Pearls in PACES- CNS (General)

Adel Hasanin

1

CNS- General

CLINICAL MARK SHEET

Examiners are required to make a judgement of the candidate's performance in each of the following

sections by filling in the appropriate box then record the overall judgement (a fail or clear fail grade must

be accompanied by clearly written explanatory comments)

1. Physical examination

� Where appropriate, assesses higher cortical function, tests cranial

nerves in sequence including optic fundi and visual fields

� Appropriately assesses motor function in limbs (tone, power,

pinprick, vibration sense, proprioception, temperature) and

coordination/ cerebellar function

� Assesses gait if appropriate

Clear

Pass

□

Pass

□

Fail

□

Clear

Fail

□

2. Identification and interpretation of physical signs

� Identifies abnormal physical signs correctly

� Interprets signs correctly

� Makes correct diagnosis

Clear

Pass

□

Pass

□

Fail

□

Clear

Fail

□

3. Discussion related to the case

� Familiar with appropriate investigation and sequence

� Familiar with appropriate further therapy and management

Clear

Pass

□

Pass

□

Fail

□

Clear

Fail

□

Overall judgement

Clear

Pass

□

Pass

□

Fail

□

Clear

Fail

□

Instructions in the CNS case may request one of the following:

1. Examine the CNS (General)…see below

2. Examine the lower limb (neurologically)…see Ch 6. CNS-Lower Limb

3. Examine the upper limb (neurologically)… see Ch 7. CNS-Upper Limb

4. Examine the cranial nerves… see Ch 8. CNS-Cranial Nerves

5. Examine the gait… see Ch 9. CNS-Gait

6. Examine the speech and higher cerebral functions… see Ch 10. CNS-Speech & Higher Cerebral

Functions

7. Examine the cerebellar system… see Ch 11. CNS-Cerebellar

Pearls in PACES- CNS (General)

Adel Hasanin

2

CNS – GENERAL

STEPS OF EXAMINATION

(1) APPROACH THE PATIENT

• Read the instructions carefully for clues

• Approach the right hand side of the patient, shake hands, introduce yourself

• Ask permission to examine him

• Expose the upper and lower limbs completely and keep the patient descent (genital area is covered)

(2) GENERAL INSPECTION: see “Ch 6. CNS – Lower Limb”

(3) EXAMINATION OF LOWER LIMBS (you may wish to start with the lower limb rather than the

upper limb as it takes shorter time and gives more information): see “Ch 6. CNS – Lower Limb”

(4) EXAMINATION OF UPPER LIMBS: see “Ch 7. CNS – Upper Limb”

(5) CRANIAL NERVES: see “Ch 8. CNS – Cranial Nerves”

(6) GAIT AND ROMBERG’S TEST: ask the examiner’s permission to examine the patient’s gait and

perform Romberg’s test: see “Ch 9. CNS – Gait”

(7) ADDITIONAL SIGNS: according to diagnosis, for example:

•••• Look for cataract and scar for pacemaker, palpate for local spinal tenderness and examine for sensory

level

•••• Tell the examiner that you would normally extend your examination to perform … (mention what is

missed in your examination because of lack of time) and woud ask about swallowing (Dystrophia

myotonica), bladder symptoms, test the anal tone (spinal cord syndrome), and to dipstick urine for

DM.

(8) THANK THE PATIENT AND COVER HIM (HER)