Upper Neuro Osce

Question 1

What are steps 1-3?

Answer 1

Wash hands
Introduce self
Identify patient name and dob
Persons preferred name
Explain process and get consent
Expose upper body

Question 2

What is step 4?

Answer 2

Ensure patient is comfortable and ask if they are in pain

Question 3

What 7 things are you looking for in step 5?

Answer 3

General appearance
Nutritional status
Walking aids
Mobility 
Balance
Posture abnormalities
Deformities

Question 4

What is step 6?

Answer 4

Romberg’s test

Question 5

What is Romberg’s test identifying?

Answer 5

For reduction in stability i.e. sensory ataxia losing send of joint position (proprioception)

Question 6

What is step 7 and what are you assessing?

Answer 6

Walk test; is it normal?

Are they steady? Are they swinging their arms? Limping? What is their stride length?

Question 7

What is step 8 and what are you testing?

Answer 7

Walk on tip toe then on heels

Testing distal power

Question 8

What is step 9 and what does it signify?

Answer 8

Heel to toe walking

If unable it is a sign of ataxia

Question 9

What is step 10?

Answer 9

Ensure adequate exposure of patient to their underwear and put patient on the couch

Question 10

What are you observing for in step 11?

Answer 10

SWIFTAA
Scars
Wasting
Involuntary movements
Fasciculations
Tremor
Asymmetry 
Atrophy

Question 11

What scars might you look for?

Answer 11

Small muscle biopsy
Trauma
Surgery

Question 12

Wear might you see muscle wasting and what does it signify?

Answer 12

The muscles in the hands. Thenar and hypothenar and dorsal hand guttering. These indicate lower motor neurone lesions

Question 13

What are fasciculations and what do they indicate?

Answer 13

Muscle twitches. Can be normal but can also signify LMN lesions

Question 14

What is step 12 and what does it mean?

Answer 14

Pronator drift with eyes closed
UMN
Pyramidal weakness if there is distal flex
Cerebellar lesion if drift is upwards

Question 15

What is step 13?

Answer 15

Assess Tone of Upper Limbs

Question 16

How do you assess Upper Limb Tone?

Answer 16

By performing passive movements supporting the elbow.
Ask patient to go floppy
Check for rotation at the shoulder
Flex and extend the arm at the elbow and wrist
Pronate and supinate the wrist

Question 17

What does it mean if there is increased tone?

Answer 17

It indicates UMN

Question 18

What does reduced tone indicate?

Answer 18

LMN

Question 19

What is step 14 and what is the scoring system?

Answer 19

Assessing POWER against resistance

MRC score 0-5