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Clinical Examinations > NEURO > Flashcards

NEURO Flashcards

1
Q

Bradykinesia

A

Finger Tapping
Hand Movements
Pronation-Supination
Toe taps

Often very asymetrical - PC one limb. so test both sides
Rated by the MDS UPDRS

Dont memorise scoring.

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2
Q

Impact of Bradykinesia

A

Hypomimia (facial expression)(mask)
Hypophonia (soft voice)
Short steps, shuffling gait
Micrographia

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3
Q

Rigidity

A

Hypotonia and Hypertonia
Spasticity and Rigidty
Paratonia and Myotonia (less common)

Increased resistance to passive movement

Do not learn the rating tool.

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4
Q

Determine between spasticity and rigidty

A

Distribution
Clinical Context
Associated signs
Effect of Velocity- spasticity worse with speed, better when slower but rigidity is present regardless
Synkeinesis- move another part of body and rigidity gets worse.

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5
Q

Tremor

A

RESTING At completely relaxed state, slow tremor will come out.
Look at speed- physiological will be fast, pathological will be slow.
Upper limbs in parkinsons, pill rolling.

Re-emergent- same muscle joints and frequency but error at rest, reduces/ disappears at movement.

Essential/action
leaves at movement, occurs at sustained postures.

Scale based on amplitude- do not learn.

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6
Q

Cogwheel rigidity

A

Rigidity and tremor superimposed.

Jumps in movement of the wrist
feeling the tremor

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7
Q

Gait

A

Reduced velocity
Reduced cadence
Reduced stride length
Asymmetric stride length
Reduced arm swing

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8
Q

Freezing in Gait

A

Motor blocks during walking:
gait initiation, turning, passing through a doorway, threshold, line on floor- zebra crossing

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9
Q

Postural instability

A

Pull test and theyll fall back- normal response is to shuffle to regain balance.

Camprocormia- bending forward
Pisa syndrom- titling
Striatal hand/foot- flexion at PIP , relax at DIP

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10
Q

RBD
Rem Sleep Behaviour Disorder

A

Act out your dreams
Kicking, flailing
Early feature

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11
Q

Cranial Nerve exam

INTRODUCTION

A

Introduce yourself
Explain examination.
Obtain consent
Offer chaperone + explain supervisor will re-examine (for ophthalmoscopy)
Clean hands
Position your patient sitting and sit opposite them

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12
Q

Cranial Nerve

GENERAL INSPECTION

A

Facial asymmetry
Eye related signs
Medical aids – glasses, eye patch, hearing aids, pen and paper for communication
Hearing aids
Fasciculations
Scars
back of ear – acoustic neuroma
craniotomy
in front of ear – parotid gland tumour, may have associated ipsilateral facial nerve palsy
Tracheostomy, nasogastric or PEG tubes

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13
Q

Cranial Nerve Exam

OLFACTORY NERVE (CN I- SENSORY)

A

“Do you have difficulty with your sense of taste or smell?”

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14
Q

Cranial Nerve Exam

OPTIC NERVE (CN II- SENSORY)

A

VISUAL ACUITY: Snellen chart (with and without glasses)/ counting fingers, hand movements, light/ dark
COLOUR VISION: Ishihara plates
VISUAL INATTENTION
VISUAL FIELDS
CENTRAL VISION
BLIND SPOT

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15
Q

Cranial Nerve Exam

OCULOMOTOR (CN III- MOTOR), TROCHLEAR (CN IV- MOTOR) and ABDUCENS (CN IV SENSORY+MOTOR)

A

EYE MOVEMENTS; including commenting on squints, nystagmus
PUPILS
Inspection
Test reaction to LIGHT (Direct and consensual)
Test ACCOMODATION

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16
Q

Cranial Nerve Exam

OPTIC NERVE (CN II- SENSORY)

A

FUNDOSCOPY/OPTHALMOSCOPY – covered in P year

17
Q

Cranial Nerve Exam

TRIGEMINAL (CN V- MOTOR + SENSORY)

A

Dab different areas of face, both sides, with cotton wool (sensory) - compare with sensation over sternum
V1 (Ophthalmic)
V2 (Maxillary)
V3 (Mandibular)
Motor component:
Clench teeth (masseter and temporalis muscles)
Open mouth against resistance (pterygoid muscles- jaw deviation)
Push jaw to one side (pterygoid weakness)
Jaw jerk and corneal reflex (with permission from supervisor

18
Q

Cranial Nerve

FACIAL (CN VII- MOTOR+SENSORY)

A

Look for asymmetry
“Raise your eyebrows – keep them there, don’t let me push them down”
“Screw your eyes up tight – keep them closed, don’t let me open them”
“Smile – show me your teeth”
“Purse your lips together, don’t let me pull them apart”
Sense of taste in anterior 2/3 of the tongue (sensory)

19
Q

Cranial Nerve exam

VESTIBULOCOCHLEAR NERVE (CN VIII- SENSORY)

A

Crude hearing (whisper a number) from 60cm whilst masking the sound in the other ear. Test both ears
If they cannot hear this perform tuning fork tests using a 512 Hz fork
Rinne’s test
Weber’s test

20
Q

Cranial Nerve Exam

GLOSSOPHARYNGEAL NERVE (CN IX- SENSORY+MOTOR) AND

VAGUS NERVES (CN X- SENSORY+MOTOR)

A

Oral cavity

Look at the tongue , uvula and palate.
Gag reflex (with permission from supervisor)

Swallow (with permission from supervisor)

21
Q

Cranial Nerve

ACCESSORY NERVE (CNXI- MOTOR)

A

Shrug shoulders
Turn head against resistance

22
Q

Cranial Nerve

HYPOGLOSSAL (CN XII- MOTOR)

A

Wasting and fasciculation of tongue
Protrude tongue: Deviation of tongue towards side of pathology
Move tongue from side to side

23
Q

Motor Neurone

General Inspection

A

SWIFT

Scars, Wasting, Involuntary Movements, Fasciculations, Tremor

When speaking to pt for intro see if they hoarseness in voice and full face movement

24
Q

Motor Neuron

Balance: Trunk and Gait

A

TRUNK

With patient sitting up
Instability; Romberg’s test
Truncal ataxia
GAIT

Look for abnormalities:
Asymmetry
Wide based gait
Poor coordination
Scissoring gait
Waddling gait
High stepping gait
Gait apraxia
Shuffling gait
Hysterical gait
Ask patient to turn around
En-block turning
Heel to toe walking
Walk on heels
Walk on toes

25
Q

Motor Neurone

Its not IPPA its….

A

Tone
Power
Coordination
Sensory Reflex

26
Q

Upper body Tone

A

Clasp knife rigidity
Lead pipe rigidity
Cog-wheel rigidity
Hypotonia
Flaccid tone
Hold the patients hand with one hand (like shaking hands) and the elbow with the other
Move elbow and wrist randomly, including a mixture of rotational and flexion/extension movements and assess the extent and timing of any resistance
Compare with other side

27
Q

Upper Body power

A

Shoulder Abduction (C5- axillary nerve)
Elbow Flexion (C5/C6 -musculo-cutaneous nerve)
Elbow Extension (C7/C8 -radial nerve)
Wrist Extension (C6/C7 -radial nerve)
Finger extensors (C6/C7 -radial nerve)
Finger flexion/grip (C8)
Abductor pollicis brevis/thumb abduction (median nerve)
Dorsal interossei/finger abduction (ulnar nerve)

MRC Grade 5

28
Q

Upper body coordination

A

Dysdiadochokinesia (cerebellar disease)
Finger-nose (cerebellar disease, dysmetria, intention tremor, past-pointing)

29
Q

Upper body reflex

A

Reflexes
Biceps (C5)
Triceps (C7)
Supinator (C6)

30
Q

Lower body tone

A

Roll leg
Lift knee and drop it
Clonus
Examine both legs and compare findings

31
Q

Lower leg power

A

Power
Hip Flexion (L2/3 -femoral nerve)
Hip Extension (L4/5 -inferior gluteal nerve)
Knee Extension (L3/4 -femoral nerve)
Knee Flexion (L5/S1 -sciatic nerve)
Ankle Dorsiflexion (L4/5 -deep peroneal nerve)
Plantar-flexion (S1/2 -tibial nerve)
Foot inversion (L4 -tibial nerve/deep peritoneal nerve)
Foot eversion (L5/S1 -superficial peroneal nerve)
Big toe Extension (L5 -deep peritoneal nerve)

32
Q

Lower limb coordination

A

Co-ordination triangle - intention tremor/past pointing in cerebellar disease

33
Q

Lower llimb reflex

A

Reflexes
Knee (L3)
Ankle (S1)
Plantar reflex (dorsiflexion of big toe/fanning of other toes -UMN lesion)

34
Q

Sensation

A

If no reported abnormalities- start distally and include all dermatomes
If there are reported abnormalities- start from area of abnormality & map it out
Test following modalities:
Light touch
Pain
Vibration sense
Position sense
Temperature, if appropriate

35
Q

Sensation exam

A

Pattern / approach to testing – as for upper limbs
Test following modalities:
Light touch
Pain
Vibration sense
Position sense - including Romberg’s test
Temperature – if appropriate

36
Q

Arm dermatome

A
37
Q

lower limb dermatome

A

Clinical Examinations (12 decks)

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