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Video: eFAST - The Extended Fast Exam

By popular demand, here’s our short (8 minute) humorous video on the basics of the extended FAST exam. Courtesy of Michael Zwank MD from Regions Hospital. From Trauma Education: The Next Generation 2014.

Enjoy!   

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Note that only the LMN that are innervating muscles of forehead and eye are getting bilateral corticobulbar innervation. In contrast LMN that serve muscles of the nose and mouth are only receiving contralateral corticobulbar innervation.

Therefore if a patient that has a weakness in the ability to wrinkle their forehead, can’t shut their eye, can’t flare their nostrils and the corner of their mouth droops- that lesion is most likely in the facial nerve as indicated by lesion B.

But if a patient presents with facial weakness and if the weakness is only limited to lower face meaning that the patient can still wrinkle their forehead and still shut their eyes bilaterally in the blink reflex- that lesion is most likely not due to facial nerve lesion but instead in the corticobulbar fibers coming out of the hemisphers. Therefore lesion A would result in contralateral lower face weakness. 

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Tuberous Sclerosis: Signs & Symptoms

Seizures

Developmental delay 

Behavioral problems

Mental Retardation

Skin abnormalities

Kidney disease

SASA HART

S hagreen patches

A sh leaf spots (hypomelanic macules)

S ebaceous Adenomas (Facial angiofibromas)

A strocytoma (Subependimal Giant Cell Astrocytoma SGCA)

H amartomas everywhere

A ngiomyolipoma in kindey (last pic)

R habdomyomas in the heart

T ubers in the brain

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Sturge Weber syndrome (AD disease) with port wine stain in the distribution of the ophthalmic and maxillary division of CN V.  Patients have an ipsilateral AV malformation with tram tracking (vessel calcification). They frequently suffer epileptic seizures and are mildly mentally retarded.

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So when it is, be ready with some “DOPAMIN RASH" for the Dx!

D iscoid Lupus (circular, red macules)

O ral ulcers

P hotosensitivity

A rthritis (nonerosive, hands, knees, wrist)

M alar rash 

I mmunology (anti-dsDNA, antiSmith, SS-A(Ro), SS-B(La), 

N eurologic (psycosis, seizures)

R enal disease (MC glomerulonephritis: membranous)

A NA (+)

S erositis (peluritis, pericarditis)

H ematologic (anemia of chronic disease, hemolytic anemia, thrombocytopenia, neutropenia, lymphopenia)

  Lupus is more common in women & more common in African Americans.

Type III (immune complex mediated) hypersentivities

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SERONEGATIVE SPONDYLOARTHROPATHIES

HLA-B27, RF(-)

Ankylosing spondylitis: young men, sacroiliac bones and spine (bamboo appereance), association with IBD

Reiter Sd: conjunctivitis, arthritis, urethritis; knees and ankles, previous STD (chlamydia) or bacillary dysentery.

Enterohepatic arthritis: 10-20% of pts with ulcerative colitis, response to it’s treatment, peripheral arthritis or spondylitis.

Psoriatic arthritis: 5-10% of pts with psoriasis, mild and slowly progressive arthritis, similar to RA.

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Brain blood supply mnemonics

Middle Cerebral Arteries Oclussion Difficulty with A-B-Cs in M-C-A” A-Apraxia B-Blindness in corresponding half of the visual field (contralateral homonymous hemianopsia) C-Contralateral Clumsiness of arm, face. — Leg is somewhat spared. M-Memorization difficulties C-Calculation difficulties A-Aphasia with language-dominant hemispheral involvement Posterior cerebral artery (PCA) occlusion: P-O-S-T P-Proximal fling movements O-Occipital lobe infarction results in contralateral homonymous hemianopsia which may be complete S-Speech and Spelling maintained, but unable to read fluently T-Thalamic syndrome External carotid artery branchesSome Angry Lady Figured Out PMSSuperior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superificial temporal

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Parkinsons disease

Abnormal Gait Exam : Parkinsonian Gait Demonstration (by onlinemedicalvideo)

Loss of DOPAMINERGIC neurons from substancia nigra: decreased direct pathway & increased indirect pathway

Lewy bodies

Causes: infections, vascular, toxic insults (MPTP), side effects of antipsycotic drugs (dopamine R blockers)

Bradykinesia: difficulty to initiate movement.

Cogwheel rigidity: reticulospinal fibers are overfired bc of less cortex activation

Pillrolling (resting) tremor: if dopamine decreases, ACh increases.

Shuffling gait: short, uncertain steps, with minimal flexion and toes dragging.

Festinating gait: trunk is flexed, legs are flexed at the knees and hips, but stiff; the steps are short and progressively more rapid.

Stooped posture

Masked face

Depression

Dementia

Tx: L-Dopa (crosses BBB), anticholinergic drugs (Benzotropine, Trihexyphenidyl)

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stroke or bells palsy

Note that only the LMN that are innervating muscles of forehead and eye are getting bilateral corticobulbar innervation. In contrast LMN that serve muscles of the nose and mouth are only receiving contralateral corticobulbar innervation.

Therefore if a patient that has a weakness in the ability to wrinkle their forehead, can’t shut their eye, can’t flare their nostrils and the corner of their mouth droops- that lesion is most likely in the facial nerve as indicated by lesion B.

But if a patient presents with facial weakness and if the weakness is only limited to lower face meaning that the patient can still wrinkle their forehead and still shut their eyes bilaterally in the blink reflex- that lesion is most likely not due to facial nerve lesion but instead in the corticobulbar fibers coming out of the hemisphers. Therefore lesion A would result in contralateral lower face weakness. 

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CVA classification

Classification of Cerebrovascular Accidents

Cerebrovascular accidents or stroke are classified into several different types. 80% of it can be ischemic which is divided into thrombolic (75%) and embolic (25%). Thrombolic stroke is divided into two, depending on the affectations, the large vessel (75%) and small vessels “lacuna” (25%). A hemorhagic stroke occurs 20% of the time. It can be divided into two: intracerebral that occurs 67% and subarachnoid that occurs 33%.