@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!)
258 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books.
258 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents.
258 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)!
263 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!!
273 days ago
Trick of the trade: Improve your ability to detect a cerebellar lesion
Posted May 18 2011 12:00am
The finger-to-nose exam is typically used to detect a cerebellar lesion. In subtle cases though, this can be be difficult to detect.
How can you improve your sensitivity of this exam?
Trick of the trade: Elbows up!
I used to do the exam with the patient's elbow down at his/her side. An abnormal finger-to-nose test can be masked because you are mainly testing only biceps and triceps strength. Also the arm motion momentum can easily compensate for a subtle deficit. Instead have the patient raise the elbows (a chicken-wing position) for the exam. It is a little more difficult to compensate now. I recently picked up a subtle cerebellar stroke with this maneuver.
Also, it is important to have the patient fully extend his/her arm so that it is stretching to reach your finger. A subtle deficit becomes more obvious.
How can you improve your sensitivity of this exam?
Trick of the trade: Elbows up!
I used to do the exam with the patient's elbow down at his/her side. An abnormal finger-to-nose test can be masked because you are mainly testing only biceps and triceps strength. Also the arm motion momentum can easily compensate for a subtle deficit. Instead have the patient raise the elbows (a chicken-wing position) for the exam. It is a little more difficult to compensate now. I recently picked up a subtle cerebellar stroke with this maneuver.
Also, it is important to have the patient fully extend his/her arm so that it is stretching to reach your finger. A subtle deficit becomes more obvious.
Thanks to Dr. Farzan for demonstrating!