3.2 Nervous History and Examination Flashcards
What are five common presenting complaints
- Headaches
- Dizziness
- Numbness
- Pain (pins and needles)
- Weakness
Name five symptoms patients might have experienced prior to coming in with a neurological presenting complaint
Problems with memory, vision, shaking, confusion, loss of consciousness
What questions might you ask a patient in regards to their presenting complaint?
Describe the complaint, frequency, location, precipitating and exacerbating/alleviating factors
Name 9 Red flags to look out for in a neurological history
- Thunderclap headache (subarachnoid hemorrhage)
- Cocaine use
- Slurred speech, weakness
- Incontinence of bladder/bowels
- Bilateral sciatica
- Seizures
- Acute confusion
- Fever
- Non blanching rash (doesn’t fade when pressed)
What is the time window from the onset of a stroke to permanent neurological damage?
4 hours
What is the lifetime risk of a seizure?
1%
What’s the most common cause of confusion in elderly?
Acute infections such as UTIs makes the brain more susceptible to dementia
Why might you ask about travel in a neurological condition?
Lime’s disease (tick bites)
What are the differentials for the following symptoms?
A) headaches
B) dizziness
C) pain
A) simple, migraine, tension, tumour, SAH
B) vertigo, benign paroxysmal positional vertigo, stroke
C) physical damage, nerve damage, psychosomatic
Define psychosomatic
When a physical condition/illness is exacerbated by a psychological factor like stress
What are the differentials for the following symptoms?
A) Numbness
B) pins and needles
C) weakness
A) nerve entrapment/damage, toxins, diabetes, MS
B) diabetes, nerve entrapment
C) stroke (or TIA transient ischemic attack ‘mini-stroke’, Gillian barre, migraine, MND (motor neurone disease)
What are the differentials for the following symptoms? A) memory B) shaking C) vision D) confusion
A) delirium, dementia, alcoholism, depression, acute confusion
B) Parkinson’s, thyroid (hyper), alcohol withdrawal
C) MS, stroke, migraine
D) infection, dementia, stroke, brain tumour
Name six major components of a neurological examination
- Mental status
- Gait
- Cranial nerves
- Cerebellar tests
- Motor function
- Fundoscopy (see inside fundus of eye), BP, CVS examination
- Special tests
What might you inspect when assessing one’s motor function?
DWAARFSS Deformities Wasting Asymmetry Atrophy Rashes Fasciculations Swellings Scars
How would you assess one’s gait in a neurological examination?
Walking: arm swinging, smooth turning, symmetry and size of steps
Pigeon steps
Tiptoes: assesses S1/2 myotome
Heels: assesses L4.5 myotome
Name seven important factors to look out for when performing a cerebellar examination
DANISHP
Dysdiadochokinesis: inability to perform and sustain a series of repeated movements
Ataxia: gross incoordination of movements
Nystagmus: repetitive, involuntary oscillation of eyes
Intention tremor: tremor when performing voluntary movements
Slurred speech
Hypotonia: muscle weakness
Pass pointing (dysmetria): patient overshoots when touching examiner’s finger
How would you check one’s tone when assessing motor function?
- Muscle resists passive movement
- Shake hands, roll legs
- Spasticity
- Rigidity
- Hypotonia; flaccidity
What is a Fasciculation?
Spontaneous contraction affecting a small number of muscle fibres causing a flicker of movement under the skin
How would you check one’s power when assessing motor function?
Assess myotomes and compare sides
MRC grading
How might you assess one’s sensation in a neurological examination?
Light touch, pin prick, temperature, vibration,
How might you assess one’s coordination in a neurological examination?
Finger-nose, heel-shin
How might you assess one’s reflexes in a neurological examination?
Jendrassik maneuver
What is fanning?
When the toes splay after running your hand down the lower calf, happens commonly in babies but pathological in adult
What are some of the special tests that might be performed in a neurological examination?
- Pronator drift
- Rhomberg’s test: close eyes and lose balance (assesses proprioception/normal functioning of dorsal spinal columns, vestibular function and vision)
- Sciatic and femoral stress test
- Tinnels/phalens test (carpal tunnel syndrome)
- Swinging light test; swing light from one eye-another
What is pronator drift a sign of?
A contralateral upper motor neurone lesion (UMN lesion)
What are abnormalities in a swinging light test a sign of?
Raised intracranial pressure or MS
