Clinical Skills

Question 1

What are the six cognitive domains?

Answer 1

memory, language, perception, praxis, executive function, speed of processing

Question 2

Define the memory cognitive domain?

Answer 2

Ability to recall information; involves multiple brain regions (including temporal lobes & hippocampus

Question 3

Define the executive functions cognitive domain?

Answer 3

A range of skills that allow a person to establish new ways of thinking and behaviour patterns; and to introspect. Associated with frontal brain regions.

Question 4

Describe what area will be affected in a CNS problem?

Answer 4

hemiplegia, paraplegia or a whole limb

Question 5

Describe what area will be affected in a PNS problem?

Answer 5

May be peripheral or localised area or can be whole limb if a plexus is involved

Question 6

Describe what area will be affected in a NMJ problem?

Answer 6

Ocular (eyes) / bulbar (palsy of cranial nerves 7-12) / proximal limb

Question 7

Describe what area will be affected in a muscle problem?

Answer 7

Proximal muscles and will be symmetrical

Question 8

Describe the description of a weakness due to problem in CNS?

Answer 8

Heaviness

Question 9

Describe a description of a weakness due to problem in PNS?

Answer 9

positional may get worse in sleep (e.g. carpal tunnel syndrome) or foot goes to sleep sitting in certain position
ascending- starts in the feet and moves uo

Question 10

Describe a description of a weakness due to a problem in NMJ?

Answer 10

fatiguable (worse after use of the muscles)
Diurnal variation (worse towards end of day)

Question 11

Describe a description of a weakness due to a problem in muscle?

Answer 11

may also have aching, may be insidious in onset

Question 12

Describe additional features in a CNS problem?

Answer 12

spasm or jerks

Question 13

Describe additional features in a PNS problem?

Answer 13

cramp and twitching (aka fasciculation)

Question 14

Describe additional features in a NMJ problem?

Answer 14

bulbar: issues with swallowing and speaking
ocular issues with diplopia and ptosis
respiratory: orthopnoea, sob on exertion

Question 15

Describe additional features in a muscle problem?

Answer 15

myalgia and cramp

Question 16

Are sensory symptoms possible in a CNS or PNS problem causing weakness?

Answer 16

Yes

Question 17

Are sensory symptoms possible in a NMJ or muscle problem causing weakness?

Answer 17

No (at this point only motor fibres are present)

Question 18

In a CNS problem causing weakness what additional difficulties are possible?

Answer 18

Cognitive 
sphincter involvement (changes to urinary frequency)

Question 19

In a PNS problem causing weakness what additional difficulties are possible?

Answer 19

Loss of grip
Tripping up
Unsteady with eyes closed

Question 20

In a NMJ problem causing weakness what additional difficulties are possible?

Answer 20

lots of chewing

Difficulties speaking or holding a prolonged gaze (may be apparent when trying to read or on prolonged drives)

Question 21

In a muscle problem causing weakness what additional difficulties are possible?

Answer 21

Getting up from low chairs
Hanging up washing
(things that involve big proximal muscles)

Question 22

In a CNS problem causing weakness what may you see on inspection?

Answer 22

changed posture

Question 23

In a PNS problem causing weakness what may you see on inspection?

Answer 23

wasting of muscles
twitching / fasciculation
pes cavus

Question 24

In a NMJ problem causing weakness what may you see on inspection?

Answer 24

ptosis

ophthalmoplegia

Question 25

In a muscle problem causing weakness what may you see on inspection?

Answer 25

proximal wasting

Question 26

In a CNS problem causing weakness describe tone?

Answer 26

increased | there is spasticity and clonus

Question 27

In a PNS problem causing weakness describe tone?

Answer 27

decreased tone

Question 28

In a NMJ problem causing weakness describe tone?

Answer 28

no change (or slight decrease shouldn't see increase)

Question 29

In a muscle problem causing weakness describe tone?

Answer 29

no change (or slight decrease shouldn't see increase)

Question 30

In a CNS problem what would pattern of weakness be?

Answer 30

pyramidal pattern in the arms the extensors are weaker than flexors in the legs the flexors are weaker than extensors

Question 31

In a PNS problem what would pattern of weakness be?

Answer 31

distal weakness specific pattern depends on whether it is a root problem (small area), plexus (arms or legs), mononeuropathy (in distribution of one nerve) or a polyneuropathy (commonly has a glove and stocking distribution)

Question 32

In a NMJ problem what would pattern of weakness be? How is it assessed?

Answer 32

fatiguability bulbar: counting out loud ocular: fixed gaze - do they develop double vision ptosis: fixed up gaze limb: repetitive movement

Question 33

In a muscle problem what would pattern of weakness be?

Answer 33

proximal symmetrical weakness

Question 34

In a CNS problem causing weakness reflexes will be _____

Answer 34

increased

Question 35

In a PNS problem causing weakness reflexes will be _____

Answer 35

decreased

Question 36

In a NMJ problem causing weakness reflexes will be _____

Answer 36

normal (maybe decreased but not increased)

Question 37

In a muscle problem causing weakness reflexes will be _____

Answer 37

normal (maybe decreased but not increased)

Question 38

In a CNS problem causing weakness the plantar response will be _______

Answer 38

extensor

Question 39

In a PNS problem causing weakness the plantar response will be _______

Answer 39

flexor (sometimes mute)

Question 40

In a NMJ problem causing weakness the plantar response will be _______

Answer 40

flexor

Question 41

In a muscle problem causing weakness the plantar response will be _______

Answer 41

flexor

Question 42

In a CNS problem causing weakness the associated sensory symptoms will occur in what pattern?

Answer 42

with brain it will be one side | with the spinal cord there will be sensory level

Question 43

Where is the lesion likely located? Increased tone and reflexes, weakness in a pyramidal pattern, extensor plantar response, associated sensory symptoms on same side of body?

Answer 43

CNS lesion (brain)

Question 44

Where is the lesion likely located? Increased tone and reflexes, weakness in a pyramidal pattern, extensor plantar response, there is a sensory level?

Answer 44

CNS (spinal Cord)

Question 45

Where is the lesion likely located? Decreased tone and reflexes, distal weakness, flexor plantar response, glove and stocking distribution?

Answer 45

PNS

Question 46

Where is the lesion likely located? Decreased tone and reflexes, fatiguability, flexor plantar response, no associated sensory symptoms?

Answer 46

NMJ

Question 47

Where is the lesion likely located? Proximal muscle wasting, decreased tone and reflexes, proximal weakness, flexor plantar response, no associated sensory symptoms?

Answer 47

muscle

Question 48

Where is the lesion likely located? hemiplegia or paraplegia, described as heaviness, spasms and jerks, sensory symptoms, sphincter involvement and or cognitive involvement?

Answer 48

CNS

Question 49

Where is the lesion likely located? localised area, worse after sleep, cramping, twitching, sensory symptoms, loss of grip?

Answer 49

PNS

Question 50

Where is the lesion likely located? worse after use of muscles, diplopia, no sensory symptoms, finds prolonged gaze difficult?

Answer 50

NMJ

Question 51

Where is the lesion likely located? proximal symmetrical muscles affected, aching pains, cramps, no sensory symptoms, finds getting up from chairs and hanging washing difficult

Answer 51

muscle

Question 52

Define agnosia and how you would test for it? what pathology does this suggest?

Answer 52

inability to process sensory information can you identify what you are holding if you close your eyes? parietal lesion

Question 53

Define apraxia? What pathology does this suggest?

Answer 53

inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement parietal lesion