Neurology history and examination

Question 1

What things can exacerbate a headache?

Answer 1

Noise
Stress
Bending
Standing up
Coughing
Sneezing
Blowing nose
Eating
Combing hair
Bright/flashing lights
Certain foods/drugs
Dehydration

Question 2

What is important to ask about in an altered consciousness history?

Answer 2

What were they doing at the time?
Pain? Injections? Hot, crowded rooms?
Stress?
Prolonged standing?
How they felt before?
Associated symptoms?
Recovery?
Witness?

Question 3

What is important to know in neurological histories?

Answer 3

Sudden onset?
How long did it take to reach the peak of symptoms?
Getting better/worse?
Static/progressive/relapsing/remitting?

Question 4

What risk factors need to be asked about in the past medical history?

Answer 4

Head/spinal trauma
Metabolic/endocrine disorders
Cancer
Epilepsy
Hypertension
AF
Heart diseases

Question 5

What drugs need to be asked about in the drug history?

Answer 5

Anti-convulsants
Drugs interacting with anti-convulsants or lower seizure threshold
Analgesics
Anti-hypertensives
Anti-depressants
Insulin
Recreational drugs

Question 6

What drugs can interact with AEDs?

Answer 6

Alcohol
Interact with each other
NOACs

Question 7

What drugs an lower the seizure threshold?

Answer 7

Anti-depressants 
Amphetamines
Cocaine
Lithium
Anti-histamines

Question 8

What should you ask about in social history?

Answer 8

Alcohol
Smoking
Recreational drugs
Occupation
Social activities/hobbies
Home circumstances/level of independence

Question 9

What should you ask about in family history?

Answer 9

Diabetes
Cerebral haemorrhage
Cerebrovascular disease/stroke
IHD
Migraine
Epilepsy

Question 10

What are the steps in a neuro examination?

Answer 10

Inspection
Tone
Power
Reflexes
Co-ordination
Sensory

Question 11

What should you ask before beginning an upper limb examination?

Answer 11

Any pain?

Right or left handed?

Question 12

What should you inspect? Upper limb

Answer 12

Posture
Wasting
Tremor
Fasciculations
Involuntary movements
Pronator drift

Question 13

How do you assess tone? Upper limb

Answer 13

Passively move each joint

Question 14

How do you assess power? Upper limb

Answer 14

Get the patient to perform each movement against resistance

Question 15

What movements do you need to assess? Upper limb

Answer 15

Shoulders - flexion, extension, abduction, adduction
Elbows - flexion, extension, pronation, supination
Wrists - flexion, extension
Fingers - flexion, extension, abduction
Thumb - palmar abduction, adduction, opposition

Question 16

What reflexes need to be assessed? Upper limb

Answer 16

Biceps
Triceps
Supinator/brachioradialis

Question 17

How do you assess co-ordination? Upper limb

Answer 17

Finger to examiners finger then own nose
Finger to own nose with eyes closed
Fine movements - fingers to thumb
Dysdiadochokinesis

Question 18

How do you assess sensation?

Answer 18

Soft touch
Pain
Temperature
Proprioception
Vibration

Question 19

Where are the dermatomes in the upper limb?

Answer 19

C5 - regimental badge
C6 - palmar side of thumb
C7 - palmar side of middle finger
C8 - palmar side of little finger
T1 - medial aspect of antecubital fossa

Question 20

What myotome and muscles are assessed in shoulder abduction?

Answer 20

C5 (axillary nerve)

Deltoid

Question 21

What myotome and muscles are assessed in shoulder aduction?

Answer 21

C6/7 (thoracodorsal)

Teres major, latissimus dorsi, pectoralis major

Question 22

What myotome and muscles are assessed in elbow flexion?

Answer 22

C5/6 (musculocutaneous and radial)

Biceps brachii, coracobrachialis, brachialis

Question 23

What myotome and muscles are assessed in elbow extension?

Answer 23

C7 (radial)

Triceps brachii

Question 24

What myotome and muscles are assessed in wrist extension?

Answer 24

C6 (radial)

Extensors of wrist

Question 25

What myotome and muscles are assessed in wrist flexion?

Answer 25

C6/7 (median) | Flexors of wrist

Question 26

What myotome and muscles are assessed in finger extension?

Answer 26

C7 (radial) | Extensor digitorum

Question 27

What myotome and muscles are assessed in finger abduction?

Answer 27

T1 (ulnar) First dorsal interosseous Abductor digiti minimi

Question 28

What myotome and muscles are assessed in thumb abduction?

Answer 28

T1 (median) | Abductor pollicis brevis

Question 29

How do you assess for tone? Lower limb

Answer 29

Passively move each joint | Ankle clonus

Question 30

What do you inspect? Lower limb

Answer 30

``` Posture Wasting Tremor Fasciculations Involuntary movements Gait - normal and heel-to-toe Romberg's test ```

Question 31

How do you assess power? Lower limb

Answer 31

Check movements against resistance

Question 32

What movements should you do? Lower limb

Answer 32

Hip - abduction, adduction, flexion, extension Knee - flexion, extension Ankle - dorsiflexion, plantarflexion Big toe - plantarflexion, dorsiflexion

Question 33

What reflexes should you assess? Lower limb

Answer 33

Knee Ankle Babinski Ankle clonus

Question 34

How do you assess co-ordination?

Answer 34

Heel-shin test

Question 35

What are the dermatomes in the lower limb?

Answer 35

L1 - inguinal region and very top of medial thigh L2 - middle and lateral aspect of anterior thigh L3 - medial aspect of knee L4 - medial aspect of lower leg and ankle L5 - dorsum and medial aspect of big toe S1 - dorsum and lateral aspect of little toe

Question 36

What myotome and muscles are assessed in hip flexion?

Answer 36

L1/2 (iliofemoral) | Iliopsoas

Question 37

What myotome and muscles are assessed in hip extension?

Answer 37

L5/S1 (sciatic) | Gluteus maximus

Question 38

What myotome and muscles are assessed in knee flexion?

Answer 38

S1 (sciatic) | Hamstrings

Question 39

What myotome and muscles are assessed in knee extension?

Answer 39

L3/4 (femoral) | Quadriceps

Question 40

What myotome and muscles are assessed in ankle dorsiflexion?

Answer 40

L4/5 (deep peroneal) | Tibialis anterior

Question 41

What myotome and muscles are assessed in ankle plantarflexion?

Answer 41

S1/2 (tibial nerve) Gastrocnemius Soleus

Question 42

What myotome and muscles are assessed in big toe extension?

Answer 42

L5 (deep peroneal) | Extensor hallucis longus

Question 43

What nerves are activated in knee-jerk reflex?

Answer 43

L3/4

Question 44

What nerves are activated in ankle-jerk reflex?

Answer 44

S1

Question 45

What nerves are activated in babinski reflex?

Answer 45

L5/S1

Question 46

What nerves are activated in biceps reflex?

Answer 46

C5/6

Question 47

What nerves are activated in supinator reflex?

Answer 47

C5/6

Question 48

What nerves are activated in triceps reflex?

Answer 48

C7

Question 49

What does an MRC grading of 5 mean?

Answer 49

Movement against gravity with full power against resistance

Question 50

What does an MRC grading of 4 mean?

Answer 50

Movement against gravity with reduced power against resistance

Question 51

What does an MRC grading of 3 mean?

Answer 51

Movement against gravity only without applied resistance

Question 52

What does an MRC grading of 2 mean?

Answer 52

Muscle contraction seen, no movement

Question 53

What does an MRC grading of 1 mean?

Answer 53

Flicker of muscle contraction seen, no movement

Question 54

What does an MRC grading of 0 mean?

Answer 54

No muscle contraction

Question 55

What are the signs of cerebellar dysfunction?

Answer 55

``` DANISH - Dysdiadochokinesia - Ataxia - Nystagmus - Intention tremor - Speech and stance - Heel-to-shin test positivity Gait abnormalities ```