Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
The simplest ophthalmoscopes consist of an aperture to look through, a diopter indicator, and a disc for selecting lenses. The ophthalmoscope is primarily used to examine the fundus, or the inner wall of the posterior eye, which consists of the choroid, retina, fovea, macula, optic disc, and retinal vessels (Figure 1). The spherical eyeball collects and focuses light on the neurosensory cells of the retina. Light is refracted as it passes sequentially through the cornea, the lens, and the vitreous body.
The first landmark observed during the funduscopic exam is the optic disc, which is where the optic nerve and retinal vessels enter the back of the eye (Figure 2). The disc usually contains a central whitish physiologic cup where the vessels enter; it normally occupies less than half the diameter of the entire disc. Just lateral and slightly inferior is the fovea, a darkened circular area that demarcates the point of central vision. Around this is the macula. A blind spot approximately 15° temporal to the line of gaze results from a lack of photoreceptor cells at the optic disc.
1Hugo W. Moser Research Institute at Kennedy Krieger, Johns Hopkins University, 2Department of Neurology, Johns Hopkins School of Medicine, 3University of Maryland, 4Experimental Neurology, Biogen Idec, 5The Brain Science Institute, Johns Hopkins School of Medicine, 6Department of Pediatrics, Johns Hopkins School of Medicine
1Department of Neurology, Mayo Clinic, 2Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, 3Center for Regenerative Medicine, Neuroregeneration, Mayo Clinic, 4Division of Neonatal Medicine, Mayo Clinic, 5Department of Pediatric and Adolescent Medicine, Mayo Clinic
Immunology and Infection
Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA
There are two main types of reflexes that are tested on a neurological examination: stretch (or deep tendon reflexes) and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1).
DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTR examination is using a stick figure diagram. The DTR test can help distinguish upper and lower motor neuron problems, and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2).
Superficial reflexes are segmental ref…
Physical Examinations III
1Department of Anesthesiology, Medical College of Wisconsin, 2Clement J. Zablocki Veterans Affairs Medical Center, 3Department of Surgery, Division of Pediatric Surgery, Children's Research Institute, 4Department of Orthopedic Surgery, Medical College of Wisconsin, 5Deptarment of Anesthesiology, Clement J Zblocki Veteran Affairs Medical Center, 6Department of Medicine, Division of Cardiology, Medical College of Wisconsin
Immunology and Infection
Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
The purpose of peripheral intravenous catheter (PIV) insertion is to infuse medications, perform intravenous (IV) fluid therapy, or inject radioactive tracers for special examination procedures. Placing a PIV is an invasive procedure and requires the use of an aseptic, no-touch technique.
Common IV venipuncture sites are the arms and hands in adults and the feet in children. According to the Intravenous Nurses Society (INS), the feet should be avoided in the adult population because of the risk of thrombophlebitis. Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. The cephalic vein has been associated with nerve damage when used for IV placements. The most distal site available on the hand or arm is preferred so that future venipuncture sites may be used if infiltration or extravasation occurs.
This video will demonstrate the insertion of a PIV, including the preparation and attachment of an IV extension s…
1Department of Biomedical Engineering, Cleveland Clinic Foundation, 2Center for Neurological Restoration, Cleveland Clinic Foundation, 3Office of Clinical Transformation, Cleveland Clinic Foundation, 4Concussion Center, Cleveland Clinic Foundation, 5Neurological Institute Center for Outcomes Research, Cleveland Clinic Foundation, 6Quantitative Health Sciences, Cleveland Clinic Foundation
1Research Unit of Experimental Neurotraumatology, Institute of Neurosurgery, Medical University Graz, 2Department of Neurology, Medical University Graz, 3Centre for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 4Centre for Molecular Medicine, Department of Medical Biochemistry and Biophysics, Karolinska Institutet
1Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), 2Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), 3School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), 4Faculdade de Desenvolvimento do Rio Grande do Sul (FADERGS), Health and Wellness School Laureate International Universities, 5Biomedical Engineering Department, Hospital de Clínicas de Porto Alegre (HCPA), 6Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), 7Department of Physical Medicine and Rehabilitation, Harvard Medical School, 8Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, 9Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), 10Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)