Neurology

Question 1

Neurological History

Answer 1

Follows the same basic principles as any medical history
- let the patient tell you about their symptoms
- keep them on track
- clarify with direct questions
- explore presence or absence of specific features
will often give you likely diagnosis
begin to formulate a plan for investigations and management

Question 2

Neuro History - Focus

Answer 2

Onset/frequency (hyperacute vs subacute vs chronic/episodic)
Duration (Transient vs minutes/hours/days)
Location (Focal vs generalised)
Triggers/Exacerbations
Associated Symptoms

Question 3

Neuro Exam

Answer 3

compliment and help interpret the history
could be viewed as objective but there is inter-rater variability
Is not infallible
May reveal unexpected findings

Question 4

Neuro Exam - Obs

Answer 4

scars, ptosis, strabismus, facial asymmetry, frontal balding, fasciculations, regional atrophy, abnormal posturing

Question 5

Neuro Exam - Gait

Answer 5

Stance/initiation/speed/stride legnth/arm swing/turning speed
Spastic? Scissoring? High-stepping?

Question 6

Neuro Exam - C Nerves

Answer 6

examine all

Question 7

Neuro Exam - Tone

Answer 7

Spasticity - lesions of motor tracts

rigidity - extrapyramidal lesions or Parkinsonism

Question 8

Neuro Exam - Power

Answer 8

MRC 0-5

Question 9

Neuro Exam - Reflexes

Answer 9

Absent (-) , reduced+, normal++, brisk+++, clonus ++++

Question 10

Neuro Exam - Co-ordination

Answer 10

Cerebellar ataxia (D.A.N.I.S.H.)
Sensory ataxia (worse with visualisation removed)

Question 11

Neuro Exam - Sensation

Answer 11

Joint position; vibration

pin prick; temperature