Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Week 6: Chapter 16 Neurology…

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Week 6: Chapter 16

Neurology

Instructor: Kathleen Bishop


What you will need for this class

– Medical Transcription Fundamentals, Gilmore

– AAMT Book of Style for Medical Transcription

– Any other resource books you may have available such as medical dictionary, PDR, Merck Manual, etc.


How this class will work• This is an open book Seminar. • Be prepared to respond to the questions on each slide.• Be prepared to share your thoughts with the other class

participants.• After the questions slide you will see an answer slide so

you can check to see how you did.


Employee vs. Independent Contractor• Employee• Independent Contractor


Employee


Independent Contractor


Independent Contractor vs. EmployeeIndependent Contractor at X per 65-character line

7891011121314


Independent Contractor vs. EmployeeStatutory Employee at X

per 65-character line6.467.398.319.2410.1611.0812.0112.93


250 Lines/hr dictationRate per line

Lines per

hour of dict

Each hour of dictatio

n earns

Hours of

dict to earn $1,000 (gross)

Hrs/ day,

5 days/ week

Hrs/ day,

4 days/ week

Hrs/ day 3

days/ week

.07 250 17.50 57.14 11.43 Na Na

.09 250 22.50 44.44 8.89 na na.095 250 23.75 42.11 8.42 na na.10 250 25.00 40.00 8 10 13.33


500 lines/hr DictationRate per line

Lines per

hour of dict


n earns

Hours of


Hrs/ day,

5 days/ week

Hrs/ day,

4 days/ week

Hrs/ day 3

days/ week

.07 500 35.00 28.57 5.71 7.14 9.52

.09 500 45.00 22.22 4.44 5.56 7.41.095 500 47.50 21.05 4.21 5.26 7.02.10 500 50.00 20.00 4.0 5.0 6.67


600 Lines/hr DictationRate per line

Lines per

hour of dict


n earns

Hours of


Hrs/ day,

5 days/ week

Hrs/ day,

4 days/ week

Hrs/ day 3

days/ week

.07 600 42.00 23.81 4.76 5.95 7.94

.09 600 54.00 18.52 3.70 4.63 6.17.095 600 57.00 17.54 3.51 4.39 5.85.10 600 60.00 16.67 3.33 4.17 5.56


Soundalike Word ChoiceWhich is the correct word in the following sentences. • 1. The patient was involved in an motor vehicle accident that damaged

his spinal (core, cord).• 2. This is a Hispanic female who has been previously diagnosed with

trigeminal (arthralgia, neuralgia) on the right side.• 3. Her CT scan showed (vesicular, ventricular) brain abnormalities

consistent with a mild stroke.• 4. The child was admitted to the hospital where a workup eventually

diagnosed (absent, absence) seizures.• 5. HEENT examination revealed extraocular movements to be intact

with no (nystagmus, nystatin) and no diplopia.


Soundalike Word Choice Answers• 1. The patient was involved in an motor vehicle accident that

damaged his spinal (core, cord).• 2. This is a Hispanic female who has been previously diagnosed

with trigeminal (arthralgia, neuralgia) on the right side.• 3. Her CT scan showed (vesicular, ventricular) brain

abnormalities consistent with a mild stroke.• 4. The child was admitted to the hospital where a workup

eventually diagnosed (absent, absence) seizures.• 5. HEENT examination revealed extraocular movements to be

intact with no (nystagmus, nystatin) and no diplopia.


Soundalike Word Choice (cont.)• 6. (Electroencephalogram, Electrocardiogram) revealed

background activity seen in the posterior regions of the brain, which was responsive to eye opening and eye closure.

• 7. Ms. Dolan was found to have a mass in the (basil, basal) ganglia.• 8. Unfortunately, the patient sustained a left (thalamic, thymic)

infarct after his cardiac catheterization last month.• 9. The bundle of nerves at the base of the spine is called the cauda

(equation, equina).• 10. Sensations are grossly intact, and deep tendon (reflexes,

refluxes) are symmetric.


Soundalike Word Choice Answers• 6. (Electroencephalogram, Electrocardiogram) revealed

background activity seen in the posterior regions of the brain, which was responsive to eye opening and eye closure.

• 7. Ms. Dolan was found to have a mass in the (basil, basal) ganglia.

• 8. Unfortunately, the patient sustained a left (thalamic, thymic) infarct after his cardiac catheterization last month.

• 9. The bundle of nerves at the base of the spine is called the cauda (equation, equina).

• 10. Sensations are grossly intact, and deep tendon (reflexes, refluxes) are symmetric.


Matching1. CNS A. Parkinson disease 2. SPECT B. peripheral nervous system 3. MS C. cerebrospinal fluid 4. VP D. central nervous system 5. PNS E. Glasgow Coma Scale 6. PET F. magnetic resonance angiography 7. LP G. electroencephalography 8. MRI H. single photon emission computed tomography 9. CSF I. computed tomography 10. CT J. lumbar puncture 11. PD K. ventriculoperitoneal 12. TN L. magnetic resonance imaging 13. GCS M. trigeminal neuralgia 14. MRA N. positron emission tomography 15. EEG O. multiple sclerosis


Matching Answers• 1. D• 2. H• 3. O• 4. K• 5. B• 6. N• 7. J• 8. L• 9. C• 10. I• 11. A• 12. M• 13. E• 14. F• 15. G


Fill in the Blanks

Fill in the blanks of the following paragraph with the correct terms from the text. Some terms may be used more than once. 1.The brain is an amazing organ. It is divided into four major parts: The ____________, ____________, ____________, and ____________.2.The largest and uppermost part of the brain is called the ____________. It is divided into two parts called the ____________ and ____________ hemispheres. They are joined by a band of fibers called the ____________. The ____________ beneath the cerebral cortex does not do any real thinking or feeling.3.The ____________ structures are often called the “feeling brain” because they are involved in emotions. One of these structures, called the ____________, serves as a relay station for the cerebral cortex. Another structure, called the ____________, regulates automatic functions like eating and drinking.


Fill in the Blanks Answers

1. The brain is an amazing organ. It is divided into four major parts: The cerebrum, limbic system, brainstem, and cerebellum.

2. The largest and uppermost part of the brain is called the cerebrum. It is divided into two parts called the right and left hemispheres. They are joined by a band of fibers called the corpus callosum. The white matter beneath the cerebral cortex does not do any real thinking or feeling.

3. The limbic system structures are often called the “feeling brain” because they are involved in emotions. One of these structures, called the thalamus, serves as a relay station for the cerebral cortex. Another structure, called the hypothalamus, regulates automatic functions like eating and drinking.


Fill in the Blanks (cont.)

1. The ____________ comes from the Latin word for little brain. Disruptions in the function of this part of the brain results in motor problems such as an unsteady gait, called ____________.

2. The ____________ is a tube-like column of tissue that connects the brain to the rest of the body. The reflexes of this part of the body can cause limbs to move, even when a patient is comatose, a phenomenon called the ____________.


Fill in the Blanks Answers1. The cerebellum comes from the Latin word for little brain.

Disruptions in the function of this part of the brain results in motor problems such as an unsteady gait, called ataxia.

2. The spinal cord is a tube-like column of tissue that connects the brain to the rest of the body. The reflexes of this part of the body can cause limbs to move, even when a patient is comatose, a phenomenon called the Lazarus sign.


Transcription Tip• References to the examination of cranial nerves are

transcribed often in medical reports. They may be transcribed using Arabic or Roman numerals, unless the dictator specifies a preference (Gilmore, 2009).


Define the Following1. corpus callosum2. bleb3. secondary brain tumor4. cauda equina5. limbic system6. Lazarus sign7. hydrocephalus8. trigeminal neuralgia9. relapsing-remitting multiple Sclerosis10.high-grade astrocytoma


Define the Following Answers1. A band of nerve fibers that connect the left and right

hemisphere of the cerebrum.2. A blister-like sac filled with blood.3. A brain tumor caused by a cancer that originates in another

part of the body.4. A bundle of nerves that extend beyond the end of the spinal

cord.5. A complex set of structures located in the cerebrum that are

involved in emotions, moods, and some functions of memory.


Define the Following Answers6. A complex spontaneous movement by nerves in the spinal

cord without conscious effort of the patient (such as after a patient is comatose or brain-dead).

7. A condition in which excess CSF fluid builds up in the brain.8. A disorder of the trigeminal nerve causing sudden attacks of

pain on one side of the face.9. A form of multiple sclerosis characterized by periods of flares

of symptoms, followed by periods of remission of symptoms.10.A glioma that occurs in the brainstem.


Define the Following1. demyelination2. enterovirus3. cerebral cortex4. subarachnoid hemorrhage5. hemorrhage6. antalgic (gait)7. spinal cord8. brain tumor9. microvascular decompression10.Parkinson disease


Define the Following Answers1. A gradual destruction of the myelin that surrounds and

protects neurons.2. A group of common viruses that is a common cause of

viral meningitis.3. A layer of millions of neurons and glia on the surface of the

brain that carry out the many functions of the cerebrum.4. A leak of blood into the space between the brain and the

skull.5. A leak of blood, or bleeding, from a vessel.


Define the Following Answers6. A limping-type gait.7. A long, tube-like column of nervous tissue that extends from

the base of the skull to near the bottom of the spine, which carries both incoming and outgoing messages between the brain and the rest of the body.

8. A mass of abnormal cells growing in the brain.9. A microsurgical displacement of a blood vessel causing

compression of the nerve root of the trigeminal nerve.10.A motor system disorder caused by deterioration of nerve

cells in the brain that control body movement.


Define the Following1. pronator muscle2. ventricles3. single photon emission computed tomography (SPECT)4. positron emission tomography (PET)5. lateral ventricles6. neurologist7. bone flap8. plasmapheresis9. microvascular clipping10.stereotactic radiosurgery


Define the Following Answers1. A muscle that returns a part into the prone position from

supine.2. A network of four chambers in the brain that produce

cerebrospinal fluid (CSF).3. A nuclear diagnostic test that obtains images of blood flow to

tissues.4. A nuclear diagnostic test that provides images of brain

activity using radioactive isotopes injected into the bloodstream.

5. A pair of ventricles in the brain where CSF is produced.


Define the Following Answers6. A physician who specializes in the field of neurology.7. A portion of the skull temporarily removed from the cranium but

left attached to overlying muscle-fascial blood supply during a surgical procedure.

8. A procedure of plasma exchange in patients with sudden, severe attacks of multiple sclerosis.

9. A procedure that involves cutting off the flow of blood supply to an aneurysm with the use of a spring-loaded clip.

10.A procedure that involves delivering a single highly concentrated dose of ionizing radiation to a target at the trigeminal nerve root.


Define the Following1. percutaneous stereotactic rhizotomy2. deep brain stimulation (DBS)3. shunt revision4. debulking5. corpus callosotomy6. photodynamic therapy (PDT)7. lumbar puncture (LP)8. coil embolization9. status epilepticus10.cerebral aneurysm


Define the Following Answers1. A procedure that involves destroying the part of the trigeminal

nerve that causes pain with a heating current.2. A procedure that involves implanting a device to deliver mild

electrical stimulation to block the brain signals that cause tremors in patients with Parkinson disease.

3. A procedure that involves repairing or replacing a shunt.4. A procedure that involves surgically reducing as much as possible

the size of a tumor that cannot be completely removed.5. A procedure that severs the network of neural connections

between the right and left hemispheres of the brain as a treatment for seizures.


Define the Following Answers6. A procedure that uses a photosensitizing agent, which is

activated by exposure to light in order to destroy cancer cells.7. A procedure used to evaluate the CSF from the space

surrounding the spinal cord.8. A procedure whereby tiny platinum coils are placed directly

into an aneurysm to block blood flow and prevent rupture.9. A prolonged seizure, or series of seizures, that lasts for more

than 30 minutes, during which time the patient is unconscious.10.A sac-like outpouching that can occur in the large arteries at

the base of the brain.


Define the Following1. Glasgow Coma Scale (GCS)2. proprioception3. subpial resection4. neurologic assessment5. anterior communicating artery (AComA)6. ventriculoperitoneal (VP) shunt7. shunt8. reflex9. aura10.ventriculostomy


Define the Following Answers1. A scoring system used to quantify a patient's level of

consciousness following a brain injury.2. A sense or a perception, usually at a subconscious level, of the

movements and position of the body and especially its limbs, independent of vision but by input from sensory nerves.

3. A series of surgical cuts to help isolate the area of the brain that is causing seizures.

4. A series of tests used to assess brain function of a patient and to evaluate for possible neurologic damage.

5. A short artery that joins the two anterior cerebral arteries in the brain.


Define the Following Answers

6. A shunt that is placed inside one of the ventricles of the brain and the other end into the abdominal cavity.

7. A silicone rubber tube used to divert CSF flow away from the brain to elsewhere in the body.

8. A simple nerve circuit.9. A subjective warning sign that occurs immediately

before the onset of a seizure.10.A surgical opening made between two ventricles to

allow flow of CSF to be unobstructed.


References• http://www.mtdaily.com/math.html• http://www.irs.gov/newsroom/article/

0,,id=173423,00.html• Gilmore, D. (2009). Medical Transcription Fundamentals.

Lippincott, Williams & Wilkins.


The End• Well that’s all for tonight! • Thanks for joining us. I hope you learned

something to help you in your transcription career.

• See you next week! Same time—same place!

• Bye for now!

Dr. B and her Mom at church dinner

theater

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Week 6: Chapter 16 Neurology…