Neurology : Listen to the patient - dysarthria or dysphasia, look around - wheelchair, sticks/crutches, splints, face - expressionless (PD), frontal is overactivity / staring eyes (PSP), Ptosis (Myotonic dystrophy or MG), Asymmetry (Facial weakness), Upper limb- hold their arms in front of them and eye close - Tremor (hands straight then traffic stopping sign), Pseudoathetosis (sensory ataxia- Writhing movement of fingers) , Pyramidal drift ( palms up- pronator drift), Rebound phenomenon (cerebellar syndrome), Fist open and close (myotonia / slow opening and closing of fist), Tone (while checking tone stabilise joint above it - At wrist - move it when relaxed, At Elbow - flexion, ext, pronation and supination, At shoulder- move, Hypotonia - LMNS, Muscular dystrophy, Hypertonia - UMNS, Power: Shoulder ( wing - press down then up), at Elbow (push away, push towards me), Cock (radial nerve) - up down, index finger (with your index finger), Little finger (with your little fingers), Thumbs up - press outside and inside - Median nerve, Proximal myopathy - PM, DM, Cushing, Hypothyroidism, FSH muscular dystrophy, Distal myopathy - Inclusion body myositis, Myotonic dystrophy, Peripheral neuropathy, Reflexes: Biceps, Supinator, then triceps and compare, Percussion myotonia - tap on thenar eminence, Ask to count 20 backwards and check for any pill rolling of fingers (PD), Coordination- Finger nose past pointing , Flip flop- dysdiadokokinesis, Nystagmus, Speech- baby Hippopotamus , British Constitution Sensation - Cotton, pin prick, vibration, position sense, look at back for winging of scapula.
Posted on: Tue, 30 Sep 2014 09:50:45 +0000
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