Flashcards in Cerebellar OSCE Exam Deck (28)
What 7 things should you do as part of your introduction?
Confirm pt details
Achieve appropriate exposure
Ask if pt has any pain anywhere before you begin
What should you look for around the bed?
Any mobility aids
eg. Wheelchair / walking stick
On general inspection, what might the patient's posture be?
On observing the pt's normal gait, what are the 4 things you should be looking for?
1. Stance: broad based gait is noted in cerebellar disease.
2. Stability: staggering / slow & unsteady
In unilateral cerebellar disease, there is deviation to the side of the lesion due to hypotonia.
3. Tandem ('heel to toe') walking: exaggerates unsteadiness
4. Romberg's test: Feet together, hands by sides, close eyes. *Be ready to support patient, in case they are unsteady.
What type of speech is characteristic of cerebellar dysfunction?
Slurred staccato speech
Which 2 phrases should you ask the pt to repeat if you suspect cerebellar dysfunction?
How would you assess a patient for nystagmus?
1. Ask pt to keep their head still & follow your finger with their eyes.
2. Move your finger throughout the axes of vision.
3. Look for multiple beats of nystagmus
What is 'physiological nystagmus'?
Nystagmus at the extremes of gaze.
Give 2 other examples of disturbances of gaze notes in cerebellar disease.
Impaired smooth pursuit
How would you assess the tone of a pt's arms?
1. Support pt's arm by holding their hand & elbow.
2. Ask pt to relax & allow you to fully control their arm.
3. Move the arm's muscle groups through their full range of movements.
4. Is the motion smooth or is there some resistance?
How is tone affected in cerebellar disease?
Hypotonia may be seen.
Describe how you'd carry out a 'finger to nose' test.
1. Ask pt to touch their nose with the tip of their index finger, the touch your fingertip.
2. Position your finger so the pt has to fully outstretch their arm to reach it.
3. Ask them to continue to do this finger to nose motion as fast as they can manage.
Describe what you'd see with an 'intention tremor' on the 'finger to nose' test.
As the pt gets closer to a target, the tremor worsens at the end points of a deliberate movement.
How would you assess for dysdiadochokinesia?
1. Demonstrate patting the palm of your hand with the back/palm of your other hand to the pt.
2. Ask pt to mimic this rapid alternating movement.
3. Then have the pt repeat this mvt on their other hand.
If a patient is unable to perform the test assessing dysdiadochokinesia, what does this suggest?
How would you assess for the rebound phenomenon?
Whilst the pt's arms are outstretched & their eyes are closed:
1. Ask pt to keep their arms in that position as you press down on their arm.
2. Release your hand.
What is a 'positive test' for the rebound phenomenon & what does this suggest?
The pt's arm shoots up above the position it originally was.
Suggestive of cerebellar disease.
To assess tone in the legs, what would you instruct the pt to do?
Ask pt to keep their legs fully relaxed & 'floppy' throughout your assessment.
What 2 tests would you use to assess leg tone?
Leg roll: roll the pt's leg & watch the foot. it should flop independently of the leg.
Leg lift: briskly lift leg off the bed at the knee joint. The heel should remain in contact with the bed.
How is tone in the legs affected in cerebellar disease?
*note: if you've already assessed tone in the upper limbs, you don't need to assess lower limbs, also.
Which nerves are involved in the Knee jerk reflex?
What might you expect in a knee jerk reflex of a pt who has cerebellar disease?
The leg keeps swinging after you elicit the knee reflex.
How would you test co-ordination in a cerebellar exam?
"Run your heel down the other leg from the knee, and repeat in a smooth motion".
What might you expect in the 'Heel to shin' test of a pt with cerebellar disease?
A coarse side to side tremor of the leg or foot may be noted.
To complete the examination, what 3 steps should you take?
Suggest 2 further assessments & investigations
Perform a full neurological examination, including:
- Cranial Nerves
- Upper & Lower limbs
If indicated, what imaging might be appropriate?
CT / MRI