Neurological Examination for MRCP PACES

We went through examination of the upper limbs.
The main thing in neurology is to stick to the system. Go through every step without omitting anything and the diagnosis will come to you.
We went through the system in detail and after demonstrating the method one of the candidates went through the method with supervision.
It was very slow to start with but this is the case when learning a new method. With repeated practice one will speed up.
The patient had no abnormality of size and shape of the limbs and there was no abnormality of the skin. Thus we excluded a long-standing neurological deficit (i.e.) one that had developed in childhood (this would have interfered with growth of the limbs e.g. childhood poliomyelitis). A sensory deficit may have resulted in trophic changes in the skin. This is the reason why it is essential not to leave out these steps in the examination.
The position of the limbs at rest were normal, hence the patient was unlikely to have a motor deficit (e.g. stroke, nerve palsy). Again examples to stress the importance of this step.
There was no wasting of muscles (no lower motor neurone lesion)
No abnormal movements
Tone, power and reflexes were all normal
On examination of the right upper limb we noticed that the patient had abnormal coordination with past- pointing and dydiadokokinesis. No dysmetria.
No sensory deficit.
Diagnosis:
Right cerebellar lesion
We asked what the candidate would like to examine next and the answer was the eyes.
On examination of the eyes, nystagmus was noticed with the fast phase to the right.
The next question would be what are the likely causes of this patient’s right cerebellar lesion.
This is where preparation from books comes in. It is essential to learn the causes of cerebellar lesions, unilateral and bilateral. However, when preparing for exams it is essential to focus on the common causes in the region where one will be examined.
For example in the UK the focus should not be on post-malarial cerebellar syndrome!