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Neurology > Neurological history and examination > Flashcards

Neurological history and examination Flashcards

1
Q

What does a medical history entail?

A

PC, HPC, PMH, DH and allergies, SH, FH, RoS

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2
Q

Parts to a neurological history

A
  • Patient +/- relative
  • Impact of consciousness, speech or memory
  • Age, gender, headedness, profession
  • Pattern of progression important
  • Impact, function, QoL
  • Expectations, understanding, information
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3
Q

PC headache questions

A

Acute/chronic
speed of onset
single/recurrent
unilateral/bilateral/worsening features [e.g. waking/coughing]
relivieng features [e.g. sleep/rest]
associated features [e.g. aura, LOC]
red flags: new headache, over 60 years old, thunderclap, infective Sx, Hx of malignancy, etc.

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4
Q

Give examples of red flag Sx for a headache

A

New headache, over 60 years, thunderclap, infective Sx, Hx of malignancy etc.

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5
Q

Questions for weakness

A
  • Onset gradual or sudden
  • Rate of progression
  • Muscle groups affected.
  • pattern: symmetrical, asymmetrical
  • associated sensory loss
    pain
  • red flags [sphincter control, sudden onset, progressive, resp/swalloing problems]
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6
Q

What are red flag Sx for weakness?

A

loss of sphincter control
sudden onset [stroke]
progressive
resp. or swallowing problems

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7
Q

Questions for visual disturbances

A 
"blurring"
visual loss [monocular vs binocular]
double vision [diplopia]
photophobia
speed of onset
pain [in the eye, eye movements?]
any other Sx [e.g. headache and visual loss in older person, acute onset]
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8
Q

Speech problems questions

A

“confusion”
comprehension? [recpetive/Wernicke’s dysphasia]
speech production? [expressive/broa’s]
repetition [conductive dysphasia, arcuate fasciculus]
articulation/slurred speech [dysarthria]: cerebellar, bulbar, pseudo-bulbar [“Donald duck” speech]
Phonation [dysphonia] e.g. laryngeal pathology, resp. muscle weakness

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9
Q

Questions for dysphagia

A

Is it neurological or mechanical?
Solids, liquids, or both?
Pain [odynophagia], things getting stuck?
Nasal regurgitation
associated coughin
speed of onset
mechanical causes incl. stricture and achalasia
neuro causes: bulbar and pseudoulbar palsy [brainstem pathology, MG, MND, etc.]

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10
Q

Sensation questions

A 
positive or negative [numbness, pins and needles, para-dysaesthesia]?
Pain, odd sensations "squeezing"?
Distribution?
Speed of onsety
Ass. weakness/clumsiness
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11
Q

Blackout/fits/faints/funny turns questions

A 
Detailed history important
The way the patient tells it
Eye witness account
was there loss of consciousness?
3 Ps: posture, provokation, prodome?
Frequency, duration
Tongue biting, incontinence, cyanosis, post-event confusion
shaking
chest pain, palpitation, FHx
driving
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12
Q

Compare epilepsy/non-epileptic attack/vasovagal syncope/cardiac syncope for situation/before/recovery/additional features/incontinence

A

slides

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13
Q

Obsrevaiton in the Dx of dementia

A 
how many people come?
Who gives the history?
head turn sign
detail of events, account of Hx
Sx of depression and anxiety
fluctuating, stepwise, progressing
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14
Q

Functional neurological disorders

A

Do the Sx add up
Do they fit into an appropriate anaotmical patterna
How does the person tell the story
what other Sx do they have
What are their ideas, concerns, and expectations

… and past past psychaitric hsitor yand social hsitory

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15
Q

PMH important qs

A

Similar/related Sx in past
DM and other vascualr RFs
AF

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16
Q

DH questions

A 
Focus depends on presentation 
Peripheral neruopathy, Parkinsonism
Now and in the past
OTC
recreational drugs
alleergies and intolerance
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17
Q

Sh questions

A 
Alcohol [seizures, neuropahy, ataxia, Wernicke-Korsakoff syndrome]
Smoking
Activities of daily living
Family support
Accomodation
Driving
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18
Q

Tools in neuro exam

A

Fundoscope, tendon hammer, tuning fork, other

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19
Q

Main parts to neuro exam

A

Gen app, arms, legs, tone/power/reflexes/coordination/sensation, CN, [cognition, movement disorder, cortical signs etc.]

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20
Q

Signs of movement disorder PD

A

slides

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21
Q

inspection elements

A 
well or unwell, thin or fat
walking into clinic, tranferring, getting dressed and undressed
PEG, catheters
weakness, wasting, fasciculations
Abnormal movements: tremor, chorea, tics, hemiballismus
speech
cognition
interaction
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22
Q

Ways of testing cognitive state

A

AVPU, AMT [10], MMSE [30], MOCA [better - 30], ACE-R [better still - 100], neurophysiology

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23
Q

AMT parts

A
  1. recall address
  2. age
  3. time [nearest hour]
  4. year
  5. recognize two people [doctor, nurse etc.]
  6. DOB
  7. Date WW2
  8. Name present monarch
  9. name of hospital
  10. Count backwards from 10
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24
Q

briefly summarise anatomically where the CNs come out from the brain

A

slides

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25
Q

Name the cranial nerves?

A

slides

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26
Q

Which nerve does COVID affect?

A

3rd

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27
Q

how to test olfactory nerve?

A
  • first ask any change sense of smell
  • test ability to distinguish different smells covering each nostril
  • smell bottles rare ward
28
Q

change olfactory nerve can be cuased by what?

A

skull fractures, infx, tumour, PD

29
Q

how to test optic nerve

A

visual fields, pupil reflexes and accomodation, visual acuity, funcdoscopy

30
Q

Go through visual field disturbances and why anatomically they prestent as such

A

slides

31
Q

How to test pupils?

A

slides

32
Q

Give examples of pupillary problems and how they may present?

A

slides

33
Q

how will an optic nerve lesion affect the pupil?

A

slides

34
Q

If ophthalmoscopy shows swollen disc, what is this sign of? What about a pale disc?

A

Swollen optic nerve: papilloedema

Pale: optic atrophy

35
Q

Which movements of the eye is the abducens nerve responsible for?

A

slides

36
Q

Which movements of the eye is the oculomotor nerve responsible for?

A

slides

37
Q

Which movements of the eye is the trochlear nerve responsible for?

A

slides

38
Q

What is ocular palsy?

A

slides

39
Q

in hypertropia, which nerve is paralysed?

A

slides

40
Q

Only one eye obeys command look to the left? Which CN affected?

A

slides

41
Q

Which deficit is nystagmus a sign of?

A

slides

42
Q

Which deficit is internuclear ophthalmoplegia a sign of?

A

slides

43
Q

Sensation and motor componenent to the trigeminal nerve

A

slides

44
Q

Give an example of animal that has a large trigeminal nerve

A

Crocodile!

45
Q

how to test for the trigeminal nerve

A

slides

46
Q

Example condition adn Sx with trigeminal nerve problems

A

look up

47
Q

Questions for facial nerve VII

A 
Raise eyebrows
clsoe your eyes
shows me your teeth/smile
puff out cheeks
LMN vs UMN
48
Q

how would LMN/UMN present in facial nerve?

A

Look up

49
Q

Commands for vestibulocochlear nerve VIIII

A

rubbing fingers, whispering numbers, Rinne’s test: in confuctive hearing loss bone conduction is louder
Weber’s test: sound is louder in affcted ear in conductive deafness

50
Q

Commands for glossopharyngeal IX/vagus X nerve

A

slides

51
Q

how to test for vagus X and accessory Xi nerves

A

power of SCM and trapezius

52
Q

how to test hypoglossal

A

tongue out and fasciculations, also speech and jew jerk

53
Q

Insepction part of the limbs

A

Wasting, fasciculations, scars, tremor

54
Q

3 types of tremor seen UL

A

rest, posture, intention

55
Q

which CNS part affected in when spastic tone in UL?

A

pyramidal tracts

56
Q

which CNS part affected when rigidity in UL?

A

basal ganglia

57
Q

all parts of the UL examination

A

slides

58
Q

how to differentiate between rigidity and spasticity in tone?

A

Spasticity: amplitude and velocity dependent, “Clasp knife”
Rigidity: present thoughout movement independent of speed, present even at slow speeds, lead pipe, cogwheel [regidity and tremor]

59
Q

How to test power UL?

A

test each muscle indivudally
compare L and R
SAb, EF, EE, WF, WE, 1st DI, FE, APB, FF
HF, KF, DF, PF, great toe exntesion

60
Q

Reflexes tested arms and limbs

A

arms: supinator, biceps, triceps, finger jerks, Hoffman’s
legs: knee, ankle, plantar

61
Q

What are brisk reflexes a sign of?

A

look up

62
Q

how to test coordination in the examination?

A 
DANISH
Dysdiadokinesis
Ataxia
Nystagmus
intention tremor
speech
[hypotonia]
63
Q

What are the 4 sensory modalities?

A

Light touch, pin prock, vibration, proprioception

64
Q

Dsecribe the course of the dorsal column system and compare to the spinothalamic tract . How does this relate tot eh sensory modalities?

A

slides

65
Q

30 yo.F headache: questions, examination, red flags?

A

SOCARATES, medication and coffee PMH

Papilloedema, BP, CNs, reflexes

66
Q

65 y/o with difficulty walking: history, examination, red flags, additoinal SHx

A

slides

67
Q

75 y/o acute onset left arm and leg weakness: history, examination, red flags

A

slides

Neurology (13 decks)

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