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Tutorial for MRCP PACES Station 3 ( Last modified: 7 December 2007)
Neurological Station
Candidates in MRCP PACES examination always find neurological station a difficult sub-station because there are too many possibilities in neurological station. Unlike abdominal and cardiovascular stations which have only limited scenariors , neurological station can be a very tricky station and you as a candidate of MRCP PACES need to read vast numbers of common neurological problems. However, three common questions in neurological station are,
Examination of lower limbs
Examination of upper limbs
Cranial nerves examination
I am going to talk about examination of lower limbs here because I think it is by far the commonest case scenario in MRCP PACES, I find the following diagram a useful tool whenever you examine a patient's lower limbs neurologically,
Remember that you will be usually dealing with either Upper Motor Lesion or Lower Motor Lesion in your MRCP PACES examination if you are given a case of lower limbs examination. However, there is a possibility other cases such as Parkinson's disease or Cerebellar diseases come out as a case of lower limbs examination. While you are examining the patients, pay attention to the following to determine whether you are dealing with upper or lower motor lesions,
Tone- flaccid or spastic, if you find it is rigid, then you are dealing with extrapyramidal conditions such as Parkinsonism.
Reflexes- pay attention to knee and ankle reflexes, if they are increased, you are dealing with upper motor lesions.
Plantar- if the plantar is up-going, then you are dealing with upper motor lesions. However, there are a few possibilities that you may find up-going plantar with loss of ankle reflex such as peripheral neuropathy in a stroke patient (such as in diabetes), Motor neuron disease, Tabes dorsalis, Conus medullaris-cauda equina lesion and subacute combined degeneration of the spinal cord.
Ankle clonus-if it is present, it signifies upper motor lesion.
Common cases with upper motor neuron lesions in MRCP PACES are as shown below,
More topics to come, stay tuned!
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