I don't even know where that is

Medial Lemniscus: the continuation of the internal arcuate tract outside the medulla is named the medial lemniscus. It connects the dorsal column nuclei with the thalamus.

Lateral Lemniscus: connects the auditory nuclei (superior olivary & cochlear) with the inferior colliculi.