CVA & Weakness

HISTORY_LIST
gradual onset of weakness
sudden onset of weakness
time of onset
location of deficit
activity prior to onset
prior headache
nausea
vomiting
loss of consciousness
brisk neck movements
visual aura
scotoma
blurred vision
diplopia
vertigo
seizure
paresthesia
neck stiffness
fever
confusion
dysarthia
incontinence
dysphagia
transient monocular blindness 
heart palpitations
CHRONIC DISEASE OR DISORDERS
prior TIA
stroke
hypertension
diabetes
coronary disease
endocarditis
hyperlipidemia
heart failure
valvular dz.
arrhythmias (A. fib)
claudication
migraine headaches
PREVIOUS TESTS
CT scan
carotid Doppler
echocardiogram
TRAUMA OR INJURIES
head injuries
SOCIAL HISTORY
smoking
alcohol
caffeine
illicit drugs - cocaine
IV drug use
ALLERGY
medications
foods
seasonal
FAMILY HISTORY
stroke
hyperlipidemia
cardiac dz.

MEDS_LAB_TESTS
**** MEDS
anticoagulants
oral contraceptives
antihypertensives
**** LAB
Electrolytes
BUN
creatnine
CBC
ESR
**** TESTS
ECG
CXR
MRI
CT scan of head

REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB (altered by position?)
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

REVIEW_OF_SYSTEMS_3
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
sagittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty in fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
psychiatric hospitalizations
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia

PHYSICAL_EVAL_1
VITALS
BP R arm
BP L arm
Pulse
Temp
GENERAL
lethargy
SKIN
petechia
splinter hemorrhages
HEENT
PERRLA
pin-point pupils
enlarged pupils
EOMI
hypertensive retinopathy
yellow retinal flecks
Roth spots
subhyloid retinal hemorrhages
retinal exudates
papilledema
venous pulsations
temporal bruits
facial symmetry
facial weakness
corneal reflex in tact
NECK
neck rigidity
carotid bruits
asymmetrical carotid pulse
vertebrobasilar bruits

PHYSICAL_EVAL_2
CHEST
clear to auscultation bilaterally
rhonchi
fine crackles
course crackles
wheezing
Cheyne Stokes breathing pattern
HEART
regular rate and rhythm
irregular, irregular rhythm
S3
murmurs
ABDOMEN
tenderness
aortic pulsations
renal bruits
RECTAL
guaiac (occult blood)
EXTREMITIES
unequal peripheral pulses
edema
cyanosis
clubbing
all pulses 2+/4 bilaterally
radial pulse
ulnar pulse
femoral pulse
popliteal pulse
posterior tibial pulse
dorsalis pedis pulse
Homan's sign
varicosities
NEURO
weakness in arm
weakness in leg
gag reflex
CN II-XII grossly intact
CN palsy
CN I intact
CN II intact
CN III intact
CN IV intact
CN V intact
CN VI intact
CN VII intact
CN VIII intact
CN IX intact
CN X intact
CN XI intact
CN XII intact
gaze
pstosis
pinprick
light touch
gait normal
gait abnormal
upper extrem strength bilat. equal
upper extremity DTR's 2+ bilat.
lower extrem strength bilat. equal
lower extremity DTR's 2+ bilat.
Babinski's sign
superficial touch sensation
deep pressure
superficial pain
positional sense
vibration sense
temperature
Romberg Test
rapid rhythmic alternating movements
finger-to-finger test
finger-to-nose test
heel-to-shin test
stereognosis
two-point discrimination
extinction phenomenon
graphesthesia
point location
nuchal rigidity
Brudinski's sign 
Kernig's sign 

DIFF_DIAGNOSIS
TIA
Brain abscess
Meningitis
Encephalitis
subdural hematoma
Hypoglycemia
demylination dz.
vasculitis
postictal paralysis
delirium
hysteria
conversion reaction
atypical migraine
basilar artery stenosis
carotid steal syndrome
SIGNS OF CEREBRAL HERNIATION
Obtundation, 
dilation of ipsilateral pupil,
decerebrate posturing
Cushing's Triad =
 bradycardia,
 hypertension,
 abnormal respiration;
ascending weakness
SIGNS OF INC INTRACRANIAL PRESSURE
 Lethargy, headache, vomiting,
 meningismus, visual changes,
 gait disturbances, 
 cranial nerve palsy,
 papilledema, 
 focal neurologic deficits,
 abnormal vital signs, 
 seizures, 
 hyperreflexia, head tilt.


