Neuro history and assessment Flashcards
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Firstly what do you verbalise when you walk into the scene?
Checking for any dangers is the scene safe?
Once the scene is safe, what do you do next?
Ask what the patient is looking like - END OF BED ASSESSMENT
After the end of bed, what next will I do?
Primary survey (abcde)
Avpu - verbalise which one they ar
FAST TEST - face, arms, speech, time
Once the primary survey is completed what must i verbalise?
if the patient is primary survey positive or negative and
if they are time critical
What must be gained from the patient?
Consent - explain the wish to treat the patient
In terms of history what acronym do i follow?
S - SITE
O - ONSET
C - CHARACTER
R - RADIATION
A - ASSOCIATED SYMPTOMS
T - TIMINGS
E - EXACERBATING/ ALLEVIATING FACTORS
S - SEVERITY
After SOCRATES, what do i do next?
Past medical history
What does past medical history involve?
Active medical problems
Previous surgerys/ resolved issues
Recemt hospital admissions
Gp visits
Any other relevant questions
After PMH what do i ask next?
Drug history
What do I ask in regards to drug history?
Medications prescribed
Any over the counter drugs
Any herbal remedies
Any recreational drugs
Last medication review
After drug histroy what do I ask about?
Does the patient have any allergies and what reaction is caused.
After allergies what do I ask about next?
Family history
What do i ask in regards to family history?
Any family members have any medical conditions (parents, siblings, grandparents)
Life status of parents and cause of death
Unexpected deaths in the family
After Family history what do i ask next?
Social history
What must i cover in the social history?
Smoker? - amount/ frequency
Alcohol? - amount/ frequency/ last intake
Occupation
Lifestyle - stress/ exercise
General - sleep/ appetite
After the social history what is the last part of the history take?
Systems review
photophobia?
Aura?
Dizziness?
Lethargy?
Nausea/ vomiting?
Fits/ faints/ funny turns?
What must I assess in this OSCE?
All 12 cranial nerves
How do i check the olfactory nerve?
Ask the patient if they are noticed any change in their sense of smell
How many tests are there to test the optic nerve?
4
What is one of the tests for the optic nerve?
Visual acuity
How do you assess visual acuity?
ask patient to cover one eye with the palm of their hand
Starting at the top ask the patient to read something in the distance (6m away).
Swap over the cover of the eye
Redo
What is another test for the optic nerve?
Pupil light reflex and consensual light.
What does pupil light reflex and consensual light relfex involve for the optic nerve?
Will involve shining a bright light into patients eyes.
Ask patient to pick a spot on the wall infront of them and keep looking at that.
Place hand on their nose and do one side at a time.
Then do swinging light test -
Swing the light from one eye to another.
What is another test for the optic nerve?
Peripheral visual fields
What does testing a patients peripheral visual fields require?
Get patient to cover one eye with palm of their hand
I cover the opposite eye
Tell the patient to let me know when they can see my finger
Tell patient to keep looking into my open eye.
Start my finger above my head and then the bottom
I then swap so i can do the other sides
Get patient to swap palm and redo
What is the last test for optic nerve?
Accomodation
What is the accomodation test for the optic nerve?
Get pt to look at the wall and then the pen - can they focus?
What is the test for the oculomotor, trochlear and abducens nerve?
H test
Ask if they have any double vision atm
Ask patient to keep head still and follow my finger
Do a H shape with my finger
Note any ptosis (occulomotor lesion)
Note any restriction of eye movement
Note any nystagmus
Ask pt if they had any double vision
What test is for the facial nerve?
Test muscles through all branches
Ask pt to raise eyebrows
Close eyes as tight as can - dont let me open
Puff out cheeks - dont let me push them in
Purse lips
Show me your teeth - smile
How many tests are there for the trigeminal nerve?
2
What is one of the tests for the trigeminal nerve?
Test for sensation through all branches:
Ask patient if they can close eyes and let me know when they can feel me touching their face.
Touch face over all the branches
Ask pt if it felt the same on both sides of their face.
What is the seocnd test for the trigeminal nerve?
Test for motor in jaw
Ask patient to clench jaw and feel either side of their eyes and relax
Clench jaw and feel cheeks and relax
Ask patient to open mouth and dont let me close
What is the test for vestibularcochlear nerve?
Assess hearing bilaterally
Place on hand on one of the patients ear
Whisper a number or word into the patients other ear
Ask them to repeat the number/word
SWAP SIDES AND DO AGAIN
What is the test for the glossopharyngeal and vagus nerve?
Assess swallowing, soft palate symmetry and position of uvula.
Get patient to open their mouth and go ahhhh
Assess the uvula - is it in the central position. If it is to one side, then it is the opposite side that is being affected.
Assess the soft palate
Ask the patient if they are able to swallow
How do you assess the accessory nerve?
Test strength and compare bilaterally
Ask patient to start by shurgging shoulders amd do not let me push them down.
Ask patient to turn head to the right and dont let me stop you - then swap over
How do you test the hypoglossal nerve?
Ask patient to open theie mouth
inspect the tongue at rest
Ask patient to stick their tongue out
Ask patient to stick toungue out to their cheek and my fingers - do both sides - any weakness?
What is the rombergs test?
Assess vestibochleear nerve and balance
Get patient to stand up
Pt to put feet together and Close eyes and stand still
Assessing for any loss of balance.
What is the gait test?
Do after assessing cranial nerves.
Assesses how the patient moves
Get patient to walk across the room
Assess stability, stance and stride length
What does gait mean?
The pattern you walk
How do you assess rapid alternating movement?
After assessing cranial nerves
Get patient to “clap” their hands
Alternating hands
What must you check the legs and arms for?
After the cranial nerves
Sensation
Do the arms first along with the other arm tests
Then move onto the legs
What tests are related to the legs - after the cranial nerves
Assess gait
Pt to do Heal to shin
Assess sensation
Assess tone and power
What tests are related to the arms - after cranial nerves
Assess sensation
Assess tone
Assess pronator drift
Assess rapid alternating movement
Assess coordination - nose to my finger
Assess power in limbs
How do you assess a pronator drift?
Get patient to lift both arms up - palms up
Get pt to close eyes
Get pt to hold it there
Assess if the arms dip or if there is pronation such as a drift.
How do you assess tone in the arms of the pt?
After cranial nerve exam
Causes of increased tone - stroke and Parkinson’s
Get patient to fully relax both arms
Move them arm towards you and the patient
Move their wrist
Move elbow up
Decrease in tone - can be cerebellar disease
How do you assess the power in the pts arm?
Get patient to lift arms up, fists forwards their chest
I Try and push them down both sides
Get pt to hold arms out straight in front of them - don’t let me push them down
Get pt to pull forwards you and away from you
How do you assess tone in the lower limbs of pt?
After cranial nerves
Get pt to relax legs
Lift knees of patient up
Shake the legs
How do you assess power of the pts lower limbs?
After cranial nerves
Get patient to lift leg up and don’t let me push it down - both sides
Push my hands further to the floor
Bring toes towards patient and don’t let me push them down
How do you assess coordination in a patients lower limb?
Get patient to do heal to shin
How do you assess coordination in the arms?
Get patient to finger to nose
