Autonomic Nervous System (ANS) Examination || CNS Examination || Pediatrics — Transcript

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1. 0:00hello everyone today i am going to cover
2. 0:03the last part of the cns examination
3. 0:06autonomic nervous system and the skull
4. 0:08spine
5. 0:09so autonomic nervous system
6. 0:12is divided into central and the
7. 0:13peripheral anus in central ions
8. 0:17structures which are included are the
9. 0:19amygdala mainly hypothalamus and also
10. 0:23role of basal forbane age in midbrain
11. 0:26and spinal cord
12. 0:29division of peripheral anus is
13. 0:31sympathetic parasympathetic and the
14. 0:33entry part
15. 0:36main function of the anus it controls
16. 0:38the known striated muscle of the
17. 0:40visceras and also glendular function
18. 0:43also it regulates the circulation
19. 0:45respiration digestion metabolism and the
20. 0:48temperature
21. 0:49so autonomic nervous system is mainly
22. 0:51for the maintenance of the vital
23. 0:53function
24. 0:55so to examine the autonomic nervous
25. 0:57system first we should take the proper
26. 0:59history then we should measure the all
27. 1:01the vitals in
28. 1:03supine and standing position so we will
29. 1:06measure the blood pressure heart rate
30. 1:09then record the temperature and there
31. 1:12are various other cutaneous signs can be
32. 1:14there because of the
33. 1:16this autoregulation
34. 1:18respiratory abnormalities can be there
35. 1:20eye sign and
36. 1:23abnormal body weight and appetite can be
37. 1:25there because of involvement of the
38. 1:26hypothalamus
39. 1:28may be having bulimia or behavior
40. 1:30changes
41. 1:32sleep disturbance because of central
42. 1:34anus or hypothalamus involvement
43. 1:38so for detailed history to rule out the
44. 1:42autonomic
45. 1:43nervous system this regulation
46. 1:46in this first we have to ask the sign
47. 1:48symptoms due to the dysfunction of git
48. 1:52and got example child may be having the
49. 1:54constipation dysphasia
50. 1:56night diarrhea weight loss
51. 1:58or sometimes urinary retention urgency
52. 2:01recurrent uti can be there fecal or
53. 2:03urinary incontinence can be there
54. 2:05because of the
55. 2:07gut dysfunction
56. 2:09then we have to ask the sign symptoms of
57. 2:12the orthostatic hypotension child may be
58. 2:14having the dizziness lightheadedness
59. 2:18history of syncope palpitation weakness
60. 2:21confusion slurred speed
61. 2:25all these symptoms will be worst when
62. 2:27child is
63. 2:28doing the exercise or after long
64. 2:31standing
65. 2:32taking the whole bath or after meal also
66. 2:36we have to ask the history of
67. 2:39related to the sweating abnormalities
68. 2:41example
69. 2:43dryness of skin leak of normal moisture
70. 2:46in socks it is characteristic
71. 2:49and
72. 2:50after taking the detailed history we
73. 2:53have to rule out sign symptoms of anus
74. 2:55disorder
75. 2:58then we have to measure the blood
76. 2:59pressure and the heart rate
77. 3:02orthostatic change in the heart rate in
78. 3:04bp occur in anes disorders
79. 3:07so we have to
80. 3:09calculate the heart rate in supine and
81. 3:11then in standing position
82. 3:13then we have to
83. 3:15measure the blood pressure in supine and
84. 3:17at one three five minutes after standing
85. 3:21so normally systolic bp on a standing
86. 3:24should not decrease more than 20 mmg and
87. 3:26diastolic vp more than 10 mmg
88. 3:29and in heart rate
89. 3:31normally it should not increase more
90. 3:33than 30 beats per minute above the
91. 3:35baseline on standing or in adolescent
92. 3:38age group
93. 3:39should not be more than 120
94. 3:44also we can perform the tilt table
95. 3:46testing in this we have to tilt the
96. 3:48table up to the 60 to 80 degree angle
97. 3:51and after five minutes we have to take
98. 3:54the heart rate and the blood pressure
99. 3:57so similar finding
100. 3:58will be there if the child is having ans
101. 4:01disorder
102. 4:02then we have to measure the temperature
103. 4:04and we have to observe for various
104. 4:06cutaneous signs
105. 4:08so
106. 4:09patient will have the abnormal sweating
107. 4:11or dryness and it will also alter the
108. 4:14temperature change in skin color or
109. 4:16temperature
110. 4:18can lead to the paler acrocyanosis
111. 4:20erythema
112. 4:22sometime mottling hypertrichosis nail
113. 4:24thickening all can be the feature of
114. 4:27various cuteness science
115. 4:30respiratory abnormalities in the form of
116. 4:32hyper apnea apnea
117. 4:34or various character of the breathing
118. 4:36biots or
119. 4:38chinese stroke building can be
120. 4:40there in eyes we have to assess the
121. 4:43lacrimation by sheamus test we have to
122. 4:46keep the strip of paper in lower eyelid
123. 4:49and after five minutes we have to
124. 4:51measure the weightness in sheamus test
125. 4:55and
126. 4:55[Music]
127. 4:57we have to also ask about the excessive
128. 4:59dryness of the eye the redness of the
129. 5:01eye should be
130. 5:02examine for the dryness and redness
131. 5:07if the child is having central autonomic
132. 5:10nervous system involvement hypothalamus
133. 5:12involvement
134. 5:14then the abnormality of the body weight
135. 5:16appetite can occur child may be having
136. 5:18the bulimia behavior changes child is
137. 5:21having irritability or
138. 5:23various behavior disorders
139. 5:27sleep disturbance can be there in the
140. 5:29form of
141. 5:30hypersomnolence or insomnia
142. 5:33so all these are the characteristic
143. 5:37testings and the symptoms of the
144. 5:40autonomic nervous system
145. 5:43now the last part is skull spine in this
146. 5:46we have to
147. 5:48inspect and also palpate the skull for
148. 5:51the size shave frontal bossing
149. 5:54prominence we should pulp it for the
150. 5:56fontanelles and scalp swelling already i
151. 5:59have explained the details in the
152. 6:01general physical examination
153. 6:03so in this picture you can see the child
154. 6:04is having hydrocephalus
155. 6:07and similarly for the spine we have to
156. 6:09inspect for any spinal deformity in the
157. 6:11form of scoliosis kyphosis
158. 6:14or lordosis look for any swelling if it
159. 6:17is present either spina bifida or having
160. 6:20the
161. 6:21some other deformity
162. 6:23then we have to palpate further any
163. 6:25tenderness or
164. 6:27all the characteristic of the mass
165. 6:31so this is all about the
166. 6:34autonomic nervous system examination and
167. 6:36the skull spine
168. 6:38thank you so much