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MD4001 > Neurological History Taking > Flashcards

Neurological History Taking Flashcards

1
Q

What are the common neurological presenting complaints?

A
  • Headache
  • Dizziness
  • Altered cognitive ability
  • Weakness or movement disorders
  • Fits, faints, funny turns
  • Numbness or sensory disorders
  • Visual impairments
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2
Q

What follow up questions can be asked following presenting complaint?

A
  • Intensity
  • Duration
  • Variation
  • Location
  • Speed of onset
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3
Q

If it is a recurring event, what should you ask?

A
  • What happened immediately before
  • What position were they in?
  • Any prodromal symptoms?
  • What happened during and after the episode?
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4
Q

What should you ask about if the presenting complaint is a headache?

A
  • Site
  • Radiation
  • Sort- what kind of pain?
  • Severity
  • Timing: sudden may be embolic, recurring could be related to myelin, deteriorating could be due to a degenerative disease
  • Aggravating and Relieving factors
  • Associated features (e.g. nausea)
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5
Q

What should you ask about if the presenting complaint is weakness?

A 
• What activities are they finding difficult? Proximal or distal muscles
• How about walking? 
- has distance managed changed?
- What makes them stop?
- One leg or both?
- Any sensory symptoms?
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6
Q

How can you test if muscle weakness is due to proximal or distal muscle weakness?

A

Proximal: (think steroids)
• Rising from siting
• Drying hair

Distal:
• Standing on tiptoes
• Fine finger movements

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7
Q

What is the test for myasthenia Gravis?

A

The ice pack test

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8
Q

What are the examples of disorders involving abnormal movement?

A
  • Parkinson’s - slowing/stiffening
  • Chorea - fidgety jerks
  • Choreoathetosis - decreased tone, writhing, rapid changes in movement
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9
Q

Give two examples of sensory disorders

A
  • Allodynia- even light touch is painful

* Paraesthesia - ‘feels like a tight bandage around the leg’

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10
Q

What origin is complete sensory loss likely to be of?

A

• functional origin

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11
Q

What are the activities of daily living?

A
  • Eating
  • Bathing
  • Dressing
  • Transferring
  • Toileting
  • Walking around or moving
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12
Q

If the patient is younger, what should you ask about?

A
  • Milestones - was there any evidence of developmental delay? ( 1 to talk, 2 to walk)
  • Think of birth history
  • Has there been any regression (this is a red flag)
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13
Q

What should be asked about a drug history?

A
  • What treatments are they on and are they compliant?
  • Is it optimal?
  • Could the drugs they are on be the cause of the problem?
  • Is there any interaction between the drugs?
  • Is the patient thinking of becoming pregnant?
  • Does the patient have any allergies? If yes, what is the reaction? Is it possible this is just a side effect?
  • Non prescribed drugs? How often, how long, how much?
  • Ask about the pattern of drinking alcohol
  • What symptoms do you get if you don’t drink/ take drugs?
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14
Q

What should be asked about a social history?

A
  • Who is at home?
  • Home circumstances - are they contributing to medically unexplained symptoms?
  • Occupational history
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15
Q

Describe cranial nerve screening

A
  • Change in sense of smell (olfactory nerve)
  • Vision/ double vision
  • Hearing or dizziness
  • Change in voice
  • Articulation
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16
Q

How many symptoms can be non- organic in origin?

A

30%

17
Q

Why should you consider investigations?

A
  • To complete a checklist
  • To increase the certainty of a diagnosis
  • To exclude important things
  • To reassure you or the patient
  • The results should guide or change the management, consider treatment
18
Q

What are the available assessment tools to assess cognitive ability?

A
  • 4As
  • Mini mental state examination (MMSE)
  • Montreal cognitive assessment (MOCA)
  • Addenbrookes cognitive examination (ACE III)
19
Q

What is delirium?

A
  • Mental confusion that can happen if someone becomes medically unwell
  • ‘Acute confusional state’
  • Common - 1 in 10 hospital patients
20
Q

What is the treatment of delirium

A

You must treat the underlying cause

21
Q

What should be thought about if a patient has delirium?

A
  • Predisposing factors
  • Triggers e.g. infection
  • What is the underlying cause?
22
Q

What are the pros of the Montreal cognitive assessment?

A
  • Good at identifying mild levels of impairment

* Less bias towards ethnicity/age/education

23
Q

What is the ACE III assessment?

A 
• Approx 20 minutes 
• Scored out of 100 
• 5 cognitive domains 
- Attention 
- Memory 
- Verbal fluency 
- Language 
- Visuospatial abilities
24
Q

What is confabulation?

A

Presenting false information, often with great authority and certainty, sounding autobiographical in nature . There is no intent to deceive

25
Q

With what diseases is confabulation more common?

A
  • Alzheimer’s disease

* Korsakoff’s syndrome

MD4001 (28 decks)

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