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Phase 2B medicine > Neurology history and examination > Flashcards

Neurology history and examination Flashcards

1
Q

What things can exacerbate a headache?

A 
Noise
Stress
Bending
Standing up
Coughing
Sneezing
Blowing nose
Eating
Combing hair
Bright/flashing lights
Certain foods/drugs
Dehydration
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2
Q

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

A 
What were they doing at the time?
Pain? Injections? Hot, crowded rooms?
Stress?
Prolonged standing?
How they felt before?
Associated symptoms?
Recovery?
Witness?
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3
Q

What is important to know in neurological histories?

A

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

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4
Q

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

A 
Head/spinal trauma
Metabolic/endocrine disorders
Cancer
Epilepsy
Hypertension
AF
Heart diseases
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5
Q

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

A 
Anti-convulsants
Drugs interacting with anti-convulsants or lower seizure threshold
Analgesics
Anti-hypertensives
Anti-depressants
Insulin
Recreational drugs
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6
Q

What drugs can interact with AEDs?

A

Alcohol
Interact with each other
NOACs

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7
Q

What drugs an lower the seizure threshold?

A 
Anti-depressants 
Amphetamines
Cocaine
Lithium
Anti-histamines
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8
Q

What should you ask about in social history?

A 
Alcohol
Smoking
Recreational drugs
Occupation
Social activities/hobbies
Home circumstances/level of independence
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9
Q

What should you ask about in family history?

A 
Diabetes
Cerebral haemorrhage
Cerebrovascular disease/stroke
IHD
Migraine
Epilepsy
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10
Q

What are the steps in a neuro examination?

A 
Inspection
Tone
Power
Reflexes
Co-ordination
Sensory
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11
Q

What should you ask before beginning an upper limb examination?

A

Any pain?

Right or left handed?

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12
Q

What should you inspect? Upper limb

A 
Posture
Wasting
Tremor
Fasciculations
Involuntary movements
Pronator drift
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13
Q

How do you assess tone? Upper limb

A

Passively move each joint

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14
Q

How do you assess power? Upper limb

A

Get the patient to perform each movement against resistance

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15
Q

What movements do you need to assess? Upper limb

A

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

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16
Q

What reflexes need to be assessed? Upper limb

A

Biceps
Triceps
Supinator/brachioradialis

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17
Q

How do you assess co-ordination? Upper limb

A

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

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18
Q

How do you assess sensation?

A 
Soft touch
Pain
Temperature
Proprioception
Vibration
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19
Q

Where are the dermatomes in the upper limb?

A 
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
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20
Q

What myotome and muscles are assessed in shoulder abduction?

A

C5 (axillary nerve)

Deltoid

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21
Q

What myotome and muscles are assessed in shoulder aduction?

A

C6/7 (thoracodorsal)

Teres major, latissimus dorsi, pectoralis major

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22
Q

What myotome and muscles are assessed in elbow flexion?

A

C5/6 (musculocutaneous and radial)

Biceps brachii, coracobrachialis, brachialis

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23
Q

What myotome and muscles are assessed in elbow extension?

A

C7 (radial)

Triceps brachii

24
Q

What myotome and muscles are assessed in wrist extension?

A

C6 (radial)

Extensors of wrist

25
Q

What myotome and muscles are assessed in wrist flexion?

A

C6/7 (median)

Flexors of wrist

26
Q

What myotome and muscles are assessed in finger extension?

A

C7 (radial)

Extensor digitorum

27
Q

What myotome and muscles are assessed in finger abduction?

A

T1 (ulnar)
First dorsal interosseous
Abductor digiti minimi

28
Q

What myotome and muscles are assessed in thumb abduction?

A

T1 (median)

Abductor pollicis brevis

29
Q

How do you assess for tone? Lower limb

A

Passively move each joint

Ankle clonus

30
Q

What do you inspect? Lower limb

A 
Posture
Wasting
Tremor
Fasciculations
Involuntary movements
Gait - normal and heel-to-toe
Romberg's test
31
Q

How do you assess power? Lower limb

A

Check movements against resistance

32
Q

What movements should you do? Lower limb

A

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

33
Q

What reflexes should you assess? Lower limb

A

Knee
Ankle
Babinski
Ankle clonus

34
Q

How do you assess co-ordination?

A

Heel-shin test

35
Q

What are the dermatomes in the lower limb?

A

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

36
Q

What myotome and muscles are assessed in hip flexion?

A

L1/2 (iliofemoral)

Iliopsoas

37
Q

What myotome and muscles are assessed in hip extension?

A

L5/S1 (sciatic)

Gluteus maximus

38
Q

What myotome and muscles are assessed in knee flexion?

A

S1 (sciatic)

Hamstrings

39
Q

What myotome and muscles are assessed in knee extension?

A

L3/4 (femoral)

Quadriceps

40
Q

What myotome and muscles are assessed in ankle dorsiflexion?

A

L4/5 (deep peroneal)

Tibialis anterior

41
Q

What myotome and muscles are assessed in ankle plantarflexion?

A

S1/2 (tibial nerve)
Gastrocnemius
Soleus

42
Q

What myotome and muscles are assessed in big toe extension?

A

L5 (deep peroneal)

Extensor hallucis longus

43
Q

What nerves are activated in knee-jerk reflex?

A

L3/4

44
Q

What nerves are activated in ankle-jerk reflex?

A

S1

45
Q

What nerves are activated in babinski reflex?

A

L5/S1

46
Q

What nerves are activated in biceps reflex?

A

C5/6

47
Q

What nerves are activated in supinator reflex?

A

C5/6

48
Q

What nerves are activated in triceps reflex?

A

C7

49
Q

What does an MRC grading of 5 mean?

A

Movement against gravity with full power against resistance

50
Q

What does an MRC grading of 4 mean?

A

Movement against gravity with reduced power against resistance

51
Q

What does an MRC grading of 3 mean?

A

Movement against gravity only without applied resistance

52
Q

What does an MRC grading of 2 mean?

A

Muscle contraction seen, no movement

53
Q

What does an MRC grading of 1 mean?

A

Flicker of muscle contraction seen, no movement

54
Q

What does an MRC grading of 0 mean?

A

No muscle contraction

55
Q

What are the signs of cerebellar dysfunction?

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

Phase 2B medicine (16 decks)

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