Here are some very useful tips for the Neurology examination during MRCP PACES!
1) Read the given clinical scenario carefully, & make a provisional diagnosis in your mind about what to expect ahead & how to elicit the signs.
2) Shake the patient’s hand firmly and introduce before you start as you can check two things with this, dystrophia myotonica/weakness of upper limbs & any speech problem.
3) Expose your patients adequately. For example, if you are asked to examine the upper limb, expose the patient’s upper half or else you may miss muscle atrophy of the deltoid or winging of the scapula which may suggest proximal myopathy.
4) When examiners ask you to examine the upper limbs, look at the patient’s lower limb before you start and vice versa, as this may give you the most important sign later and help you to come to a diagnosis.
5) Gait is always a part of a complete lower limbs examination.
It is even a better idea to check it at the start and ask the patient if he/she is able to walk. If yes, check gait which will give you the most important clues right at the beginning like Parkinsonian gait, ataxic gait, the unilateral stiff gait of hemiparesis, or foot drop in LMN paraparesis.
6) On fundoscopy examination, if you find that your patient is having diabetic retinopathy, at the end of examination suggest you would like to examine urine for microalbuminuria and check the patient’s blood pressure.
7) If you are examining for cranial nerves, always start with the most relevant examination first. For example, if a candidate’s information stem states that this patient has a speech problem, then start from lower cranial nerves examination first, because most probably you are going to find abnormalities there.
8) In a lower limb examination case, if you find there is a weakness, always suggest that you would like to check the anal tone and peri-sacral sensation.
9) In a patient with Parkinsonism, always suggest to examiners you would like to check for Parkinson plus syndrome.
10) In a young patient with Parkinsonism, always think of Wilson’s disease.
11) Do not forget to check vertebral Spine (Back of patient) & Gait in a patient with lower limb examination.
12) Even if you are unable to do a complete neurological survey after finishing a pertinent part like cranial nerves, and you expect to find signs in lower limbs (like in Multiple sclerosis), tell the examiners what you will want to do further e.g., I would like to check upper and lower limbs, for cerebellar signs & would do fundoscopy.
Thanks for your blog, nice to read. Do not stop.