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MD4001 Clinical > Neurological History Taking > Flashcards

Neurological History Taking Flashcards

1
Q

What should you be observing when looking at a patient?

A
  • State of health
  • Mode of dress
  • Age
  • Eye contact
  • Mood
  • Tics
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2
Q

What should you be looking out for in regards to the content of conversation with a patient?

A
  • Level of education
  • Intelligence
  • Mood
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3
Q

What is dysphasia?

A

Language disorder as a result of brain damage which causes a deficiency in the generation of speech

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4
Q

What is dysarthria?

A

motor speech disorder resulting from neurological injury of the motor component of the motor–speech system and is characterized by poor articulation of phonemes.

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5
Q

What can dizzy mean?

A
  • Rotatory movement or light hadedness

- Common cause is benign positional vertigo

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6
Q

What is benign positional vertigo?

A

Dizziness which comes on suddenly (feels like on a roundabout - usually fine when head kept still)

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7
Q

What should your follow up questions be after PC?

A
  • Duration of symptoms
  • Speed of onset
  • Location
  • Variation
  • Intensity
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8
Q

What are common neurological presentations?

A
  • Altered cognitive ability
  • Fits, faints and funny turns
  • Headache
  • Dizziness
  • Weakness or movement disorders
  • Numbness or sensory disorders
  • Visual impairents
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9
Q

What are some good questions to ask in order to find out about pattern recognition?

A
  • Have you noticed any changes in your writing

- Any differences in the way you walk

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10
Q

If someone collapses what are the 3 most likely origins of the collapse?

A
  • Neurological
  • Cardiovascular
  • Endocrine
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11
Q

How common is epilepsy?

A

~ 1% of population

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12
Q

WHat can cause/trigger seizures?

A
  • Abnormal electolytes
  • Abnormal blood glucose
  • Under stress - no sleep for a prolonged period of time
  • Can affect everybody (just depends on seizure threshold)
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13
Q

How can fits, faints and funny turns be diagnosed?

A
  • Good history from patient
  • Description from witness
  • If recurrent think of asking to record the event
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14
Q

What should you ask in relation to a seizure?

A
  • What was happening immediately before?
  • What factors might have lowered the seizure threshold?
  • What position was the patient in?
  • Any prodromal symptoms?
  • After?
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15
Q

What should you ask in regards to the time course and evolution of neurological symptoms?

A
  • Sudden e.g. “thunder clap” headache
  • Recurrent (but well between episodes)
  • Deterioration over hours (infection)
  • Relapsing / remitting (MS?)
  • Deterioration over weeks / months (Degenerative disease)
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16
Q

What should you ask or be thinking about when weakness is mentioned?

A
  • Chronic “aesthenia” “fatigue” or specific muscle weakness
  • What activities are they finding difficult (proximal or distal muscles)
  • Is the problem in the muscle or in the nerve supply to the muscle
17
Q

What can the ice pack test diagnose?

A

Myasthenia Gravis (reduced ptosis in the eye)

18
Q

What should be asked in relation to walking?

A
  • Has the distance they can manage changed?
  • Why? What makes them stop?
  • What about hills?
  • One leg or both?
  • Any sensory symptoms?
19
Q

What can be the cause of too little movement?

A

Parkinson’s

20
Q

What can be the cause of too much movement?

A
  • Chorea - “fidgety jerks”

- Can be over treatment of Parkinson’s

21
Q

What is Allodynia?

A

a condition where pain is caused by a stimulus that does not normally elicit pain

22
Q

What can paraesthesia be described like?

A

Tight bandage wrapped around the leg

23
Q

What should you refer to when treating/diagnosing younger patients?

A
  • Was there any evidence of developmental delay (1 to talk 2 to walk)
  • Also think birth history/complications
  • Regression is always a red flag
24
Q

What should you be thinking/ask in relation to drugs?

A
  • What treatment are they on
  • Are they complaint
  • Is it optimal
  • Could it be the cause of the problem
  • Is there any interaction between the drugs
  • Is the patient thinking of becoming pregnant
  • Allergy
25
Q

What should be included in the systems enquiry?

A
  • Psychological…depressed?
  • Autonomic nervous system…bowel, bladder function, sexual dysfunction, light headedness
  • Recent infection?
26
Q

What are the cranial nerve screening questions?

A
  • Change in your sense of smell
  • Vision? Double vision?
  • Dry eyes? Dry mouth? Change in taste
  • HEaring? Dizziness?
  • Change in voice?
  • Articulation?
27
Q

What should be rememberd in regards to documentation?

A
  • Not verbatim record of what patient has told you
  • Filtered and critically analysed record
  • Often important to record negatives
  • Conclude with summary, differential diagnosis and action plan
28
Q

What percentage of patient symptoms are non-organic in origin?

A

30% (not fitting pattern of anatomy and physiology / medically unexplained)

29
Q

How can you check altered cognitive ability?

A
  • Is patient orientated?
  • Memory function of patient
  • 4 As test (for delirium)
  • Mini mental State examination
  • Montreal cognitive assessment
  • Addnbrookes Cognitive Examination (ACE II)
30
Q

What are the 4As?

A
  • Alertness
  • AMT4
  • Attention
  • Acute change or fluctuating course
31
Q

What is confabulation (presenting false info often with great certainty) common in?

A
  • Korsakoff’s syndrome

- Alzheimer’s dementia

MD4001 Clinical (4 decks)

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