Neurological History Taking

Question 1

Presentation:

The dizziness started suddenly when I was in bed and rolled over…
Feels like I am on a roundabout…lasts a couple minutes then settles
OK if I keep my head still but if I look up suddenly it can start again

Answer 1

Benign positional vertigo

Question 2

follow up questions for BPV?

Answer 2

• Duration of symptoms • Speed of onset
• Location
• Variation
• Intensity

Question 3

shuffling gait

increasing difficulty going up buttons

Answer 3

Parkinsons Disease

Question 4

three main origins of a collapse

Answer 4

• endocrine
• cardiovascular
• Neurological

Question 5

sudden thunder clap headache

Answer 5

indicates bleeding in or around the brain, most common cause is a ruptured aneurysm

Question 6

a headache which deteriorates over hours

Answer 6

most likely linked to infection

Question 7

relapsing or remitting headaches

Answer 7

could indicate MS

Question 8

If the headache deterioration is over weeks and months

Answer 8

this indicates chronic conditions such as Parkinson’s or a slow growing tumour etc.

Question 9

neurological test for myasthenia gravis

Answer 9

the ice pack test

Question 10

what does a focal weakness suggest

Answer 10

a neurological origin

Question 11

if the problem is a proximal weakness what activities would the individual find difficult

Answer 11

rising from the sitting position

Drying their hair

Question 12

if the problem is a distal weakness what activities would the individual find difficult

Answer 12

fine finger movements and standing on their tip toes

Question 13

if there is too much movement in the body

Answer 13

Chorea – “fidgety jerks”

choreoathetosis..decreased tone…rapid, writhing changes in movement (consider over treatment of PD)

Question 14

if there is too little movement in the body

Answer 14

E,g. Parkinson’s disease…slowing of movement, stiffness

Question 15

Allodynia

Answer 15

chronic pain syndrome where even fine touch is perceived as painful

Question 16

full sensory loss is almost always likely to be

Answer 16

functional origin

Question 17

Presentation:

“Wake up in the middle of the night with ache and numbness in my thumb and first two fingers”

Answer 17

median nerve compression due to carpal tunnel syndrome

Question 18

What chronic illnesses may result in neurological impairment?

Answer 18

diabetes (peripheral vascular disease)
alcohol related disease
hormonal conditions

Question 19

Cranial Nerve screening questions

Answer 19

Change in your sense of smell?
Vision? Double vision?
Dry eyes? Dry mouth? Change in taste? Hearing? Dizziness?
Change in voice?
Articulation?

Question 20

tests for cognitive assessment

Answer 20

• 4As test (rapid, initial screen for delirium)
• Montreal Cognitive Assessment (MOCA)
• Addenbrookes Cognitive examination (ACE III)

Question 21

What is delirium?

Answer 21

Mental confusion that can happen if someone becomes medically unwell

triggers can be infection and hypoxia and even covid

Question 22

good things about moca test

Answer 22

• Better at identifying mild levels of impairment • Less bias ethnicity / age/ education

Question 23

ACE III

Answer 23

• Scored out of 100
• 5 cognitive domains: 
– Attention
– Memory
– Verbal fluency
– Language
– Visuospatial abilities

Question 24

Confabulation

Answer 24

• Presenting false information
• Great authority, great certainty
• Often autobiographical in nature
• No intent to deceive
• Korsakoff’s syndrome
• Alzheimer’s dementia