Cerebellar OSCE Exam Flashcards
What 7 things should you do as part of your introduction?
Wash hands Introduce yourself Confirm pt details Explain examination Gain consent Achieve appropriate exposure Ask if pt has any pain anywhere before you begin
What should you look for around the bed?
Any mobility aids
eg. Wheelchair / walking stick
On general inspection, what might the patient’s posture be?
Truncal ataxia
On observing the pt’s normal gait, what are the 4 things you should be looking for?
- Stance: broad based gait is noted in cerebellar disease.
- Stability: staggering / slow & unsteady
In unilateral cerebellar disease, there is deviation to the side of the lesion due to hypotonia. - Tandem (‘heel to toe’) walking: exaggerates unsteadiness
- Romberg’s test: Feet together, hands by sides, close eyes. *Be ready to support patient, in case they are unsteady.
What type of speech is characteristic of cerebellar dysfunction?
Slurred staccato speech
Which 2 phrases should you ask the pt to repeat if you suspect cerebellar dysfunction?
“British constitution”
“Baby hippopotamus”
How would you assess a patient for nystagmus?
- Ask pt to keep their head still & follow your finger with their eyes.
- Move your finger throughout the axes of vision.
- Look for multiple beats of nystagmus
What is ‘physiological nystagmus’?
Nystagmus at the extremes of gaze.
Give 2 other examples of disturbances of gaze notes in cerebellar disease.
Dysmetric saccades
Impaired smooth pursuit
How would you assess the tone of a pt’s arms?
- Support pt’s arm by holding their hand & elbow.
- Ask pt to relax & allow you to fully control their arm.
- Move the arm’s muscle groups through their full range of movements.
- Is the motion smooth or is there some resistance?
How is tone affected in cerebellar disease?
Hypotonia may be seen.
Describe how you’d carry out a ‘finger to nose’ test.
- Ask pt to touch their nose with the tip of their index finger, the touch your fingertip.
- Position your finger so the pt has to fully outstretch their arm to reach it.
- Ask them to continue to do this finger to nose motion as fast as they can manage.
Describe what you’d see with an ‘intention tremor’ on the ‘finger to nose’ test.
As the pt gets closer to a target, the tremor worsens at the end points of a deliberate movement.
How would you assess for dysdiadochokinesia?
- Demonstrate patting the palm of your hand with the back/palm of your other hand to the pt.
- Ask pt to mimic this rapid alternating movement.
- Then have the pt repeat this mvt on their other hand.
If a patient is unable to perform the test assessing dysdiadochokinesia, what does this suggest?
Cerebellar ataxia.