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Phase 2b > Neurology > Flashcards

Neurology Flashcards

1
Q

Topic 1

A

Taking a neurological history

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2
Q

Where can the lesion be?

A

Brain
Spinal cord
Anterior horn cell
Neuromuscular junction
Muscle
Peripheral nerve

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3
Q

What can the aetiology be?

A

Vascular
Inflammatory/immune
Trauma
Toxic/metabolic
Infective
Neoplastic
Degenerative
Genetic

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4
Q

Topic 2

A

How to perform a neurological examination

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5
Q

Examination structure

A

Gait
Cranial nerves
Upper limbs
Lower limbs

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6
Q

How would you examine the patient’s gait?

A

First get patient to walk normally then heel to toe.
Note - posture, balance, stride, arm swing.
Pattern recognition of gait
Romberg’s test

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7
Q

What are the different types of gait patterns?

A

Hemiplegic
Spastic
Ataxic
Apraxic/festinant/shuffling
High steppage
Waddling
Antalgic

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8
Q

What is the Romberg’s test?

A

Get patient to stand with their feet together, arms outstretched in front and hands supinated.
1. If unable to do so with eyes open = cerebellar lesion
2. If the patient can maintain the position with eyes open but loses balance when eyes are closed = loss of proprioception

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9
Q

How would you examine CN 1 - Olfactory nerve?

A

Ask the patient “Have you noticed a recent change in your sense of smell or taste?
Use bedside products (orange, coffee, chocolate)
Test each nostril separately

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10
Q

How would you examine CN 2 - Optic nerve?

A

Test for:
1. Visual acuity - test each eye separately, snellen chart, get them to read newspaper/magazine/finger counting
2. Visual inattention
3. Visual fields - assessed by confrontation using a red pin. Test each eye separately.
4. Light reflex - direct and consensual, use a bright pen torch
5. Accommodation - observed by watching the pupil as gaze is shifted from a distant object to a near object
6. Fundoscopy

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11
Q

How would you examine CN 3 - Oculomotor nerve, CN 4 - Trochlear nerve, CN 6 - Abducens nerve?

A

Extraocular eye movements - H and I shape
Fixation
Saccades
Smooth pursuit
Nystagmus

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12
Q

How would you examine CN 5 - Trigeminal?

A

CN 5 is a sensory nerve via 3 distributions
V1 - ophthalmic, V2 - maxillary, V3 - mandibular
Sensation to ant. 2/3 of tongue
Motor fibres to muscles of mastication
Jaw jerk
Corneal reflex

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13
Q

How would you examine CN 7 - Facial?

A

Muscles of facial expression. Get patient to:
raise their eyebrows, shut their eyes tight and don’t let them open, puff out their cheeks, purse their lips and smile (get them to show their teeth)
Facial nerve supplies taste to anterior 2/3 of the tongue (not tested)
LMN (complete ipsilateral facial weakness) vs UMN (sparing of the forehead) facial nerve palsies

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14
Q

How would you examine CN 8 - Vestibulocochlear?

A

This nerve has 2 divisions - cochlear (hearing) and vestibular (balance)
Test hearing - whisper a number on one ear whilst covering the other
If a hearing abnormality is suspected, perform Rinne’s and Weber’s tests

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15
Q

How would you examine CN 9 - Glossopharyngeal?

A

Get patient to open their mouth wide and assess whether the uvula is in the middle at rest (can shine a torch).
Say “aah” and note any asymmetry of movement. The uvula will deviate away from the side of a glossopharyngeal nerve palsy.
Ask whether there is any difficulty swallowing (gag reflex is not performed) - CN 9 is afferent.

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16
Q

How would you examine CN 10 - Vagus?

A

Ask whether any difficulty swallowing (gag reflex is not performed) - CN 10 efferent

Ask the patient to cough. A bovine (non-explosive) cough suggests a vagal nerve palsy.

Note any hoarseness of the voice.

17
Q

How would you examine CN 11 - Accessory

A

Innervation to sternocleidomastoid and trapezius.

Sternocleidomastoid - ask to turn head against resistance and palpate sternocleidomastoid muscle.

Trapezius - ask to shrug shoulders against resistance.

18
Q

How would you examine CN 12 - Hypoglossal?

A

Inspection at rest
Observe for tongue fasciculations
Ask to push tongue inside mouth against cheek
Move tongue side to side
Tongue is deviated towards the side of the lesion.

19
Q

Limb examination - how does the presentation of a UMN differ from a LMN?

A

UMN
Increased tone (spastic)
Pyramidal weakness
Brisk reflexes

LMN
Muscle wasting and fasciculations
Decreased tone
Depressed/absent reflexes

20
Q

Limb examination - what should you look for when inspecting the upper and lower limbs?

A

Patient and surroundings
Posture
Involuntary movement/tremor
Muscle wasting/fasciculations

21
Q

What is the systematic approach for upper and lower limb examination?

A
  1. Tone
  2. Power
  3. Reflexes
  4. Coordination
  5. Sensation
22
Q

How would you examine the tone in the upper and lower limbs?

A

Passively move each joint.
Assess if there is hypertonia/hypotonia or normal
Hypertonia can be determined by spasticity or rigidity.
Spasticity - velocity dependent, UMN lesion
Rigidity - same irrespective of speed of movement, parkinsonism.
UMN lesion - pronator drift known as barre test

23
Q

How would you examine power in the upper and lower limbs?

A

Use the MRC scale of muscle strength.
Score of 0 to 5 to grade the power of a particular muscle group about the movement of a single joint.

Score - Description
0 - No contraction
1 - Flicker or trace of contraction
2 - Active movement, with gravity eliminated
3 - Active movement against gravity
4 - Active movement against gravity and resistance
5 - Normal power

For UMN assess: shoulders, elbow, wrist, fingers.
Look for: unilateral or bilateral, proximal or distal or global, pyramidal weakness (UMN), isolated lesion of nerve root or nerve or muscle

24
Q

How would you examine reflexes?

A

Assess if present or absent.
If present - depressed or increased (brisk)
Reinforcement
In lower limn examination - remember to examine the plantar reflex (lateral border of foot towards big toe)

25
Q

How would you examine limb coordination?

A
  • Upper limbs
    Tremor and dysmetria
    Finger-nose test
    Fine motor skills
    Rapid alternating hand movements (dysdiadochokinesis)
  • Lower limbs
    Heel-shin test
26
Q

How would you examine for sensation?

A

Sensation
* 2 parts – dorsal column and spinothalamic tract
* Vibration and joint position test 128 Hz tuning fork
* Light touch and pinprick
Dermatomes

Phase 2b (7 decks)

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