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Y2 Campus to Clinic > Neurological Examination 1 > Flashcards

Neurological Examination 1 Flashcards

1
Q

What is meant by the FAST test to determine whether someone is having a stroke?

A

Facial weakness:

  • can the person smile?
  • has their face fallen on one side?

Arm weakness:

  • can the person raise both arms and keep them there?

Speech problems:

  • can the person speak clearly and understand what you say?
  • is their speech slurred?

Time:

  • if you see any one of these three signs, it’s time to call 999
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2
Q

What are the 2 areas that must be focused on when taking a stroke/neurological history?

A

Help make a diagnosis:

  • where is the lesion?
  • what is the most likely diagnosis?

Decide on emergency treatment:

  • thrombolysis decisions need precise times of onset of symptoms
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3
Q

What factors would help you to determine where the lesion might be?

A
  1. What are the neurological symptoms?
  2. Are symptoms global or focal?
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4
Q

What factors should be looked at when considering what is the most likely diagnosis?

A
  1. Time of onset and duration of symptoms
  2. Are the symptoms still present?
  3. Associated symptoms
  4. Possible causes
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5
Q

What associated symptoms would be looked for in a neurological/stroke history?

A

Headache, visual disturbance, seizures, drowsiness, fever

Headache can be a sign of a sub-arachnoid haemorrhage

this involves a sudden onset of the “worst ever” headache

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6
Q

What possible causes may be associated with stroke?

A

Falls, head injury, anticoagulants

look at PMHx for neurological conditions and atrial fibrillation

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7
Q

What risk factors are associated with stroke?

A
  1. Cardiovascular disease
  2. Diabetes mellitus
  3. Hypertension
  4. Family history
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8
Q

What are the 4 stages involved in the neurological examination?

A
  1. Assessment of conscious level
  2. Neurological examination of the limbs
  3. Cranial nerve examination
  4. Examination of other systems, including CVS
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9
Q

What are the 2 methods of assessing conscious level?

Which one is more commonly used?

A

AVPU or Glasgow Coma Scale (GCS)

AVPU is more commonly used as it is quicker

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10
Q

What is AVPU as a measurement of conscious level?

A

A - alert

V - responds to voice

P - responds to pain

U - unresponsive

Any score less than A is an indication to get further help

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11
Q

What are the stages in the Glasgow Coma Scale?

A

3 areas are measured:

Eye opening:

  • this is scored from 1-4

Verbal response:

  • this is scored from 1 - 5

Motor response:

  • this is scored from 1-6

A fully alert healthy individual will score 15/15

The lowest possible score is 3/15

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12
Q

How is the Glasgow Coma Scale worked out?

A
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13
Q

How is tone assessed as part of the neurological examination of the upper limb?

A
  • Hold the patient’s hand as if shaking hands, and support their arm at the elbow with the other hand
  • start by flexing and extending the wrist, and then the elbow
  • pronate and supinate the forearm
  • rotate the shoulder

Compare both sides

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14
Q

What may it suggest if someone has increased tone?

A

Upper motor neurone disorders:

  • ‘clasp-knife’ spasticity is felt
  • this is initial resistance followed by sudden reduction in resistance to movement

disorder of the basal ganglia:

  • ‘lead pipe’ rigidity is felt
  • this is due to sustained resistance throughout the range of movement

Parkinson’s disease:

  • ‘cog-wheel’ rigidity
  • this is when a tremor is superimposed on the underlying lead-pipe rigidity
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15
Q

Why may someone have reduced tone?

A

Lower motor neurone lesion or cerebellar lesion

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16
Q

How is pronator drift assessed as part of the power exam in the neurological examination of the upper limb?

A
  • Ask patient to extend their arms with their palms facing upwards and close their eyes
  • If there is an upper motor neurone lesion, the affected arm will pronate and fall
  • this is a positive pronator drift sign
17
Q

What is important to remember when carrying out each stage of the power examination?

A

Ask the patient to perform the movement, and then test power against resistance

compare both sides

18
Q

How is shoulder abduction and adduction assessed?

A
  • Ask patient to flex their elbows, then abduct their arms against resistance applied to the upper arm
  • then ask patient to abduct and adduct an outstretched arm from the shoulder
19
Q

How is elbow flexion and extension assessed as part of the power examination?

A
  • Ask patient to flex their elbows to 90 degrees
  • use one hand to support their upper arm, and the other to provide resistance to their forearm as you test flexion and extension
20
Q

How is wrist flexion and extension assessed as part of the power examination?

A
  • Ask patient to hold out their arms and make a fist
  • then flex and extend the wrist
21
Q

How is finger adduction, abduction, flexion and extension assessed as part of the power examination?

A
  • Ask patient to squeeze your fingers, then open their fist against resistance
  • ask them to spread their fingers wide and then bring them back together
22
Q

How is thumb adduction and abduction assessed as part of the power examination?

A
  • Ask patient to lift their thumb away from a flat palm, then bring it back towards a flat palm
23
Q

What is meant by the finger-nose test as part of the coordination assessment?

A
  • Ask patient to touch their nose with their index finger
  • then ask them to reach out to touch your finger held in front of them
  • ask them to repeat this movement backwards and forwards between the finger and their nose as quickly as they can
  • compare both sides
24
Q

What signs should be looked for during the finger-nose test?

A

Past-pointing and intention tremor are suggestive of cerebellar lesions

coordination will also be affected by weakness or sensory disturbance

25
Q

How is dysdiadokokinesis tested for?

When is this present?

A
  • Ask patient to hold one hand out with the palm facing upwards
  • ask them to place the other hand, also palm upwards, into the other hand
  • ask them to turn the hand over so the back of their hand faces upwards and repeat as quickly as possible

dysdiadokokinesis is present when the movements are erratic in force and rhythm

26
Q

Which reflexes are tested as part of the coordination assessment?

A
  1. Supinator - C5/C6
  2. Biceps - C5/C6
  3. Triceps - C6/C7
27
Q

How is sensation assessed as part of the upper limb neurological examination?

A
  1. Test for light touch sensation using cotton wool in each dermatome, comparing sides
  2. Repeat process testing for sharp touch sensation using a neuro-tip
28
Q

How is joint position sense/proprioception tested for as part of the sensation examination?

A
  • Test this at the DIP joint of the index finger
  • hold finger-tip at the sides of the finger distal to the DIP joint, whilst stabilising the joint below this
  • ask patient to close their eyes
  • move your finger-tip up and down and ask the patient to sense the direction of that movement
  • repeat this test 3 times
  • if they correctly detect the movement, then their joint position sense is intact. If they do not, test a more proximal joint until joint position sense can be accurately detected
29
Q

How is vibration sense examinated as part of the sensation examination?

A
  • Confirm that the patient can detect the vibration of a 128hz tuning fork on the sternum
  • ask patient to close their eyes and test whether they can detect the same vibration on the DIP joint of their index finger, and also when the vibration stops
  • if they cannot detect this, test a more proximal joint until vibration sense can be accurately detected
30
Q

How is power graded on a scale of 0 - 5?

A

0 - no muscle contraction visible

1 - muscle contraction visible, but no movement of joint

2 - joint movement when effect of gravity eliminated

3 - movement sufficient to overcome effect of gravity

4 - movement overcomes gravity plus added resistance

5 - normal power

31
Q

What is a subdural haematoma?

A

A type of bleeding in which blood collects between the inner layer of the dura mater and the arachnoid mater of the meninges

It usually causes a headache that keeps getting worse, and feeling and being sick

32
Q

What is a subarachnoid haemorrhage?

A

Bleeding into the subarachnoid space between the arachnoid mater and pia mater of the brain

it is often caused by a burst blood vessel in the brain

33
Q

Complete the table for the differences between upper and lower motor neurone lesions

A
34
Q

Which muscles, nerve and nerve root are involved in hip flexion and extension?

A

Hip flexion:

  • iliopsoas
  • iliofemoral nerve (L1/L2)

Hip extension:

  • gluteus maximus
  • sciatic nerve (L5/S1)
35
Q

Which muscle, nerve and nerve root are concerned with knee extension and flexion?

A

Knee extension:

  • quadriceps
  • femoral nerve (L3/L4)
  • knee jerk reflex tests L3

Knee flexion:

  • hamstrings
  • sciatic nerve (S1)
36
Q

Which muscle, nerve and nerve root are concerned with ankle dorsiflexion and plantarflexion?

A

Dorsiflexion:

  • tibialis anterior
  • deep peroneal nerve (L4/L5)

Plantarflexion:

  • gastrocnemius and soleus
  • tibial nerve (S1/S2)
  • ankle jerk reflex tests S1

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