Neurology Flashcards
what questions should be asked in the presenting complaint of a headache history relating to pain?
site; unilateral, bilateral, neck, eye
prodromal symptoms
character; sharp, dull, tight, throbbing
duration/timing
frequency; one off, intermittent/episodic, progressive, constant
onset; acute, gradual
severity
radiation; other parts of the head, eye, neck
aggravating factors; leaning forward, bright lights, sound, lying flat
relieving factors; standing, sitting, lying still
special times; mornings, menses, overtired, stressed
associated; vomiting, drowsiness, temperature, fever, rash
what questions should be asked in the presenting compliant of a headache history not relating to pain?
cognitive/higher function changes mood/mental state alteration visual disturbances speech alteration episodes of loss of consciousness seizures sensory symptoms; numbness, pins and needles motor symptoms; involuntary weakness, reduction of power
what are the symptoms of migraines?
unilateral headache attacks lasting from 4-72 hours pulsating moderate-severe aggravated by routine activities photophobia phonophobia visual upset nausea and vomiting sleepiness tingling aura; zigzag lines, scotoma, dizziness, numbness, word salading, cravings, lethargy postdrome; feeling washed out, hungover triggers; chocolate, coffee, menses
what are the symptoms of tension-type headaches?
mild-moderate bilateral non-pulsating tightness/squeezing associated with stress or worry
what are the symptoms of meningism?
pain at the back of the neck neck stiffness drowsiness movement aggravates symptoms lying still relieves symptoms
what are the symptoms of raised intercranial pressure?
increasing headache day by day
worse in the mornings
drowsiness
made worse by coughing, stooping, straining
what are the symptoms of subarachnoid haemorrhage?
described as the worst headache ever
usually sudden onset
neck stiffness; may take hours to develop
what questions should be asked in the presenting compliant of a collapse history?
witness account did the patient actually lose consciousness where did the event happen when did the event happen what were they doing at the time before during after history of similar episodes
what questions should be asked in the before section of a collapse history?
how did they feel before the event
chest pain
palpitations
dyspnoea
warning/prodrome; pins and needles, sleepiness
prolonged period of standing
change in posture
micturition
vigorous coughing
associated symptoms; nausea, vomiting, headache, photophobia, neck stiffness
precipitating factors; not eating, dehydration, emotion, pain, sleep deprivation
what questions should be asked in the during section of a collapse history?
how long was the LOC if no LOC, were they aware of their surroundings injuries convulsing/jerking of the arms and legs focal features; deviation of head, repetitive limb movement tongue biting urinary/faecal incontinence change in colour of patient did a witness take a pulse
what questions should be asked in the after section of a collapse history?
how long did they take to recover how did they feel after the event; confusion amnesia drowsiness muscle weakness limb weakness speech alteration associated symptoms; nausea, sweating, chest pain, back pain, dyspnoea
what conditions should be asked about in a collapse history?
previous head injury epilepsy ischaemic heart disease CVA pacemaker diabetes
describe the examination of the 1st cranial nerve
olfactory
test one nostril at a time with the opposite side occluded with a non-irritating stimulant
eyes closed
describe the examination of the 2nd cranial nerve
optic inspect eyes visual acuity; glasses on if applicable visual fields colour vision fundoscopy pupils; size, irregularities, asymmetry, reflexes, direct/consensual response to light, accommodation
describe the examination of the 3rd, 4th and 6th cranial nerves
oculomotor, trochlear, abducens extra ocular movements eyelid elevation pupils; sizes and reflexes presence of a squint or nystagmus
describe the examination of the 5th cranial nerve
trigeminal
motor; palpate temporalis and masseter muscles, clench teeth, open mouth, repeat against resistance, jaw deviation, jaw-jerk reflex
sensory; close eyes, touch forehead, cheek, chin with cotton wisp, do they feel it and is it symmetrical
corneal reflex; no contact lenses, direct and consensual response, repeat on both sides
describe the examination of the 7th cranial nerve
facial
motor; inspection of face for involuntary movements, wrinkle forehead, close eyes tightly, smile, show teeth, puff out cheeks, observe for any asymmetry
special sensory; protrude tongue, close eyes an apply 1 of 5 tastes and ask patient what taste
describe the examination of the 8th cranial nerve
vestibulocochlear
cochlear; whisper test, rinne’s, weber’s
vestibular; observe for nystagmus when extra ocular movements are assessed
describe the examination of the 9th and 10th cranial nerves
glossopharyngeal and vagus
say ah
observe palatal movement
gag reflex; gently stroking the soft palate on each side
swallowing reflex; sip of water and observe them swallow
describe the examination of the 11th cranial nerve
accessory
ask to remove shirt
shrug shoulders passively and against resistance
laterally flex their neck on both sides
flex their neck forward against resistance
observe for any symmetry
describe the examination of the 12th cranial nerve
hypoglossal
observe the tongue at rest; asymmetry, atrophy, fasciculation
push the tongue into each cheek and then protrude; asymmetry, deviation
describe the steps of an upper limb motor examination
inspection
tone
power; shoulder abduction elbow flexion and extension wrist flexion and extension abduction of fingers grip
coordination;
finger to nose
dysdiadochokinesis
reflexes; clench teeth
biceps; C5, C6
supinator; C5, C6
triceps; C7, C8
describe the steps of a lower limb motor examination
inspection
tone
power; hip flexion knee flexion and extension ankle dorsiflexion and plantarflexion great toe extension and flexion
coordination;
heel sliding shin to ankle
reflexes; hook their fingers together and pull
knee or patellar; L2, 3, 4
ankle; S1, S2
Babinski response
describe the MRC scale for muscle power
0; total paralysis
1; flicker of contraction
2; active joint movement possible with gravity eliminated
3; movement against gravity but not resistance
4; movement against some resistance but not complete
5; normal power
describe the steps of a sensory examination
inspection; exposure, scars, muscle bulk, asymmetry, abnormal movements
light touch pain temperature vibration position sense
describe the examinations of light and sharp touch
both have a baseline established by touching the sternum
ask the patient to close their eyes
keep the timing of the touch irregular
compare each limb in the same position
describe the examination of vibration sense
establish a baseline by putting it on the sternum
strike the fork
place it on a distal bony prominence (DIP)
if no sensation if present, move to a more proximal bone prominence
ask them when the tuning fork stops vibrating
what re the 3 components of the GCS?
best eye response
best verbal response
best motor response
what are the scores of best eye response of the GCS?
4; open eyes spontaneously (including from sleeping)
3; open eyes in response to speech (“open your eyes”)
2; open eyes in response to pain
1; none
what are the scores of best verbal response of the GCS?
5; orientated 4; confused 3; inappropriate words 2; incomprehensible words 1; none
what are the scores of best motor response of the GCS?
6; obeys commands 5; localises pain 4; flexion withdrawal 3; abnormal flexion 2; extension to pain 1; none
what are the questions of the abbreviated mental test?
1; what is your age? 2; what is the time to the nearest hour? give them an address (42 West Street) and ask them to repeat it 3; what is the year? 4; where are you situated? 5; can you recognise two people here? 6; what is your date of birth? 7; what year did WW1 begin? 8; name the current prime minister/president 9; count backwards from 20 10; recall the earlier address
what questions should be asked in the PMHx of a seizure/collapse history?
normal full term pregnancy, delivery, developmental milestones febrile seizures as a child CNS infections; meningitis, encephalitis known AVM traumatic brain injury brain tumour stroke
what questions should be asked in the FHx of a seizure/collapse history?
seizures
genetic conditions known to cause epilepsy
