Pearls in PACES- CNS (General)

Adel Hasanin
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
2. Identification and interpretation of physical signs

Identifies abnormal physical signs correctly

Interprets signs correctly

Makes correct diagnosis
3. Discussion related to the case

Familiar with appropriate investigation and sequence

Familiar with appropriate further therapy and management
Overall judgement

Clear
Pass

Pass

Fail

Clear
Pass

Pass

Fail

Clear
Pass

Clear
Pass

Pass

Fail

Pass

Fail

Clear
Fail

Clear
Fail

Clear
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
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 ROMBERGS TEST: ask the examiners permission to examine the patients gait and
perform Rombergs 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)