Guides

PARKINSONS DISEASE ASSESMENT FORMAT

PERFORMANCE CHECKLIST

PERFORMANCE/STEPS

NOT DONE

POORLY

DONE

GOOD

VERY

GOOD

EXCELLENT

INSPECTION

1

2

3

4

5

EXAMINATION FOR FRONTAL LOBE RELEASE SIGNS:

·      GLABELLAR TAP

·      PALMOMENTAL REFLEX

1

2

3

4

5

EXAMINATION FOR RIGIDITY

·      TONE IN ALL LIMBS (LEAD PIPE vs COGWHEEL)

1

2

3

4

5

EXAMINATION FOR TREMORS

·      REST TREMORS vs ACTION TREMORS (Archemides spiral, Straight line)

1

2

3

4

5

EXAMINATION FOR BRADYKINESIA

·      Facial hypomimia

·      Finger tapping amplitude and velocity

·      Micrographia

·      Gait:

·      Slowness of initiation(gait freezing)

·      Festination (short shuffling gait)

·      Turning (multiple steps)

·      Reduces arm swing

1

2

3

4

5

EXAMINATION FOR POSTURAL INSTABILITY AND ATTENTION  TO DETAIL

1

2

3

4

5

COMPOSURE AND COURTESY

1

2

3

4

5

SUBTOTAL

35 (50%)

·      Presents findings clearly, sequentially and correctly

·      Differential diagnosis (includes most probable cause)

·      Investigations and possible results

·      Management

50%

FINAL GRADE (S/N 1-8)

EXAMINERS COMMENTS AND SIGNATURE

GAS,TROINTESTINAL SYSTEM                                     PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT

DONE

POORLY

DONE

GOOD

VERY

GOOD

EXCELLENT

1

GENERAL INSPECTION

Observes, presence of IVs, NG tubes, catheters, bed pans for Maelena etc )

Ill looking, in pain, wasted, drowsy, confused, Abdomen etc.

1

2

3

4

5

2

GENERAL EXAMINATION

Jaundice, anaemia, pedal oedema, hair texture & distribution, gynaecomastia, purpura, Hands: pallor, palmar erythema, dupuytren’s contracture, finger clubbing, flapping tremor (asterixis), Mouth and Face: parotid gland enlargement, buccal

mucosa and palate (ulcers, thrush etc.) Dentition, Tongue. Lymphadenopathy: (Virchow’s and Inguinal nodes)

2

4

5

3

ABDOMEN — Inspection: spider naevi, scratch marks / scars, distension, umbilicits, hair distribution pattern, peristaltic movements, prominent abdominal veir.s/Striae

1

2

4

5

4

ABDOMEN — Palpation/ Bailoiiiig : light palpation , deep palpation, direction of flow in distended abdominal veins, Palpation for the liver, spleen and kidneys, and characterisation of masses present, Hemial orifices

2

3

4

5

ABDOMEN – Percussion

Fluid thrill, Shifting dullness, Liver span

1

2

4

6

ABDOMEN – Auscultstion

Bowel sound — present/absent/frequency, Liver bruit, Other bruit

4

7

PERINEUM: Offers to perform genital examination & rectal examination and overall attention to sequence

2

3

4

5

8

Composure and Courtesy

2

3

4

5

SUBTOTAL

40 [50%]

9

Presents findings clearly, sequentially and correctly 10 marks Differential diagnosis(includes most probable cause) 20 marks Investigations and possible results                           10 marks

Management                                                        10 marks

FINAL GRADE(S/N 1-9)

Examiners Comments and Eaaminers Signature:

HISTORY ASSESSMENT FORMAT

PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT DONE

POORLY DONE

GOOD

VERY GOOD

EXCELLENT

ESTABLISHMENT OF RAPPORT

Introduction, Reassurance of confidentiality

1

2

3

4

5

PRESENTING COMPLAINT(S) & CHRONOLOGY

1

2

3

4

5

HISTORY OF PRESENTING COMPLAINT

1

2

3

4

5

DIRECT QUESTIONING

1

2

3

4

5

SYSTEMS INQUIRY

1

2

3

4

PAST MEDICAL HISTORY

1

2

3

4

5

DRUG AND ALLERGY HISTORY

1

2

3

4

5

FAMILY HISTORYfBASIC O&G HISTORY in

females

1

2

3

4

5

SOCIAL HISTORY

Marital and sexual history, Recreational drugs, alcohol and smoking, Travel, Hobbies, pets, housing, Assessment of related risks

1

2

3

4

5

Overall Attention To Sequence Composure and

Courtesy

1

2

3

4

5

SUBTOTAL

50 [50%]

Presents findings clearly, sequentially and correctly 10marks Differential diagnosis(includes most probable cause)20 marks Investigations and possible results                       10 marks

Management                                                  10 marks

50%

FINAL GRADE(’¥OTAL S/N 1-11)

Examiners Comments and Signature:

GENERAL EXAMINATION

PERFORMANCE CiJECKLIST

S/N

PERFORMANCE STEPS

NOT DONE

POORLY DONE

GOOD

VERY GOOD

EXCELLENT

GENERAL APPEARANCE & MENTAL STATUS

Appearance, wellness, dyspnoea, orientation in TPP, coma scale

1

2

3

4

5

2

NUTRITIONAL STATUS, SKIN, GENERAL OEDEMA

Fluffy/silky hair, cachexia, small for age, facial puffiness,

anasarca, periorbital and sacral oedema

1

2

3

4

5

HANDS EXAMINATION, METABOLIC FLAP

Checks palms, fingers, nails, dorsum — pallor, clubbing, muscle wastin,°, 1* ”p*r , I:err.or, foeis pulse?

1

2

3

4

5

4

HEAD AN@NECK

Pallor, jaundice, cyanosis, temperature, hydration, neck swellings and thyroid examination

1

2

3

4

5

5

LYMPHADENOPATHY

Checks lymphadenopathy or offers to check it — cervical (sits pafient up), axillary, epitrochlear, inguinal LNs

1

2

3

4

5

6

LEGS EXAMINATION

Appearance, tenderness, warmth, toes & web spaces,

measurement of leg circumference, pitting oedema

1

2

3

4

5

7

Composure & courtesy

1

2

3

4

5      ‘

SUBTOTAL

8

Presents findings clearly, sequentially and correctly 10 marks Differential diagnosis(includes most probable cause) 20marks Investigations and possible results  ’                     lllmarks

Management                                                     10 marks

50%

FINAL GRADE (Total S/N 1-8)

Examiners Comments and Examiners Signature:

NEUROLOGICAL EXAMINATION OF THE

LOWER LIMBS

PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT

DONE

POORLY

DONE

GOOD

VERY

GOOD

EXCELLENT

Inspection of Lower Limbs

Anatomical positon of limbs/Habit, muscle wasting, urinary catheters etc.

1

2

3

4

2

Examination of Muscle Bulk, fasciculatîon and Tone

1

2

5

Examination for Muscle Powër (MRC grade)

(Individual muscle groups vs. Overall limb)

2

4

Deep tendon Reflexes of Lower limbs Knee, ankle and

Plantars) CIonus-Ankle& Knee

1

2

4

5

Sensory Examination in Lower Limbs

(Dermatomal approach)

Pain and Temperature pathway (Lateral)Vibration and Proprioception pathway(Posterior) Light Touch pathway(Anterior)

2

4

5

6

Examines the Back for Gibbus and Overall Attention To

Sequence

1

2

4

5

7

Composure and Courtesy

2

4

5

SUBTOTAL

8

Presents findings clearly, sequentially and correctly 10marks Differential diagnosis(includes most probable cause) 20 marks Investigations and possibleresults                       10 marks

   Management                                                 10 marks

50%

FINAL GRADE (S/N 1-8)

Examiners Commente and Examiners Signature:

NEUROLOGIC EXAMINATION:

CEREBELLUM

PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT

DONE

POORLY

DONE

GOOD

VERY GOOD

EXCELLENT

INSPECTION

Posture of limbs

Abnormal movements (tremors, chorea etc.) Gross deformity of limbs (contractures etc.) Gross wasting / hypenrophy (muscles)Fasciculation ’s (spontaneous / induced)

1

2

Examination for Nystagmus

(gaze evoked& spontaneous)

1

2

5

E xainination for Scanning epeecH and Dysarthria

2

3

COORDINATION and DYSMETRIA

•               Intention tremors

 Dvsdiadochokinesis                                                        

2

4

Lower Limb COORDINATION

•        Heel to Shin Test

2

DEEP TENDON REFLEX

•        ELLICITS PENDULAR KNEW TERM

1

2

4

5

GAIT ASSESSMENT

•             Broad based cerebellar Ataxia

•              Postural Tremor (Tremor of proximal muscuJature when weight bearing or fixedposture is attempted)

2

Composure and courtesy

1

2

3

4

5

SUBTOTAL

40 {50%J

Presents findings clearly, sequentially and correctly 10 marks

Differential did8 ‘l °• iS(ifl cludes most probable cause) 20marks Investigations and possible results                         10marfis

 Management                                                       10 marks

50 %

FINAL GRADE (S/N 1-9)

Examiners Comments (examiner must justify penalties):

Examiners Signature:

RESPIRATORY SYSTEM EXAMINATION

PEFORMANCE CHECK-LIST

S/N

PERFORMANCE / STEPS

NOT DONE

POORLY DONE

GOOD

VERY GOOD

EXCELLENT

1

A. INSPECTION

1.       Shape and symmetry of Chest, Scarification marks, Signs

of Respiratory Distress, Respiratory rate

2.      Patient environment: Looks out for presence of Sputum Bowl, IV lines in situ, Chest Tube in situ, Urethral catheter

1

2

3

4

5

B. GENERAL EXAMINATION

Digital clubbing, Finger staining, Weight Loss,Pedal Oedema, Lyrnphadenopathy

1

2

3

4

5

3

PALPATION

Trachea Position, Areas of Tenderness, Chest expansion,

Tactile vocal fremitus

1

2

3

4

5

4

PERCUSSION

Hand and finger positioning

Finger alignment along intercostal spaces (horizontal)

Symmetrical progression of percussion

& Lung zone coverage (DULL, STONY DULL, RESONANT,

” ““”’. RESONANT)

1

2

3

4

5

AtISCULTATlON

Symmetrical progression of auscultation

Degree of LUNG Zone coverage

Breath Sounds, Vocal fremitus, added sounds

1

2

4

5

Repeat examination posteriorly or ask to examine posteriorly Overall Attention To Sequence of examination

1

2

3

4

5

7

Composure and Courtesy

1

2

3

4

5

SUBTOTAL

35 |50%]

Presents findings clearly, sequentially and correctly 10 marks Differential diagnosis(includes most probablecause) 20 marks Investigations and possibleresults                          10 marks

Management                                                      10 marks

50 %

FINAL GRADE (Total S/N 1-8)

Examiners Comments and Signature:

CARDIOVASCULAR SYSTEM EXAMINATION

PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT

DONE

POORLY

GOOD

VERY GOOD

EXCELLENT

GENERAL EXAMINATION

Inspection, Patients general condition: position, dyspnoea, pain,

Anasarca, Head Bobbing

Patient’s environment: presence of IVs, oxygen, Sputum Bowl. Hands: Pallor, Clubbing, Splinter haemorrhages, Capillary refi11time. Janeway lesions / Oslers nodes

Cvanosis. Bipedal Oedema

1

2

4

2

Examination of the Radial Pulse: Rate, Rhythm, Volume.

Character, Collapsing Synchrony, Vessel wall.

2

4

4

Examination of the Jugular Venous Pressure (JYP)

Palpation of Liver (hepatojugular reflex)

1

2

3

4

5

5

PRECORDIUM — INSPECTION

1

2

3

4

5

6

PRECORDIUM – PALPATION

Location of Apex beat, Tracheal position when Apex is displaced, thrills and heaves

2

4

7

PRECORDIUM – AUSCULTATION

Heart sounds / murmurs.

Manoeuvres to increase intensity of murmurs Auscultation of hung bases

4

8

Asks to Check blood pressure and overall anention tosequence

I

2

4

5

9

Composure and Courtesy

1

2

5

SUBTOTAL

50%

10

Presents findings clearly, sequentially and correctly 10 marks Differential diagnosis(includes most probable cause) 20 marks Investigations and possible results                          10  marks

Management                                                      10 marks

50%

FINAL GRADE(S/N 1-10)

Examiners Comments and Signature

3″ ,4″ and 6″ CRANIAL NERVES ASSESSMENT

FORMAT

PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT

DONE

POORLY

DONE

AVERAGE

WELL

DONE

EXCELLENT

Inspection of face stands at Arm’s length

1

2

3

4

Examine Frontalis muscle over activity

1

2

Examination of eye movements in all directions of GAZE- Nvstagmus & Diplopia assessed

2

Test for Eye lid Fatigability

2

4

5

Examines the pupils light reflex ( focusing on efferent arc-

consensual response)

2

4

Composure and Courtesy

2

SUBTOTAL

30 (50%)

Presents findings clearly, sequentially and correctly        10 marks

Differential diagnosis(includes most probable cause}      20 marLs Investigations’ and possible results                             10 marLs

   Management                                                        10 marLs

50%

FINAL GRADE (SfN 1-7)

Examiners Comments Signature:

FACIAL (7TH) CRANIAL NERVE EXAMINATION

PERFORMANCE CHECK-LIST

PERFORMANCE / STEPS

NOT

DONE

POORLY

DONE

GOOD

VERY GOOD

EXCELLENT

1

Inspection of face

2

3

4

2

Examination of Frontalis

4

Examination of Orbicularis Oculi

2

3

4

Examination of Buccinators

2

3

4

5

Examination of Orbicularis Oris

1

2

3

5

Examination of Platysma

2

3

4

5

Tests for Hyperacusis

2

3

4

Tests for taste anterior 2/3rds of Tongue

2

9

Composure and Courtesy

2

3

4

SUBTOTAL

45 |50%]

10

Presents findings clearly, sequentially and correctly 10 marks Differential diagnosis(includes most probable cause) 20 marks Investigations and possible results                         10marks

  Management                                                     10 marks

50 %

FINAL GRADE (S/NI-10)

Examiners Comments and Signature: