History taking and diagnosis Flashcards
According to Mr Carroll
What is the ‘pain tool’?
Site - where exactly does it hurt? (point to it)
Radiation - does it travel anywhere? (point to it)
Onset - does it come on within minutes/hours/days/weeks/months/years? (how many of the units chosen?)
Precipitating - what was happening when you first noticed it? were you doing anything specific?
Duration - when it comes on, how long does it last? minutes/hours/days?
Course - is it there all the time or does it come and go? How frequently does it happen?
Progression - how has it changed since you first noticed it?
Character - is it a sharp/dull/burning/aching/crushing pain?
Severity - how would you rate it on a scale of 1-10, 10 being the most painful?
Sleep disturbance - does it stop you getting to sleep or wake you up at night?
Alleviating/exacerbating - does anything make it better/worse? position, pain relief, pressure, movement?
Associated features - have you noticed anything else going on? (examples given will depend on Hx so far ie sensation/visual changes, continence, weight loss, weakness etc)
Previous episodes - has this or something similar happened before? Was it the same or different?
Response to conservative measures - have you received any treatment for this before? did it work? why are you not taking it now?
Impact on ADLs - question feeds into the domain tool…
What is the ‘domain tool’?
Assesses impact on lifestyle across 7 domains:
Mobility Communication Interpersonal relationships School/work/hobbies Continence/sexual function/personal hygiene Sleep Eating/drinking/nutrition
+ overall impact on mood
Will also give access to ‘patient speak phrases’ - useful to quote in notes as can give indications to pathology as well as functioning
What is the ‘core neurological examination’ made up of?
General appearance - drowsy, agitated, aggressive, unwell, shocked, toxic
Gait - assessed when calling a patient in
Vital signs - often performed by colleague
Fundoscopy - optic atrophy and papilloedema
Long tract signs
Vibration sense - 125Hz tuning fork
What is the importance of vital signs?
To distinguish between primary and secondary brain problems
Secondary - pathology is outside the brain - ie patient may be drowsy from hypovolaemia/shock, hypoxia, systemic infection and pyrexia
Primary - pathology is inside the brain - ie pyrexia for CNS infection, irregular pulse/AF in the context of a stroke
What are long tract signs?
UMN/pyramidal/descending tract/corticospinal tract signs
Spastic gait - stiff foot dragging walk
Hypertonia
Hyper-reflexia
Babinski - upgoing plantars
Clonus - >5 beats is significant
Cross-adductors - contraction of both hip adductors when either knee jerk is elicited
Hoffman’s sign - loosely holding the middle finger and flicking fingernail downwards; positive response is flexion and adduction of thumb on same hand
Loss of fine finger movements (‘treacle hands’)
Deltopectoral reflex
Why are long tract signs useful to examine?
For the identification of myelopathy - where signs may present before symptoms or with the patient only complaining of neck pain; or peripheral neuropathy
Why is vibration sense useful to be tested?
It is the first modality to go in peripheral neuropathies and isnt something the patient is likely to report
What should be examined beyond the core examination?
Head/cranial nerves - patient sitting opposite doctor
Upper and lower limbs (ATORCS)
Trunk
What do you look for in a neuro examination of the trunk?
(6P’s 4S’ NUT)
Paraspinal mass Paravertebral muscle spasm Pit/patch of hair in midline (dysraphism) Palpable/percussable bladder Patulent anal sphincter Perianal sensation
Sensory level
Spinal deformity
Surgical wounds
Sacral pressure area
NF1 skin lesions eg cafe au lait
Urostomy, colostomy
Truncal flexion
