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CLINICAL               4        PATIENT PRESENTATIONS RELATED TO THE
          PRESENTATION
                                          NERVOUS SYSTEM AND MENTAL HEALTH




             Patient presentations span all relevant age                              The Guide to clinical presentations in this category may
             categories, special populations, and varied                              include, but is not limited to, the following ways in which
             clinical settings.                                                       patients present for osteopathic medical care:


                                                                                      speech/language-related disorders, including alexia, aphasia (fluent and
             4.1   ANXIETY                                                            nonfluent), dysphasia, and dysarthria • stereotypy • stroke (eg, transient
                                                                                      ischemic attack, hemorrhagic stroke) • subarachnoid hemorrhage • subdural
             4.2   DISTURBANCES OF MOOD/DEPRESSIVE DISORDERS
                                                                                      hematoma • substance-related and addictive disorders, including oral and
             4.3   COGNITIVE DISTURBANCES
                                                                                      intravenous abuse of tobacco, alcohol, opioids, cocaine, and cannabis;
             4.4   DISTURBANCES OF BEHAVIOR AND PERCEPTION
                                                                                      intoxication; withdrawal symptoms (eg, delirium tremens) • suicidal ideation •
             4.5   LIFE ADJUSTMENT AND STRESSORS                                      tactile disturbances, including sensory loss, numbness, vibration/temperature/
             4.6   DISTURBANCES OF THE SPECIAL SENSES                                 proprioception loss, tingling, and paresthesia • tics and tic disorders (eg, Tourette
                                                                                      syndrome) • tinnitus, unilateral or bilateral, with or without hearing loss, including
             4.7   HEADACHE
                                                                                      tinnitus secondary to ototoxic medications, tinnitus with somatic triggers (eg,
             4.8   SPEECH AND LANGUAGE DISTURBANCES
                                                                                      labyrinthitis, Meniere disease) • trauma and stressor-related disorders (eg,
             4.9   MOVEMENT DISTURBANCES                                              adjustment disorders, post-traumatic stress disorder) • vascular and
             4.10  SEIZURES                                                           inflammatory masses • weakness and paralysis, focal (eg, hemiplegia); postural
                                                                                      instability or tremors)
             4.11  SENSORY DISTURBANCES AND PAIN
             4.12  SLEEP DISTURBANCES

             4.13  SUBSTANCE ABUSE                                                    CONSTITUTIONAL SIGNS AND SYMPTOMS
             4.14  NERVOUS SYSTEM TRAUMA                                              fatigue  • fever  • generalized weakness  • involuntary weight loss  • malaise  •
                                                                                      night sweats  • pallor
             4.15  WEAKNESS AND PARALYSIS
             4.16  PHYSICAL EXAM FINDINGS RELATED TO THE NERVOUS
                 SYSTEM AND MENTAL HEALTH                                             PHYSICAL EXAM FINDINGS
                                                                                      abdominal reflex  • Chvostek test  • clonus, Glasgow coma score, mini-cog testing
             4.17  LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
                 RELATED TO THE NERVOUS SYSTEM AND MENTAL HEALTH                      • corneal reflex, nystagmus  • cranial nerve examinations  • cremasteric reflex  •
                                                                                      decreased muscle tone  • dysdiadochokinesia  • fundoscopic findings and cup,
                                                                                      disc ratios  • heel to shin test  • Hoffman reflexes  •         


        COMLEX-USA MASTER BLUEPRINT                                                                DIMENSION 2     CLINICAL PRESENTATION 4    PAGE 43
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