Practical examination Part1

Question 1

What does the nervous system consist of?

Answer 1

The brain and spinal cord = Central Nervous System (CNS)

The Peripheral Nervous system (PNS) *The PNS also includes the autonomic nervous system (involuntary functions)

Question 2

How many spinal pairs are there?

Answer 2

There are 31 pairs :
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal spinal nerve

Question 3

What are dermatomes?

Answer 3

The surface of the skin is divided into specific areas called dermatomes
Each dermatome relies on specific pairs of spinal nerves

Question 4

What does ICE mean?

Answer 4

Presenting Complaint
Employ ICE mnemonic to provide context in which symptoms have arisen

Ideas on what is happening to them
Concern in terms of impact on them
Expectations of the illness and of you, the practitioner

Question 5

What drugs are used for tremors?

Answer 5

B agonists
lithium
sodium valporate

Question 6

What drugs are used for peripheral neuropathy?

Answer 6

Chemotherapy
Metronidazole
Amiodarone
Antiretroviral drugs

Question 7

Parkinsonism drugs?

Answer 7

Neuroleptics
prochloperazine
metoclopramide

Question 8

Myopathy drugs

Answer 8

Statins
Corticosteroids

Question 9

Headaches

Answer 9

Glyceryl trinitrate

Question 10

Epileptic seizures

Answer 10

Tricyclic antidepressants
Phenothiazines
Clozapine

Question 11

Ataxia

Answer 11

Phenytoin
Carbamazepine
Lithium

Question 12

What does SOCRATES stand for?

Answer 12

Pain: Site
Onset
Character / Severity
Radiation
Associated symptoms
Timing
Exacerbating / relieving factors
Severity / symptom progression

Question 13

What is syncope? What are the most common causes?

Answer 13

Syncope is loss of consciousness due to inadequate cerebral perfusion

Commonest causes of TLOC
Vasovagal syncope
Cardiac syncope
Epileptic seizures
Postural hypotension
Functional or psychiatric

Question 14

What are the causes of dizziness?

Answer 14

Postural hypotension
Cerebrovascular disease
Cardiac arrhythmia
Hyperventilation (anxiety or panic induced)
Infection
Dehydration
Drugs!

Question 15

What is Vertigo and what causes it?

Answer 15

The illusion of movement - What could be causing this?

Labyrinthitis
Vestibular neuronitis
Meniere’s disease
Head injury
Ischaemia e.g. stroke
Drugs!

Question 16

What are the three main pathways for examinations?

Answer 16

Sensory

Motor

Integrative

Question 17

What is Stance and Gait?

Answer 17

Stance and Gait is a multifactorial process which is dependent upon intact;
Visual
Sensory
Corticospinal
Extrapyramidal and cerebellar pathways
Functioning lower motor neurones
Spinal reflexes

Parkinsons humph, posture stopped, foot dragged, one arm imobile, gait is unsteady and wide

Question 18

What are tests of co-ordination and power?

Answer 18

Co-ordination
Finger –to-nose test
Rapid alternating movements
Heel to shin test

Power
Finger grip strength
Lift leg off bed independently / against resistance

Question 19

What are motor neurons and how do they work?

Answer 19

Motor Neurones control essential voluntary muscle activity such as;
- speaking, walking, breathing, and
swallowing
Normally, messages from nerve cells in the brain (upper motor neurons) are transmitted to nerve cells in the brain stem and spinal cord (lower motor neurons) and from them onto particular muscles

Question 20

What is the difference between upper motor neurons and lower motor neurons?

Answer 20

Upper motor neurons direct the lower motor neurons to produce movements such as walking or chewing.

Lower motor neurons control movement in the arms, legs, chest, face, throat, and tongue.

Question 21

What causes spasticity?

Answer 21

Disruptions in the signals between upper motor neurons and lower motor neurons cause limb muscles to develop stiffness (spasticity)
Movements become slow and effortful, and tendon reflexes such as knee and ankle jerks become overactive. Over time, the ability to control voluntary movement can be lost.

Question 22

What side effects occur when there is upper motor neurone legions?

Answer 22

Upper motor neurone lesions
If the lesion affects the CNS pathways the lower motor neurones are under the uninhibited influence of the spinal reflex
As a result the motor units have an exaggerated response to;
Tone (spasticity)
Brisk reflexes
Weakness but not wasting

Question 23

What are the side effects of lower motor neuron lesions?

Answer 23

Lower motor neurone lesions
The presence of a lower motor neurone lesion causes;
Weakness and wasting (muscle fibres)
Reduced tone (flaccidity)
Fasciculation
Reduced or absent reflexes