Clinical Skills Flashcards
What are the six cognitive domains?
memory, language, perception, praxis, executive function, speed of processing
Define the memory cognitive domain?
Ability to recall information; involves multiple brain regions (including temporal lobes & hippocampus
Define the executive functions cognitive domain?
A range of skills that allow a person to establish new ways of thinking and behaviour patterns; and to introspect. Associated with frontal brain regions.
Describe what area will be affected in a CNS problem?
hemiplegia, paraplegia or a whole limb
Describe what area will be affected in a PNS problem?
May be peripheral or localised area or can be whole limb if a plexus is involved
Describe what area will be affected in a NMJ problem?
Ocular (eyes) / bulbar (palsy of cranial nerves 7-12) / proximal limb
Describe what area will be affected in a muscle problem?
Proximal muscles and will be symmetrical
Describe the description of a weakness due to problem in CNS?
Heaviness
Describe a description of a weakness due to problem in PNS?
positional may get worse in sleep (e.g. carpal tunnel syndrome) or foot goes to sleep sitting in certain position
ascending- starts in the feet and moves uo
Describe a description of a weakness due to a problem in NMJ?
fatiguable (worse after use of the muscles) Diurnal variation (worse towards end of day)
Describe a description of a weakness due to a problem in muscle?
may also have aching, may be insidious in onset
Describe additional features in a CNS problem?
spasm or jerks
Describe additional features in a PNS problem?
cramp and twitching (aka fasciculation)
Describe additional features in a NMJ problem?
bulbar: issues with swallowing and speaking
ocular issues with diplopia and ptosis
respiratory: orthopnoea, sob on exertion
Describe additional features in a muscle problem?
myalgia and cramp
Are sensory symptoms possible in a CNS or PNS problem causing weakness?
Yes
Are sensory symptoms possible in a NMJ or muscle problem causing weakness?
No (at this point only motor fibres are present)
In a CNS problem causing weakness what additional difficulties are possible?
Cognitive sphincter involvement (changes to urinary frequency)
In a PNS problem causing weakness what additional difficulties are possible?
Loss of grip
Tripping up
Unsteady with eyes closed
In a NMJ problem causing weakness what additional difficulties are possible?
lots of chewing
Difficulties speaking or holding a prolonged gaze (may be apparent when trying to read or on prolonged drives)
In a muscle problem causing weakness what additional difficulties are possible?
Getting up from low chairs
Hanging up washing
(things that involve big proximal muscles)
In a CNS problem causing weakness what may you see on inspection?
changed posture
In a PNS problem causing weakness what may you see on inspection?
wasting of muscles
twitching / fasciculation
pes cavus
In a NMJ problem causing weakness what may you see on inspection?
ptosis
ophthalmoplegia
In a muscle problem causing weakness what may you see on inspection?
proximal wasting
In a CNS problem causing weakness describe tone?
increased
there is spasticity and clonus
In a PNS problem causing weakness describe tone?
decreased tone
In a NMJ problem causing weakness describe tone?
no change (or slight decrease shouldn’t see increase)
In a muscle problem causing weakness describe tone?
no change (or slight decrease shouldn’t see increase)
In a CNS problem what would pattern of weakness be?
pyramidal pattern
in the arms the extensors are weaker than flexors
in the legs the flexors are weaker than extensors
In a PNS problem what would pattern of weakness be?
distal weakness
specific pattern depends on whether it is a root problem (small area), plexus (arms or legs), mononeuropathy (in distribution of one nerve) or a polyneuropathy (commonly has a glove and stocking distribution)
In a NMJ problem what would pattern of weakness be? How is it assessed?
fatiguability
bulbar: counting out loud
ocular: fixed gaze - do they develop double vision
ptosis: fixed up gaze
limb: repetitive movement
In a muscle problem what would pattern of weakness be?
proximal symmetrical weakness
In a CNS problem causing weakness reflexes will be _____
increased
In a PNS problem causing weakness reflexes will be _____
decreased
In a NMJ problem causing weakness reflexes will be _____
normal (maybe decreased but not increased)
In a muscle problem causing weakness reflexes will be _____
normal (maybe decreased but not increased)
In a CNS problem causing weakness the plantar response will be _______
extensor
In a PNS problem causing weakness the plantar response will be _______
flexor (sometimes mute)
In a NMJ problem causing weakness the plantar response will be _______
flexor
In a muscle problem causing weakness the plantar response will be _______
flexor
In a CNS problem causing weakness the associated sensory symptoms will occur in what pattern?
with brain it will be one side
with the spinal cord there will be sensory level
Where is the lesion likely located?
Increased tone and reflexes, weakness in a pyramidal pattern, extensor plantar response, associated sensory symptoms on same side of body?
CNS lesion (brain)
Where is the lesion likely located?
Increased tone and reflexes, weakness in a pyramidal pattern, extensor plantar response, there is a sensory level?
CNS (spinal Cord)
Where is the lesion likely located?
Decreased tone and reflexes, distal weakness, flexor plantar response, glove and stocking distribution?
PNS
Where is the lesion likely located?
Decreased tone and reflexes, fatiguability, flexor plantar response, no associated sensory symptoms?
NMJ
Where is the lesion likely located?
Proximal muscle wasting, decreased tone and reflexes, proximal weakness, flexor plantar response, no associated sensory symptoms?
muscle
Where is the lesion likely located?
hemiplegia or paraplegia, described as heaviness, spasms and jerks, sensory symptoms, sphincter involvement and or cognitive involvement?
CNS
Where is the lesion likely located?
localised area, worse after sleep, cramping, twitching, sensory symptoms, loss of grip?
PNS
Where is the lesion likely located?
worse after use of muscles, diplopia, no sensory symptoms, finds prolonged gaze difficult?
NMJ
Where is the lesion likely located?
proximal symmetrical muscles affected, aching pains, cramps, no sensory symptoms, finds getting up from chairs and hanging washing difficult
muscle
Define agnosia and how you would test for it? what pathology does this suggest?
inability to process sensory information
can you identify what you are holding if you close your eyes?
parietal lesion
Define apraxia? What pathology does this suggest?
inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement
parietal lesion
