Neurological history and examination Flashcards

1
Q

What does a medical history entail?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give examples of red flag Sx for a headache

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are red flag Sx for weakness?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

slides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PMH important qs

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DH questions

A
Focus depends on presentation 
Peripheral neruopathy, Parkinsonism
Now and in the past
OTC
recreational drugs
alleergies and intolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sh questions

A
Alcohol [seizures, neuropahy, ataxia, Wernicke-Korsakoff syndrome]
Smoking
Activities of daily living
Family support
Accomodation
Driving
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tools in neuro exam

A

Fundoscope, tendon hammer, tuning fork, other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Main parts to neuro exam

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Signs of movement disorder PD

A

slides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ways of testing cognitive state

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

briefly summarise anatomically where the CNs come out from the brain

A

slides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Name the cranial nerves?
slides
26
Which nerve does COVID affect?
3rd
27
how to test olfactory nerve?
- first ask any change sense of smell - test ability to distinguish different smells covering each nostril - smell bottles rare ward
28
change olfactory nerve can be cuased by what?
skull fractures, infx, tumour, PD
29
how to test optic nerve
visual fields, pupil reflexes and accomodation, visual acuity, funcdoscopy
30
Go through visual field disturbances and why anatomically they prestent as such
slides
31
How to test pupils?
slides
32
Give examples of pupillary problems and how they may present?
slides
33
how will an optic nerve lesion affect the pupil?
slides
34
If ophthalmoscopy shows swollen disc, what is this sign of? What about a pale disc?
Swollen optic nerve: papilloedema | Pale: optic atrophy
35
Which movements of the eye is the abducens nerve responsible for?
slides
36
Which movements of the eye is the oculomotor nerve responsible for?
slides
37
Which movements of the eye is the trochlear nerve responsible for?
slides
38
What is ocular palsy?
slides
39
in hypertropia, which nerve is paralysed?
slides
40
Only one eye obeys command look to the left? Which CN affected?
slides
41
Which deficit is nystagmus a sign of?
slides
42
Which deficit is internuclear ophthalmoplegia a sign of?
slides
43
Sensation and motor componenent to the trigeminal nerve
slides
44
Give an example of animal that has a large trigeminal nerve
Crocodile!
45
how to test for the trigeminal nerve
slides
46
Example condition adn Sx with trigeminal nerve problems
look up
47
Questions for facial nerve VII
``` Raise eyebrows clsoe your eyes shows me your teeth/smile puff out cheeks LMN vs UMN ```
48
how would LMN/UMN present in facial nerve?
Look up
49
Commands for vestibulocochlear nerve VIIII
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
Commands for glossopharyngeal IX/vagus X nerve
slides
51
how to test for vagus X and accessory Xi nerves
power of SCM and trapezius
52
how to test hypoglossal
tongue out and fasciculations, also speech and jew jerk
53
Insepction part of the limbs
Wasting, fasciculations, scars, tremor
54
3 types of tremor seen UL
rest, posture, intention
55
which CNS part affected in when spastic tone in UL?
pyramidal tracts
56
which CNS part affected when rigidity in UL?
basal ganglia
57
all parts of the UL examination
slides
58
how to differentiate between rigidity and spasticity in tone?
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
How to test power UL?
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
Reflexes tested arms and limbs
arms: supinator, biceps, triceps, finger jerks, Hoffman's legs: knee, ankle, plantar
61
What are brisk reflexes a sign of?
look up
62
how to test coordination in the examination?
``` DANISH Dysdiadokinesis Ataxia Nystagmus intention tremor speech [hypotonia] ```
63
What are the 4 sensory modalities?
Light touch, pin prock, vibration, proprioception
64
Dsecribe the course of the dorsal column system and compare to the spinothalamic tract . How does this relate tot eh sensory modalities?
slides
65
30 yo.F headache: questions, examination, red flags?
SOCARATES, medication and coffee PMH | Papilloedema, BP, CNs, reflexes
66
65 y/o with difficulty walking: history, examination, red flags, additoinal SHx
slides
67
75 y/o acute onset left arm and leg weakness: history, examination, red flags
slides