Cheatography
https://cheatography.com
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This is a draft cheat sheet. It is a work in progress and is not finished yet.
Introduction:
W |
Wash Hands |
I |
Introduce Yourself + Check Patient's Identity |
P |
Permission |
P |
Patient Position + Pain |
E |
Explain |
Patient must be placed at 45° and limbs exposed
Equipment:
Cotton Wool
Neurotips
Tendon Hammer
128Hz Tuning Fork |
General Inspection:
S |
Symmetry (Posture - Truncal Ataxia) |
W |
Wasting |
I |
Involuntary Movements |
F |
Fasiculations |
T |
Tremors |
Speech Abnormalities |
Cerebellar Disease = Slurred staccato speech |
Medical Paraphernalia |
Waking/Hearing Aids |
Truncal Ataxia is associated with midline cerebellar lesions
Face:
Nystagmus: |
Tell patient to follow your finger in a "H" shape across 30° of their FOV - >30° can cause pathological nystagmus |
Speech: |
Patient repeats the phrase "British Constitution" - Mention Scanning Speech |
Ask patient to sit at side of bed
Upper Limb Examination:
Check for pain |
Rebound: |
Patient puts both arms straight out, push down on one, observe for rebound |
Tone: |
Increased: Clasp Knife Rigidity, Cog Wheeling, Lead Pipe Rigidity
Decreased: LMN Lesion |
Dysdiadokinesis: |
Rapidly alternating supination + pronation |
Past Pointing/Intention Tremor: |
Finger to nose test |
Reflexes: |
Compare right to left
Brachioradialis - C5,6
Biceps - C5,6
Triceps - C7,8 |
Lower Limb Examination:
Check for Pain |
Tone: |
Roll the relaxed leg from side to side and watch foot
Flex and extend knee quickly |
Extra movement => Decreased tone
Less movement => Rigidity |
Clonus: |
Ensure no pain
Relax foot
Hold lower leg with one hand and extend the ankle joint with the other
Suddenly dorsiflex ankle and hold in position
Compare with other leg |
Dysdiadokinesis: |
Heel-Shin Test
Foot Tapping |
Reflexes: |
Ankle Reflex - S1,2
Patellar Reflex - L3,4 |
Clonus is seen in UMN lesions
Reflexes may be present/absent, or reduced/brisk
Gait Examination:
Ask if the patient experiences trouble walking |
Walk to end of bed: |
Observe:
• Arm Swing
• Patient Turning |
Heel-Toe Walk |
Romberg's Test: |
Stand Close to Patient
Falling without correction = Positive
Swaying with correction = Negative but could be due to truncal ataxia |
Romberg's Test: Patient stands with feet together and eyes closed with arms by their side
Cerebelllar Signs:
DANISH |
D |
Dysdiadochokinesia |
A |
Ataxia |
N |
Nystagmus |
I |
Intention Tremor |
S |
Slurred Speech |
H |
Hypotonia/Hyporeflexia |
SPINDAR |
S |
Staccato Speech |
P |
Past Pointing |
I |
Intention Tremor |
N |
Nystagmus |
D |
Dysdiadochokinesia |
A |
Ataxia |
R |
Rebound |
Causes of Cerebellar Dysfunction:
PASTRIES |
P |
Paraneoplastic |
A |
Alcohol |
S |
Sclerosis |
T |
Tumour |
R |
Rare |
Fredrich's Ataxia, MSA, Ataxia Telangiectasia |
I |
Iatrogenic |
Phenytonin |
E |
Endo |
Hypothyroidism |
S |
Stroke |
Vertebrobasilar |
MSA = Multiple Systems Atrophy
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