While the patients were getting briefed on how to act for their certain disorder, we were able to review the patient's chart. This consisted of a little vital data (BP, HR, etc), a few sentences from the ER staff as to what the patient was in the hospital for, and some information that the patients wouldn't be able to demonstrate (such as dilated or constricted pupils, etc). My group made the mistake of tailoring our exam too much to reflect our thoughts after reading this little initial information. Our exam didn't flow well, and there was considerable "down time" as we flipped through our books or notes trying to decide if their was something else we should ask the patient to do. As a result, we were plain lucky to find out, very near the end of our ten-minute exam time, that our patient exhibited weakness and sensory deficits on her left side. Also, based on my time as a patient, I realized that my group had focused too much on sensory and motor tests when designing our exam, and had left out tests of cognitive function.
After we were done examining the patient, we had another ten minutes or so to formulate a diagnosis. My group concentrated a little more heavily on what had happened, rather than where it happened. Still, we ended up getting pretty much the correct diagnosis, with lots of guidance from the "residents," or preceptors. We first said what we thought had happened, then the resident asked what that would cause, and what we had seen in the patient that was like that. He asked what areas of the brain were affected by what we thought had occurred, and we ended up talking through the correct diagnosis. Then we had to "break the news" to the patient and tell them what came next. We told ours what area of her brain seemed to be affected, and that we were going to get an MRI to see what exactly happened in that area to cause the problem. After that, we didn't know what would happen.
Overall, the day was extremely fun and educational. I've seen lots of neuro exams performed, but it is harder to actually do one than I thought. You have to remember all of the tests and not forget to examine some function. But the diagnosing is the best part. It is like solving a mystery. You have all of these individual clues that you have picked up, but you need to figure out how it all fits together so that you can figure out what happened. I'm really looking forward to becoming a neurologist.