Sensory Disturbance Interview

Question 1

What is sensation?

Answer 1

Stimuli detected by specialised receptors in skin/muscles/joints
Transmitted to brain via PNS

Question 2

What does sensation allow the body to do?

Answer 2

Maintain posture
React to pain and other noxious stimuli
Provide info about surrounding envrio

Question 3

Is sensation a continuous process?

Answer 3

Yes

Question 4

Is sensation a conscious process?

Answer 4

Usually no

Question 5

What can disordered sensation cause?

Answer 5

Considerable disability and distress

Question 6

What are the three parts to gathering information about sensory disturbance?

Answer 6

What symptoms
Pattern
Underlying cause

Question 7

What are the two main categories of sensory symptoms?

Answer 7

Positive

Negative

Question 8

What are positive sensory symptoms caused by?

Answer 8

Heightened activity in sensory pathways

Question 9

What are negative sensory symptoms caused by?

Answer 9

Loss of sensory function

Question 10

What sort of descriptions will patients use when describing positive sensory symptoms?

Answer 10

Tingling
Pins and needles
Pricking
Burning
Tightness
Band-like sensation around body
Electric shock
Pain - often sharp and stabbing

Question 11

Do patients with positive sensory symptoms have sensory deficits on examination?

Answer 11

Usually no

Question 12

Define paraesthesia

Answer 12

Abnormal sensation perceived without abnormal stimulus

Question 13

Define hyperaesthesia

Answer 13

Abnormal increase in sensitivity to stimulus

Question 14

Define dysaesthesia

Answer 14

All positive sensory changes whether due to stimulus or not

Question 15

Define hyperalgesia

Answer 15

Heightened response to noxious stimulus

Question 16

Define allodynia

Answer 16

Normal stimulus felt as pain

Question 17

What sorts of descriptions will patients use when describing negative sensory symptoms?

Answer 17

Numbness
Coldness
Loss of feeling in particular distribution

Question 18

Do patients reporting negative sensory symptoms have sensory deficits on examination?

Answer 18

Often, yes

Question 19

Define hypoaesthesia

Answer 19

Diminished ability to perceive pain/temperature/touch

Question 20

Define anaesthesia

Answer 20

Complete inability to perceive pain/temperature/touch

Question 21

Define analgesia

Answer 21

Complete insensitivity to pain

Question 22

What might a patient have if they have a sensory disturbance involving the receptors in the muscles, tendons and joints?

Answer 22

Proprioception affected
Sensory ataxia
- Imbalance
- Unsteady gait
- Lack of precision with movements

Question 23

Why is it important to establish the pattern of sensory loss?

Answer 23

Helpful in determining likely site of underlying problem

Question 24

What are the patterns of sensory loss?

Answer 24

One side of the body
Whole limb or part of limb
Symmetric/asymmetric

Question 25

What are some common patterns of sensory loss?

Answer 25

Glove and stocking distribution due to peripheral neuropathy Dermatomal pattern due to spinal cord/nerve root lesion Area supplied by particular nerve Hemisensory loss due to lesion of spinal cord/brainstem/thalamus/cortex

Question 26

What are some examples of CNS conditions that cause sensory disturbance?

Answer 26

Cerebrovascular disease MS Tumours

Question 27

What are some examples of PNS conditions that cause sensory disturbance?

Answer 27

Diabetes Alcohol excess Nerve entrapment syndromes

Question 28

What do you ask about the site?

Answer 28

``` Where is the sensory disturbance? Does it affect one half of the body? A whole limb? Part of a limb? Is it symmetric or asymmetric? ```

Question 29

What do you ask about the quality?

Answer 29

Positive or negative sensory symptoms | Combination of both

Question 30

What do you ask about the severity?

Answer 30

Determine degree to which sensory symptoms disrupt patient's life

Question 31

What do you ask about the time course?

Answer 31

Did it come on suddenly or over days to months? | Is it worse at night?

Question 32

What do you ask about context?

Answer 32

Is there anything in particular they noticed at the time the sensory disturbance started?

Question 33

What do you ask about aggravating factors?

Answer 33

Is there anything that makes it worse?

Question 34

What do you ask about relieving factors?

Answer 34

Is there anything that makes it better?

Question 35

What do you ask about associated features?

Answer 35

``` Alcohol use Medications Past history Muscle weakness Gait disturbance Have you sustained any injuries as a result? ```

Question 36

What are the three steps to respond to a patient who is emotional?

Answer 36

Identify Acknowledge Empathise