Neurology

Question 1

What area will be affected in a CNS problem?

Answer 1

Hemiplegia, paraplegia or a whole limb

Question 2

What area will be affected in a PNS problem?

Answer 2

May be peripheral or localised area or can be whole limb if a plexus is involved

Question 3

What area will be affected in a NMJ problem?

Answer 3

Ocular (eyes) / bulbar (palsy of cranial nerves 7-12) / proximal limb

Question 4

What area will be affected in a muscular problem?

Answer 4

Proximal muscles and will be symmetrical

Question 5

Describe the description of a weakness due to problem in CNS?

Answer 5

Heaviness

Question 6

Describe a description of a weakness due to problem in PNS?

Answer 6

Positional may get worse in sleep (e.g. carpal tunnel syndrome) or foot goes to sleep sitting in a certain position
ascending- starts in the feet and moves up

Question 7

Describe a description of weakness due to a problem in NMJ?

Answer 7

fatigue (worse after use of the muscles)
Diurnal variation (worse towards the end of the day)

Question 8

Describe a description of weakness due to a problem in muscle?

Answer 8

May also have aching, maybe insidious in onset

Question 9

Describe additional features in a CNS problem?

Answer 9

spasm or jerks

Question 10

Describe additional features in a PNS problem?

Answer 10

cramp and twitching (aka fasciculation)

Question 11

Describe additional features in an NMJ problem?

Answer 11

bulbar: issues with swallowing and speaking
ocular issues with diplopia and ptosis
respiratory: orthopnoea, sob on exertion

Question 12

Describe additional features in a muscle problem?

Answer 12

Myalgia and Cramp

Question 13

Are sensory symptoms possible in a CNS or PNS problem causing weakness?

Answer 13

Yes

Question 14

Are sensory symptoms possible in an NMJ or muscle problem causing weakness?

Answer 14

No

Question 15

In a CNS problem causing weakness what additional difficulties are possible?

Answer 15

Cognitive
sphincter involvement (changes to urinary frequency)

Question 16

In a PNS problem causing weakness what additional difficulties are possible?

Answer 16

Loss of grip
Tripping up
Unsteady with eyes closed

Question 17

In an NMJ problem causing weakness what additional difficulties are possible?

Answer 17

lots of chewing

Difficulties speaking or holding a prolonged gaze (may be apparent when trying to read or on prolonged drives)

Question 18

In a muscle problem causing weakness what additional difficulties are possible?

Answer 18

Getting up from low chairs
Hanging up washing
(things that involve big proximal muscles)

Question 19

Patterns of loss indicative of a UMN problem (6)

Answer 19

. Affecting groups of muscles
. Extensors (ARMS) Flexors (LEGS)
. Spasticity in flexors (ARMS) extensors (LEGS) 
. Hyperreflexia
. +ve Babinski sign
. Loss of skilled fine finger movement

Question 20

Patterns of loss indicative of an LMN problem (4)

Answer 20

. affected muscles show wasting
. soft floppy limbs (flaccidity)
. reduced reflexes
. weakness corresponds to muscles supplied by LMN

Question 21

Which conditions show mixed LMN and UMN signs

Answer 21

. MND
. B12 deficiency
. Taboparesis

Question 22

Where is the lesion …

Answer 22

. UMN, LMN, NMJ or Muscle
. Vertebral level
. Motor or sensory (or both)
. Symmetrical or asymmetrical

Question 23

Specific HEADACHE questions

Answer 23

. Onset 
. Duration
. Photophobia
. Stiff neck
. Conscious level
. Visual changes 
. Auditory changes 
. Pain worse on moving?
. Worse at any time of day? 
. SOCRATES
. (SITE) - . one sided . behind eye . scalp (GCA)

Question 24

Specific MIGRAINE questions

Answer 24

. Unilateral
. Character- Throbbing
. behind eye
. Visual or Auditory aura 
. Nausea or Vomiting

Question 25

Specific VERTIGO or DIZZINESS questions

Answer 25

``` . Establish what dizzy spells means . rotational movement? . faintness . loss of consciousness . falls? . frequency . hearing loss? ```

Question 26

Specific WEAKNESS questions

Answer 26

. sudden or gradually worsening . bowel and bladder control? . saddle anaesthesia . pain (cardiac, arthritic?)

Question 27

Specific LOSS OF CONSCIOUSNESS questions

Answer 27

. BEFORE - any warning (palpitations, discomfort) - particular circumstances - are attacks preventable . DURING - loss of consciousness - loss of awareness - movement . AFTER - how much do you remember - confusions - pain - confusion or sleepiness

Question 28

Neurology systemic enquiry for all history taking

Answer 28

* Fevers * Night sweats * Weight change * Fatigue ``` • Visual symptoms: • Headache • Motor or sensory problems • Loss of consciousness including seizures • Confusion . nausea or vomiting ``` ``` . rashes or skin changes . bone and joint pain . abdo pain . changes to toileting habits . bretahlessness . palpitations . dizziness . chest pain ```

Question 29

Neuro specific PAST MEDICAL HISTORY

Answer 29

. History of trauma to head or spine . Heart disease . Ever had a brain scan

Question 30

Neuro specific DRUG HISTORY

Answer 30

``` . Initiation of any medications . Think if peripheral neuropathy . Narcotics? . Over counter . Allergies ```

Question 31

Neuro specific SOCIAL HISTORY

Answer 31

. how are they coping- screen for depression | . ARE THEY STILL DRIVING!!!!!!