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ETA 5: NERVOUS SYSTEM > 3.2 Nervous History and Examination > Flashcards

3.2 Nervous History and Examination Flashcards

1
Q

What are five common presenting complaints

A
  1. Headaches
  2. Dizziness
  3. Numbness
  4. Pain (pins and needles)
  5. Weakness
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2
Q

Name five symptoms patients might have experienced prior to coming in with a neurological presenting complaint

A

Problems with memory, vision, shaking, confusion, loss of consciousness

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3
Q

What questions might you ask a patient in regards to their presenting complaint?

A

Describe the complaint, frequency, location, precipitating and exacerbating/alleviating factors

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4
Q

Name 9 Red flags to look out for in a neurological history

A
  1. Thunderclap headache (subarachnoid hemorrhage)
  2. Cocaine use
  3. Slurred speech, weakness
  4. Incontinence of bladder/bowels
  5. Bilateral sciatica
  6. Seizures
  7. Acute confusion
  8. Fever
  9. Non blanching rash (doesn’t fade when pressed)
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5
Q

What is the time window from the onset of a stroke to permanent neurological damage?

A

4 hours

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6
Q

What is the lifetime risk of a seizure?

A

1%

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7
Q

What’s the most common cause of confusion in elderly?

A

Acute infections such as UTIs makes the brain more susceptible to dementia

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8
Q

Why might you ask about travel in a neurological condition?

A

Lime’s disease (tick bites)

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9
Q

What are the differentials for the following symptoms?
A) headaches
B) dizziness
C) pain

A

A) simple, migraine, tension, tumour, SAH
B) vertigo, benign paroxysmal positional vertigo, stroke
C) physical damage, nerve damage, psychosomatic

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10
Q

Define psychosomatic

A

When a physical condition/illness is exacerbated by a psychological factor like stress

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11
Q

What are the differentials for the following symptoms?
A) Numbness
B) pins and needles
C) weakness

A

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)

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12
Q 
What are the differentials for the following symptoms? 
A) memory  
B) shaking  
C) vision 
D) confusion
A

A) delirium, dementia, alcoholism, depression, acute confusion
B) Parkinson’s, thyroid (hyper), alcohol withdrawal
C) MS, stroke, migraine
D) infection, dementia, stroke, brain tumour

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13
Q

Name six major components of a neurological examination

A
  1. Mental status
  2. Gait
  3. Cranial nerves
  4. Cerebellar tests
  5. Motor function
  6. Fundoscopy (see inside fundus of eye), BP, CVS examination
  7. Special tests
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14
Q

What might you inspect when assessing one’s motor function?

A 
DWAARFSS
Deformities 
Wasting 
Asymmetry
Atrophy 
Rashes
Fasciculations 
Swellings 
Scars
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15
Q

How would you assess one’s gait in a neurological examination?

A

Walking: arm swinging, smooth turning, symmetry and size of steps

Pigeon steps

Tiptoes: assesses S1/2 myotome

Heels: assesses L4.5 myotome

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16
Q

Name seven important factors to look out for when performing a cerebellar examination

A

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

17
Q

How would you check one’s tone when assessing motor function?

A
  1. Muscle resists passive movement
  2. Shake hands, roll legs
  3. Spasticity
  4. Rigidity
  5. Hypotonia; flaccidity
18
Q

What is a Fasciculation?

A

Spontaneous contraction affecting a small number of muscle fibres causing a flicker of movement under the skin

19
Q

How would you check one’s power when assessing motor function?

A

Assess myotomes and compare sides

MRC grading

20
Q

How might you assess one’s sensation in a neurological examination?

A

Light touch, pin prick, temperature, vibration,

21
Q

How might you assess one’s coordination in a neurological examination?

A

Finger-nose, heel-shin

22
Q

How might you assess one’s reflexes in a neurological examination?

A

Jendrassik maneuver

23
Q

What is fanning?

A

When the toes splay after running your hand down the lower calf, happens commonly in babies but pathological in adult

24
Q

What are some of the special tests that might be performed in a neurological examination?

A
  1. Pronator drift
  2. Rhomberg’s test: close eyes and lose balance (assesses proprioception/normal functioning of dorsal spinal columns, vestibular function and vision)
  3. Sciatic and femoral stress test
  4. Tinnels/phalens test (carpal tunnel syndrome)
  5. Swinging light test; swing light from one eye-another
25
Q

What is pronator drift a sign of?

A

A contralateral upper motor neurone lesion (UMN lesion)

26
Q

What are abnormalities in a swinging light test a sign of?

A

Raised intracranial pressure or MS

ETA 5: NERVOUS SYSTEM (18 decks)

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