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神经病学  Neurology    (英文原版改编版)(留学生与双语教学用)
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神经病学 Neurology (英文原版改编版)(留学生与双语教学用)

  • 作者:[美] H. 罗伊登·琼斯(H. Royden Jones J
  • 出版社:清华大学出版社
  • ISBN:9787302510734
  • 出版日期:2018年11月01日
  • 页数:720
  • 定价:¥99.80
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    内容提要
    Preface
    Ç°.ÑÔ
    Neurological diseases are some of the most frequently encountered diseases in medicine. Neurology has always been independently and widely learned by medical students across the globe. In recent years, an increasing number of foreign students have arrived in China and enrolled in the Bachelor of Medicine programs. Unfortunately, it is often difficult for medical students to learn the complexities of neurologic anatomy and physiology. Thus, it is imperative and highly beneficial t
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    Initial Clinical Evaluation

    Chapter
    1


    Clinical Neurologic Evaluation


    Overview and Basic Tenets
    The neurologic examination begins the moment the patients get out of their seat to be greeted, the character of their smile or lack thereof, and subsequently as they walk to enter the neurologist’s office. An excellent opportunity to judge the patient’s language function and cognitive abilities occurs during the acquisition of the patient’s history. Concurrently, the neurologist is always attuned to carefully making observations in order to identify various clinical signs. Some are overt movements (tremors, restlessness, dystonia or dyskinesia); others are subtler, e.g., vitiligo, implying a potential for a neurologic autoimmune disorder. Equally important may be the lack of normal movements, as seen in patients with Parkinson disease. By the time the neurologist completes the examination, she or he must be able to categorize and organize these historical and examination findings into a carefully structured diagnostic formulation.
    The subsequent definition of the formal examination may be subdivided into a few major sections. Speech and language are assessed during the history taking. The cognitive part of the examination is often clearly defined with the initial history and often does not require formal mental status testing. However there are a number of clinical neurologic settings where this evaluation is very time consuming and complicated; Chapter 2 is dedicated to this aspect of the patient evaluation. However, when there is no clinical suspicion of either a cognitive or language dysfunction, these
    more formal testing modalities are not specifically
    required.
    Here the multisystem neurologic examination provides a careful basis for most essential clinical evaluations. Neurologists in training and their colleagues in practice cannot expect to test all possible cognitive elements in each patient that they evaluate. Certain basic elements are required; most of these are readily observable or elicited during initial clinical evaluation. These include documentation of language function, affect, concentration, orientation, and memory. When concerned about the patient’s cognitive abilities, the neurologist must elicit evidence of an apraxia or agnosia and test organizational skills. Once language and cognitive functions are assessed, the neurologist dedicates the remaining portion of the exam to the examination of many functions. These include visual fields, cranial nerves (CNs) (Fig. 1-1), muscle strength, muscle stretch reflexes (MSRs), plantar stimulation, coordination, gait and equilibrium, as well as sensory modalities. These should routinely be examined in an organized rote fashion in order not to overlook an important part of the examination. The patient’s general health, nutritional status, and cardiac function, including the presence or absence of significant arrhythmia, heart murmur, hypertension, or signs of congestive failure, should be noted. If the patient is encephalopathic, it is important to search for subtle signs of infectious, hepatic, renal, or pulmonary disease.
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