Neuro

Question 1

how should you summarise

Answer 1

general observations
-muscle wasting and fasciculations
tone
power 
reflexes
co-ordination 
sensation 
summary 
differential

Question 2

what should you do before testing vibration sense

Answer 2

test on sternum

Question 3

how should you complete the exam

Answer 3

neck stiffness and kernigs sign

Question 4

how do you assess temperature sensation

Answer 4

use freeze spray on sternum and then arms and legs

Question 5

what should you do before testing sensation

Answer 5

ask the patient if they have noticed any altered sensation or numbness

Question 6

what are the important sensory modalities

Answer 6

light touch
pinprick
vibration
proprioception

Question 7

how do you assess cerebellar drift

Answer 7

ask patient to hold out arms with palms facing up
look for upward drift
push down one hand and then the other

Question 8

how do you perform a heel shin test

Answer 8

first do with eyes open and then eyes closed, this differentiates between a cerebellar and sensory cause

Question 9

what causes sensory ataxia

Answer 9

sensory peripheral neuropathies

conditions causing dysfunction of the dorsal columns

Question 10

how should you elicit foot clonus

Answer 10

foot in same position as ankle jerk

Question 11

brachioradialis reflex

Answer 11

C6

Question 12

triceps reflex

Answer 12

C7

Question 13

biceps reflex

Answer 13

C5

Question 14

what should you remember when eliciting reflexes

Answer 14

ensure the muscle is exposed and watch the muscle rather than the joint movement

compare side to side, reflexes should be symmetrical

Question 15

what is a normal reflex

Answer 15

++

Question 16

screening for LL power

Answer 16

lift your leg up, don’t let me push it down
squeeze your knees together, don’t let me push them apart
kick your leg out
curl your ankle towards you
curl your big toe up
point your foot down

Question 17

Screening for UL power

Answer 17

make wings with your arms
pull me towards you
push me away
make a fist, push up and then down 
squeeze my fingers
spread your fingers apart
put your thumb up

Question 18

how do you grade muscle power

Answer 18

0-5

5 = normal power

Question 19

what does clonus suggest

Answer 19

UMN lesion

Question 20

how do you test for knee clonus

Answer 20

knee extended
grip lateral borders of the patella
pull down sharply and hold

Question 21

how do you assess lower limb tone

Answer 21

roll right leg side to side

place hand under knee and pull upwards and drop back on to bed

Question 22

which muscles should you palpate

Answer 22

quadriceps and calves

Question 23

how should you look for fasciculations

Answer 23

rest hands on your lap and look for fasciculations in large muscle groups

Question 24

general inspection

Answer 24

around the bed
posture, symmetry, muscle wasting, movements
skin

Question 25

inspection and palpation of upper and lower limb

Answer 25

inspection of fasciculations
shake hands
ask if right or left handed
palpate muscle bulk 
pronator drift and cerebellar

Question 26

tone

Answer 26

upper limb
lower limb
clonus x2

Question 27

reflexes

Answer 27

UL
LL
clonus
babinski

Question 28

what are the steps

Answer 28

general inspection
inspection and palpation UL and LL
tone
power 
reflexes
coordination 
gait 
sensation