Neurology Communication Flashcards
If asking history about a nerve palsy, think about the nerve itself first, then consider anatomically adjacent areas
i.e. CrN VII palsy, ask about hearing as well
How do you assess an obtunded patient?
ABC
GCS - cerebral perfusion/metabolic problem
Pupils - cerebral herniation
How do you measure CPP? (cerebral perfusion pressure)
CPP = MAP - ICP
Upper limb neurological examination
Intro, patient ID, explanation, consent
*remember OTPCRS
Observation; SWIFT
Tone; ASK PAIN check tone of muscles by passively moving elbow, pronation/supination and wrist
Power; check patient power in shoulder, elbow, wrist, metacarpophalangeal, thumb, spread fingers, “grip my finger”, pronator drift
Co-ordination; finger-nose test and check dysdiadochokinesis
Reflexes; biceps, supinator, triceps, remember to try reinforcement
Sensation; light touch, pin-prick, vibration (182Hz tuning fork), proprioception
Lower limb neurological examination
Intro, patient ID, explain, consent
OTPCRS
Observation; SWIFT
Tone; ASK PAIN, ‘shake’ legs and lift and drop, clonus
Power; hip, knee, ankle, big toe
Co-ordination; heel-shin
Reflexes; knee and ankle, remember to try reinforcement, plantar response
Sensation; light touch, pinprick, vibration (182Hz tuning fork), proprioception
Gait; rise without using arms, walk normally and turn, walk on toes and heels, heel to toe (balancing them)
How do you record limb reflexes on patient notes?
Increased +++ Normal ++ Reduced + Only present with reinforcement ± Absent -
Plantar response
Large toe extension only; abnormal
Large toe extension, others abduct; Babinski sign
No movement large toe; no response
MRC Power Scale
0 - no muscle contraction visible
1 - flicker of contraction but no movement
2 - Joint movement when effect of gravity eliminated
3 - Movement against gravity but not examiner’s resistance
4 - movement against resistance but weaker than normal
5 - normal
