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OSCE > Cerebellar Exam > Flashcards

Cerebellar Exam Flashcards

1
Q

What is included in general inspection in cerebellar examination?

A

Look around bed

Patients posture

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2
Q

What should be noted around the bed in cerebellar exam?

A

Any mobility aids, e.g. wheelchair, walking stick

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3
Q

What should be noted regarded the patient’s posture in cerebellar examination?

A

Any truncal ataxia

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4
Q

What can the components of cerebellar examination be broadly divided into?

A
  • Gait
  • Head
  • Arms
  • Legs
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5
Q

What are the components to assessing a patients gait in cerebellar exam?

A
  1. Stance
  2. Stability
  3. Tandem (heel toe walking)
  4. Romberg’s test
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6
Q

Why is it important to note patients stance in cerebellar exam?

A

Broad-based gait is noted in cerebellar disease

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7
Q

What might happen to stability of gait in cerebellar disease?

A

Can be staggering, often slow and unsteady - similar to drunk person walking

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8
Q

What might happen to gait in unilateral cerebellar disease?

A

May veer towards side of lesion

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9
Q

Why is heel toe walking a good test for cerebellar dysfunction?

A

Very sensitive test and will exaggerate any unsteadiness

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10
Q
A
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11
Q

What structure is the heel-toe test particularly sensitive at assessing the function of?

A

Cerebellar vermis

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12
Q

How is Romberg’s test done?

A

Ask the patient to put their feet together, keep their hands by their side and close their eyes (be ready to support them in case they are unsteady)

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13
Q

What is Romberg’s test a test of?

A

Proprioception (not cerebellar disease)

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14
Q

Is swaying with correction on Romberg’s test a positive result for cerebellar disease?

A

No (although may indicate cerebellar disease

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15
Q

What is an abnormal Romberg’s test?

A

Falling without correction

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16
Q

What does a positive Romberg’s test indicate?

A

Unsteadiness is due to sensory ataxia from a lack of proprioception rather than cerebellar ataxia

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17
Q

What are the components to ‘head’ assessment in cerebellar exam?

A
  • Speech
  • Nystagmus
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18
Q

What speech abnormality is characteristic of cerebellar dysfunction?

A

Slurred, staccato speech

Staccato means ‘performed with each note sharply detached or separated from the others.’

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19
Q

What phrases should you use to assess if their speech is slurred?

A
  • British constitution
  • Baby hippopotamus
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20
Q

What is this?

A

Nystagmus

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21
Q

How do you assess for nystagmus?

A
  1. Ask the patient to look straight ahead and examine the eyes in the primary position. Look for any abnormal movement such as nystagmus.
  2. Ask the patient to keep their head still and follow your finger with their eyes.
  3. Move your finger throughout the various axes of vision.
  4. Look for multiple beats of nystagmus
22
Q

When might nystagmus be physiological?

A

Few beats of nystagmus at the extremes of gaze

23
Q

How can nystagmus be further characterised?

A
  • Direction (this is kinda confusing to work out, but geeky medics say its not really important soooo)
  • Present on horizontal or vertical gaze
  • If it beats on horizontal or vertical plane
24
Q

What other disturbances of gaze may be seen in cerebellar disease?

A
  • Dymetric saccades
  • Impaired smooth pursuit
25
Q

What is this?

A

Dysmetric saccades (sorry couldnt find one without what it was at the end of the gif loool what a giveaway)

26
Q

How do you elicit dysmetric saccades?

A

Hold your hand about 30cm to the side of your head. Ask the patient to look at your hand, then back to your nose when you ask them to. Do this on both sides.

27
Q

What is dysmetric saccades?

A

The movement from looking at your hand to nose should be quick and accurate. In cerebellar lesions, there will often be overshoot - eyes go too far past the target, and then correct themselves back to the target

28
Q

What is meant by impaired smooth pursuit?

A

When the patient is tracking your finger, the eyes should move smoothly. In cerebellar lesions, pursuit can be “jerky” or “saccadic” i.e. made up of lots of small movements (saccades) added together.

i cant find a gif but heres a youtube video xx https://www.youtube.com/watch?v=gqCgzSSwPLk

29
Q

What are the components to arm examination in cerebellar examination?

A
  • Finger to nose test
  • Rebound phenomenon
  • Tone
  • Dysdiadokinesia
30
Q

How do you perform finger to nose test?

A
  1. Ask the patient to touch their nose with the tip of their index finger, then touch your fingertip.
  2. Position your finger so that the patient has to fully outstretch their arm to reach it.
  3. Ask them to continue to do this finger to nose motion as fast as they can manage.
31
Q

What might suggest a cerebellar lesion with the finger nose test?

A

Inability to do this test accurately, with past pointing or incoordination/dysmetria

32
Q

What is an intention tremor (with regard to finger nose test)?

A

A terminal tremor that occurs as the finger approaches the target.

33
Q

What do you need to be careful not to mistake an intention tremor for in the finger nose test?

A

An action tremor, which occurs throughout the movement

34
Q

How do you elicit the rebound phenomenon?

A

Whilst the patient’s arms are still outstretched and their eyes are closed:

  1. Ask the patient to keep their arms in that position as you press down on their arm.
  2. Release your hand.
  3. When resistance is suddenly removed, a healthy patient’s limb normally moves a short distance in the desired direction and then rebounds (jerks back in the opposite direction)
35
Q

What does an exaggerated version of the rebound phenomenon suggest?

A

Spasticity

36
Q

What does the absence of the rebound phenomenon suggest?

A

Cerebellar disease

37
Q

How should you assess tone of the arms?

A
  1. Support the patient’s arm by holding their hand and elbow.
  2. Ask the patient to relax and allow you to fully control their arm.
  3. Move the arm’s muscle groups through their full range of movements.
  4. Is the motion smooth or is there some resistance?
38
Q

What happens to tone in cerebellar disease?

A

Reduced on side of lesion

However, reduced tone is a very subjective phenomenon and tone can often can appear to be normal in cerebellar disease. It is advisable not to put too much weight on this sign or the lack of it.

39
Q

How do you elicit dysdiadochokinesia?

A
  1. Demonstrate patting the palm of your hand with the back/palm of your other hand to the patient.
  2. Ask the patient to mimic this rapid alternating movement.
  3. Then have the patient repeat this movement on their other hand.
40
Q

What does an inability to do the hand thing in dysdiadokinesia suggest?

A

Cerebellar ataxia

41
Q

What are the components to leg examination in cerebellar examinatino?

A
  • Reflexes
  • Co-ordination
42
Q

What reflex is tested in cerebellar examination?

43
Q

What nerve roots (?) is important for knee jerk?

sorry i dont know if this question makes sense idrk how reflexes work

44
Q

What are the reflexes described as in cerebellar disease?

45
Q

What is meant by pendular reflexes?

A

This means less brisk and slower in rise and fall.

46
Q

What is the problem with testing reflexes in cerebellar examination?

A

This sign is very subjective, and often reflexes appear to be normal

47
Q

How do you instruct a patient to perform the heel shin test?

A

“Put your heel on your knee, run it down your shin, lift it off and repeat in a smooth motion”

48
Q

What further investigations/assessments can you suggest after cerebellar exam?

A

Full neuro exam, including cranial nerves and upper and lower limbs

Appropriate imaging if indicated

49
Q

What mnemonic can help you remember the key parts of cerebellar exam?

A

DANISH

  • Dysdiadochokinesia
  • Ataxia (gait and posture)
  • Nystagmus
  • Intention tremor
  • Slurred, staccato speech
  • Hypotonia/Heel-shin test
50
Q

What the frick even causes cerebellar ataxia?

A
  • MS
  • Infection
  • Bleeding
  • Infarction
  • Tumours
  • Neurodegenerative disease including progressive suprannuclear palsy and multiple systems atrophy
51
Q

Who deserved better?

OSCE (19 decks)

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