Examinations Flashcards
What are the 6 checks and examinations in the Ageing and Complex Health section?
Assessment of Parkinson’s
Assessment of a suspected stroke
Comprehensive Geriatric Assessment
Mental Capacity Act
Nutritional Assessment
Delirium Assessment
In the Parkinson’s Assesment, what should you do on General Inspection?
Walking aids, tremors (esp Parkinsonian tremor), Hypomimia (lack of facial expressions)
In the Parkinson’s Assesment, which tremors are you supposed to look for?
Fine tremor (resting tremor) - to exacerbate this tremor you have to distract the patient using techniques (counting backwards from 20)
Positional tremor - ask the patient to stick their hands out
Action tremor - finger-nose test OR picking up a cup
Bradykinesia - check when the patient is carrying out an activity with their hands (tapping thumb and middle finger);
In the Parkinson’s Assessment, how do you assess Rigidity?
Tone - this is done the normal neuro way. However, if you don’t see any changes then you can ask the patient to do something else with their other hand to distract them. This is called Synkinesis.
What do you see on power, reflexes and sensation parts of the Parkinson’s Assessment?
Normal findings
What are the findings on Gait of a patient with Parkinson’s?
Stooped posture
Shuffling steps
Difficulty starting movements
Reduced arm swing
Festination (speeding up and shortening steps)
Difficulty turning
Freezing
Which eye tests should you do in the Parkinsons Assessment?
H test
(paying attention to vertical gaze palsy and nystagmus)
How do you assess dysarthria in Parkinson’s Assessment?
You should the patient to say ‘British Constitution’, ‘West Register Street’ or ‘Baby Hippopotamus’
What other tests are there to do (that you don’t have to do) in the Parkinson’s Assessment?
Lying and standing blood pressure
Micrographia or Spiral copying
Cogntiion
In what order should you do the Parkinson’s Assessment?
General inspection
Tremor
Rigidity
Other parts of neurology examination - power, reflexes and sensation; Gait; eye movements; speech
Other tests
What is involved in a Suspected Stroke Assessment?
ABCDE
and important investigations - Thrombolytic window, CT brain, ECG, Bloods
What are the 5 main domains of the Comprehensive Geriatric Assessment?
(with 2 split in two)
Physical Health - Medical Diagnoses and Medications
Mental Health Conditions
Social Circumstances (and Economic Circumstances)
Functional Abilities
Environment
(the ones in both are thee two split in two)
What questions should you consider when assessing a patients nutritional intake?
Are they able to feed themselves?
Are they able to prepare their own food?
Are they able to do their own shopping?
Is there ay change in weight or appetite?
Do they have any problems swallowing or problems with their dentition?
What is their usual dietary intake?
What is the mnemonic for delirium?
PInCH ME
Pain
Infectio
Constipatio
Hydration
Medication
Environment
What is CAM?
The Confusion Assessment Method (CAM) is based on ICD 10 criteria for delirium.
If a patient is CAM positive then they have a delirium.
There are four features that make up the CAM assessment method.
To be ‘CAM positive’, a patient must have features 1 and 2, plus either feature 3 or 4
- Acute onset and fluctuating course
PLUS
- Inattention
(counting backwards or reduced attention during review)
AND EITHER
- Disorganised thinking (incoherent disorganised speech)
OR
- Altered level of consciousness
(hyperalert, hypoalert or both)
What is 4AT?
The 4AT is a validated tool that is quick to complete and easy to use in most clinical settings. It incorporates a short version of the abbreviated mental test score (AMTS)
There are four sections/categories that the patient is assessed on (all starting with ‘A’ – a good way to remember the features), scoring points for the presence or absence of each feature.
