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Phase 2B OSCEs > Examination of the CNS > Flashcards

Examination of the CNS Flashcards

1
Q

Associated features of a migraine

A
  1. AURA: nausea/vomiting, photophobia and phonophobia
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2
Q

Where is a cluster headache pain located

A

Orbital or retroorbital - unilateral non-pulsatile

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3
Q

Pain location of temporal arteritis

A

Temple and scalp

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4
Q

Describe a neuro history taking

A
  1. Socrates (Sight, Onset, Character, Radiation, Association Symptoms, Time, Exacerbating factors + Severity)
  2. Does medication/posture/menstruation cycle help relief?
  3. Drug history (Excessive drug use can cause CNS problems e.g. phenytoin = ataxia and analgesics = headache)
  4. Family History (MND, Charcot-Marie-Tooth)
  5. Social History (How they cope? Can they work? Support circumstances? ALCOHOL and DIET? Recreational drug use )
    Travelling and sexual history
  6. Past Medical History
  7. Occupational History
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5
Q

How does diet contribute to CNS problems

A

Veggie = lack of B12

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6
Q

How does travelling cause CNS problems

A
  1. Lyme disease and Malaria
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7
Q

Three clinical presentations of a interior circulation stroke

A
  1. Hemiparesis
  2. Hemianopia
  3. Dysphasia
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8
Q

Three clinical presentations of posterior circulation stroke

A
  1. Ipsilateral cranial nerve palsy with contralateral deficit
  2. Bilateral deficit
  3. Eye movement deficit
  4. Cerebellar dysfunction
  5. Homonymous hemianopia
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9
Q

Three clinical presentations of lacunar stroke

A

ONE OF THREE:

  1. Pure sensory loss
  2. Pure sensory motor loss
  3. Ataxic hemiparesis
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10
Q

Describe initial physical examination of a near patient

A
  1. Assess consciousness level via GCS
  2. Signs of meningeal irritation (Neck stiffness, Kernig’s)
  3. Examine dysarthria and dysphagia
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11
Q

How is neck stiffness assessed

A
  1. Place hands on either side of the patient’s head
  2. Flex patient’s head gently until chin touches chest
  3. Ask patient to hold position for 10 seconds
  4. Positive: Spasming in neck muscles or neck is not being passively flexed
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12
Q

How is Kerning’s sign carrie out

A
  1. Flex legs to 90 degrees at both hip and knee with left hand placed over medial hamstrings
  2. Extend knee while hip is maintained in flexion

POSITIVE: Extension is resisted by spasming of hamstrings

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13
Q

How is patient speech assessed

A
  1. Listen to spontaneous speech
  2. Assess tongue: repeat ‘yellow lorry’
  3. Assess lips: repeat: baby hippopotamus
  4. Ask to count to 30 to assess fatigue
  5. Ask patient to cough and say AH - palate raising bilaterally
  6. Inspect mouth for loose-fitting dentures
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14
Q

How is dysphagia assessed (broca’s and wernicke’s assessment)

A
  1. Spontaneous speech
  2. Give patient a common object and ask to name it
  3. Give three-stage command (pick up paper, fold in half and place under a book)
  4. Repeat simple sentence
  5. Ask to read a passage
  6. Ask to write a sentence
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15
Q

Symptoms seen in frontal lobe damage

A
  1. Personality and behaviour changes
  2. Loss of emotional responses
  3. Cognitive impairment (attention and concentration effected)
  4. Dysphagia
  5. Urinary incontinence
  6. Primitive reflexes lost
  7. Seizures
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16
Q

Symptoms seen in temporal lobe damage

A
  1. Memory impairment
  2. Seizures
  3. Changes in smells
17
Q

Symptoms seen in parietal lobe damage

A
  1. Cortical sensory impairment
  2. Dyslexia, dyscalculia
  3. Apraxia
  4. Sensory seizures
  5. Visuospatial disturbances
18
Q

How is trigeminal nerve function assessed

A

SENSORY:
Ask patient to close eyes and say yes if they feel a light touch across trigeminal distributions
2. Repeat with neurological pin
3. Compare both sides
4. Nasal tickle test
MOTOR:
Inspect signs for wasting of muscle mastication
2. Ask patient to clench teeth
3. Ask patient to open jaw and see deviations of the jaw to one side or the other
CORNEAL REFLEX:
Ask to remove lenses
2. Depress lower eyelids and ask patient to look up
3. Touch lateral edge of cornea with damp cotton wool
4. Look for direct and consensual blinking
JAW JERK:
1. Let mouth hang loosely and place forefinger in middle between lower lip and chin
2. Tendon hammer under forefinger
CHECK BOOK

19
Q

How is facial nerve assessed

A
  1. Inspect the face for asymmetry, differences in blinking and eye closure
  2. Watch for twitching
  3. Demonstrate yourself doing an action and get them to repeat
  4. Ask to raise eyebrows (frontal muscles
  5. Ask patient to screw eyes shut (orbiculares oculi)
  6. Ask patient to bare teeth (orbiculares iris)
  7. Ask patient to blow cheeks with mouth (buccinator)
20
Q

Examination of the glossopharyngeal and vagus nerve

A
  1. Say AH and look at palate and uvula
  2. Ask patient to puff cheeks with lips closed (for cheeks to puff, palate must elevate and occlude nasopharynx - damage you should hear air escape through the nose)
  3. Ask patient to cough for strength
  4. Swallow test: Give three teaspoons of water and observe for absent swallowing or delayed cough
21
Q

Examination of the accessory nerve

A
  1. Face patient and inspect sternomastoid muscles for wasting and hypertrophy
  2. Stand behind patient to inspect trapezius muscle for asymmetry
  3. Ask patient to shrug shoulders and apply downward pressure for strength
  4. Test power in left sternomastoid by asking patient to turn head to right while placing resistance and repeat for right
  5. Test both sternocleidomastoid muscles by asking patient to flex neck/ apply your palm to forehead as resistance
22
Q

How is the hypoglossal nerve examined

A
  1. Ask patient to stick out their tongue and look for deviation
  2. Ask patient to move their tongue quickly from side to side
  3. Test power by asking patient to press tongue inside cheek while you press from outside
  4. Assess speech (yellow lorry)
  5. Assess swallowing with water swallow test
23
Q

Outline the 6 stages of motor system lesion examinations

A
  1. Assessment of stance and gait
  2. Inspect and palpate muscles
  3. Assess tone
  4. Tets power and movement
  5. Examine reflexes
  6. Test coordination
24
Q

How is stance assessed

A
  1. Ask patient to stand with feet close together and eyes open
    CEREBELLAR ATAXIA: Swaying, lurching and struggling to stand in position
  2. Ask patient to close their eyes and be prepared to steady them (swaying is common, falling is not)
  3. PULL test: inform you will push them forwards or backwards and should try maintain position
25
Q

How is Gait examined

A
  1. Look at patient’s shoes for abnormal footwear patterns
  2. Time patient walking a measured 10 m, with walking aid if needed and turning 180 degrees
  3. Note stride length, arm swing, steadiness, limping or other difficulties
  4. Look for abnormal movements in walk
  5. Listen to slapping sound of foot-drop gait
  6. Ask patient to walk on tiptoes, then heels for foot drop
  7. Ask patient to walk heel to toe in straight line (gait ataxia)
26
Q

How to we inspect the muscles

A
  1. Expose appropriately
  2. Look for asymmetry, and deformities
  3. Inspect for wasting or hypertrophy, fasciculations and involuntary movement
27
Q

How is tone examined

A
  1. Ask patient to lie supine and relax (go floppy)
  2. Ask about pain or limitations in movement BEFORE proceeding
  3. Passively move each joint as full range as possible slowly and quickly
  4. Be unpredictable to avoid assistance by patient by asking them to count back from 20
28
Q

How is tone of the upper limb further examined

A
  1. Hold patient’s hands if shaking and support elbow with other - assess tone at wrist and elbow with supination and flexion movements
  2. Activation method: Ask patients to describe circles in the air with contralateral limb as you assess tone in other one (assess extrapyramidal tone increase but slight increase is normal)
29
Q

How is lower limb tone further examined

A
  1. Roll leg form side to side and then briskly flip knee up into flexed position, observing movement of the foot
30
Q

How is ankle clonus examined

A
  1. Support patient’s leg with both knee and ankle resting in 90 degree flexion
  2. Briefly dorsiflex and partially evert the foot, sustaining pressure (clonus will be felt as repeated beats of doors and plantar flexion)
31
Q

How is myotonia examined

A
  1. Ask patient to make a fist and to relax and open their hand (watch for speed of relaxation)
  2. Use tendon hammer to percuss belly of thenar eminence - shows wasting as induces contraction of thumb muscles

Phase 2B OSCEs (1 decks)

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