Neurological Examination Flashcards
Describe the basic steps involved in a neurological examination of the limbs
Inspection: WARDS (including muscle bulk and fasciculations)
Tone: normal, spastic, rigid, flaccid
Power: balance effort of examiner and patient - length of muscle and lever
Coordination: dysdiadochokinesis, dysmetria, intention tremor
Stretch reflexes: consistent and reproducible stimulus
Sensation: joint position, vibration, light touch, pain/temperature (testing a specific hypothesis!)
How should station and gait be assessed?
Muscle strength: knee bends (standing from rising), standing on toes and heels
Balance: Romberg test, standing on one foot and hopping, postural righting relexes (if assessing Parkinsonism)
Observe gait from distance, ask for an assistant to ensure patient safety: casual gait, tandem gait
Describe the basic structure of a cranial nerve examination
I: smell
II, III, IV, VI: fundoscopy, VA, VF, pupils, EOM
V, VII: facial sensorimotor, jaw jerk, corneal reflex
VIII: hearing, vestibular function (nystagmus)
IX, X: palate
XII: tongue
XI: SCM, trapezius
How should visual fields be assessed by confrontation?
Patient should be seated or even standing
Examiner should be at same eye level
Stay in the plane bisecting the distance between you and the patient
Mapping the blind spot is your quality control
What characteristics of a tremor should be noted?
Distribution
Rate
Amplitude
Outline 3 types of tremor and their relative significance
Resting: PD (observe when patient is distracted, e.g. counting backwards)
Postural/action: think essential tremor (ask patient to write, draw spirals)
Intention: think of cerebellar pathway lesion
List 4 features of Parkinsonism
Bradykinesia
Tremor
Rigidity
Postural instability
List 5 features of Parkinsonian gait
Flexed posture
Reduced arm swing
Enhanced resting tremor
Shuffling, festinating gait
En bloc turning
What language abnormaliies must be distinguished from each other?
Dysphasia
Dysarthria
Dysphonia
Dysprosody
What aspects of language should be assessed?
Fluent vs. non-fluent spontaneous speech
Comprehension
Repetition
Naming
How can fluent vs non-fluent spontaneous speech be assessed?
Boston cookie theft picture
How can repetition be used to distinguish between dysphasia and dysarthria?
Dysphasia: trouble with sentences like “no ifs, ands or buts”, or “one thing a nation must have to be rich and great is a large secure supply of wood”
Dysarthria: trouble with statements like “West Register Street, Royal Ulstar Constabulary, British constitution” or “Methodist Episcopal Church, statistical analysis”
How can reading be assessed?
With the “Rainbow Passage”
How is the Folstein Mini-Mental Status Examination performed?
Orientation (10 marks): time (date/day/month/year/season), place (floor/building/suburb/state/country)
Attention (5 marks): serial 7s, DLROW
Registration (3 marks): apple, table, penny
Language (8 marks): name pencil and watch, repeat “no ifs, ands or buts”, 3-stage command, CLOSE YOUR EYES, write a sentence
Construction (1 mark): interlocking pentagons
Recall (3 marks): apple, table penny
Describe the steps in the frontal assessment battery
Similar objects: in what way are they alike - fruit (banana and apple), furniture (table and chair), flowers (tulip, rose and daisy)
Lexical fluency: list words beginning with S (should get >9 words in 60 secs)
Luria test: fist-palm-edge
Conflicting instructions: “tap twice when I tape once”, “tap once when I tap twice”
Go-No Go: “tap once when I tap once”, “do not tap when I tap twice”
Grasp: “don’t take my hands”
