Examination (WM) Flashcards
What are the four features of Gerstmann’s syndrome? (and how do you test them)
Left right dissociation (cross hands and ask which is which)
Finger Agnosia (point to left index, point to left ring)
Acalculia (serial 7s)
Agraphia (can’t write)
What are the 6 things to examine common to both parietal lobes?
3-2-1 (3 somatosensory, 2 hands, 1 eyes) 3 somatosensory:- Two point discrimination Tactile location Tactile extinction (sensory inattention) 2 hands:- Sensory perception (write on hand - graphaesthesia) Stereognosis (coin and key) 1 eyes:- Visual fields
How do you specifically examine the dominant parietal lobe?
4 Gerstmann items \+ Motor dyspraxia (three hand test) \+ Ideomotor dyspraxia (show me how to slice a loaf of bread)
How do you examine specifically the non-dominant parietal lobe?
Spatial apraxia (clock face, five pointed star)
Dressing apraxia
Geographical apraxia
Put the whole parietal exam together (schematic)
Right or left handed?
Both lobe exam
Dominant or non-dominant specific exams as indicated
Examine this patient’s speech
Assess this patients speech
Observation: Scars, trachy, peg
Ask if right or left handed
Dyphasia
- “Describe your journey here today” Long sentence (expressive speech, ?frontal operculum)
- “What’s this?” (pen, coin) - nominal (dominant frontal operculum)
- “Name as many animals as you can in 10 seconds” - (dominant frontal operculum)
- “when I clap my hands left hand on nose right hand on knee” Complex task (receptive speech, posterior-superior temporal gyrus, wernicke’s)
- “Repeat this sentence “a stitch in time saves 9”” (conductive- arcuate)
Dysarthria
- Repeat “British constitution”, “west register street”, “baby hippopotamus”
Dysphonia
- Cough
- Say “eeeee”
- “aaaaaa”
Dyslexia
- Read aloud
Dysgraphia
- Write down this phrase “
If dysarthric then lower cranial nerves +/- cerebellar exam
Examine this patient’s gait
Inspect - Shoes and aids Walking Heel toe walk Walk on toes and heels Romberg
Examine this patient for Parkinson’s
Bradykinesia \+ Rigidity Tremor Postural instability;gait
Observation
- Spontaneous movements - Eye blink (lack of blink)
Bradykinesia - do they get slower over time or smaller over fime (speed and amplitude)
Observation - mask facies, reduction in spontaneous movements
1) Bradkyinesia - finger tapping as big and as fast as you can Fist open close Toe tapping Heel tapping 2) Rigidity - wrist, elbow (do activation manouvre - tap with contralateral hand) Ankle, knee (can activate with contralateral hand still) ?couch Tremor within rigidity is cogwheel rigidity 3) Tremor. Resting, postural (arms outstretched), kinetic tremor (finger-nose) 4) Gait and balance. Standing from chair (arms crossed), walk (turns, step length, heel strike, arm swing). Pull test (should correct in 1 or 2 steps)
Examine this patient’s upper limbs
To Do
Expose Inspection (scars including neck) Tone Power C5-T1 Reflexes Biceps, triceps, supinator Finger jerks, (?pectoral (C5), ?deltoid (C5),?scapulohumeral) Sensation Fine touch and pin prick
Other tests
Myelopathy - hoffman’s - hold middle finger and flick distal phalanx towards palm
Median - pinprick. Does it feel sharp
OK sign. Tinel and phalen
Ulnar - sensory mapping. Tinel and elbow and guyon’s canal.
Fromment’s -ulnar. Wasting first dorsal interosseous
Joint position sense - finger, wrist, elbow, shoulder
vibration
Sensory - Fine touch - Pinprick Then go on to do temperature vibration 2 point discrimination
Examine this patient’s lower limbs
Walk Heel walk Toe walk Rombergs Expose Surroundings (I see a stick at the bedside) Back for deformity or scars Tone "is there any pain". Clonus Power Reflexes - knee, ankle, babinski
Examine this patient’s hands
Place hands on lap or pillow
Compare both sids
Describe e.g. wasting and weakness
Gross movements
Functional - buttons
Examine for ulnar
Power abductor digiti minimi
Abductor pollicis (froment’s sign)
Flexor digitorum profundis
Median nerve:
Pope can’t make a fist - hand of benediction (high)
Ape hand at rest
Test is OK sign
Radial
Finger drop and partial wrist just below elbow
Distal forerm sensory only
Go on to do phalen’s, tinel’s
OK sign - flexor polices longs and flexor digitorum profundis
Examine this patients Vth cranial nerve
V 3 areas Corneal Feel temporalis and masseter Pterygoids primarily pull jaw in - if right is weak, jaw deviates to right
Examine this patients eyes
CN II - Can you see well with both eyes? Do you wear glasses?
Snellen chart 6 metres first (if not available then reading)
Fields
Fundoscopy - examine the red reflex, then look at back of eye (describe what you’re doing as you do it - discs, vessels, scan rest of retina)
CN III, IV, VI-
Inspect
Direct and consensual
RAPD
Accomodation (constriction when looks more closely)
Movements Saccades and pursuit
IV palsy on looking downwards and inwards
Children with Ivth will try to tilt away (run away from problem) from bad eye
Pupil reaction (direct, consensual, swinging light) + accomodation
Examine this child
Feel fontanelle Measure head circ + map Ask parents about milestones Examine scars, shunts etc Midline defects
Age appropriate neurological exam
Infant coma scale Eyes - same as adult Verbal - 5 coos, 4 irritable, cries 3 moans, 1 none Motor - 6 is normal spontaneous, 5 is withdraws touch
Examine this patient’s spine
Inspect
Tenderness
Movements c, t, l
Completeness - neurological exam
