Importance of correct clinical method

One of the medical students was asked to perform a neurological examination on a patient who had poor mobility.
His findings were of bilateral incoordination of movement with past pointing and dysdiadokokinesis. The diagnosis was a bilateral cerebellar lesion.
On approaching the patient we looked at his face and noticed that there was paucity of facial expression, a mask like facies. Immediately, the possibility of parkinsonism was raised.
Glabella tap was positive, again a sign in favour of parkinsonism.
We thought of examining the upper limbs.
There was no deformity or gross change in size of the limbs and the skin looked normal.
There was no wasting of muscles but the patient had a resting tremor of his hands.
Again a sign indicating parkinsonism.
The tone in his upper limbs was increased. It was rigidity of the cogwheel type. This more or less confirmed our diagnosis of parkinsonism.
Power was reasonable but there was bradykinesia and hence movement was impaired. Coordination was difficult to assess but appeared intact.
This was an important learning point; in neurological examination it is of utmost importance to follow the steps of the examination in order, as the detection of some abnormalities will interfere with further evaluation.