History taking and diagnosis Flashcards Preview

Finals - Neurology > History taking and diagnosis > Flashcards

Flashcards in History taking and diagnosis Deck (9)
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1
Q

What is the ‘pain tool’?

A

Site - where exactly does it hurt? (point to it)
Radiation - does it travel anywhere? (point to it)
Onset - does it come on within minutes/hours/days/weeks/months/years? (how many of the units chosen?)
Precipitating - what was happening when you first noticed it? were you doing anything specific?
Duration - when it comes on, how long does it last? minutes/hours/days?
Course - is it there all the time or does it come and go? How frequently does it happen?
Progression - how has it changed since you first noticed it?
Character - is it a sharp/dull/burning/aching/crushing pain?
Severity - how would you rate it on a scale of 1-10, 10 being the most painful?
Sleep disturbance - does it stop you getting to sleep or wake you up at night?
Alleviating/exacerbating - does anything make it better/worse? position, pain relief, pressure, movement?
Associated features - have you noticed anything else going on? (examples given will depend on Hx so far ie sensation/visual changes, continence, weight loss, weakness etc)
Previous episodes - has this or something similar happened before? Was it the same or different?
Response to conservative measures - have you received any treatment for this before? did it work? why are you not taking it now?
Impact on ADLs - question feeds into the domain tool…

2
Q

What is the ‘domain tool’?

A

Assesses impact on lifestyle across 7 domains:

Mobility 
Communication 
Interpersonal relationships 
School/work/hobbies 
Continence/sexual function/personal hygiene 
Sleep 
Eating/drinking/nutrition 

+ overall impact on mood

Will also give access to ‘patient speak phrases’ - useful to quote in notes as can give indications to pathology as well as functioning

3
Q

What is the ‘core neurological examination’ made up of?

A

General appearance - drowsy, agitated, aggressive, unwell, shocked, toxic
Gait - assessed when calling a patient in
Vital signs - often performed by colleague
Fundoscopy - optic atrophy and papilloedema
Long tract signs
Vibration sense - 125Hz tuning fork

4
Q

What is the importance of vital signs?

A

To distinguish between primary and secondary brain problems

Secondary - pathology is outside the brain - ie patient may be drowsy from hypovolaemia/shock, hypoxia, systemic infection and pyrexia

Primary - pathology is inside the brain - ie pyrexia for CNS infection, irregular pulse/AF in the context of a stroke

5
Q

What are long tract signs?

A

UMN/pyramidal/descending tract/corticospinal tract signs

Spastic gait - stiff foot dragging walk
Hypertonia
Hyper-reflexia
Babinski - upgoing plantars
Clonus - >5 beats is significant
Cross-adductors - contraction of both hip adductors when either knee jerk is elicited
Hoffman’s sign - loosely holding the middle finger and flicking fingernail downwards; positive response is flexion and adduction of thumb on same hand
Loss of fine finger movements (‘treacle hands’)
Deltopectoral reflex

6
Q

Why are long tract signs useful to examine?

A

For the identification of myelopathy - where signs may present before symptoms or with the patient only complaining of neck pain; or peripheral neuropathy

7
Q

Why is vibration sense useful to be tested?

A

It is the first modality to go in peripheral neuropathies and isnt something the patient is likely to report

8
Q

What should be examined beyond the core examination?

A

Head/cranial nerves - patient sitting opposite doctor
Upper and lower limbs (ATORCS)
Trunk

9
Q

What do you look for in a neuro examination of the trunk?

A

(6P’s 4S’ NUT)

Paraspinal mass
Paravertebral muscle spasm 
Pit/patch of hair in midline (dysraphism) 
Palpable/percussable bladder 
Patulent anal sphincter 
Perianal sensation 

Sensory level
Spinal deformity
Surgical wounds
Sacral pressure area

NF1 skin lesions eg cafe au lait
Urostomy, colostomy
Truncal flexion