[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient presented with an abnormal gait.  Please examine their cerebellum to determine why, then discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191747″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]

  1. How do you account for this patient’s symptoms?
  2. How would you like to investigate this patient next?
  3. What causes of unilateral cerebellar pathology can you identify?
  4. What causes of bilateral cerebellar pathology do you know of?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has a normal cerebellar examination with no clinical signs.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]Examination of the normal cerebellum should involve the following assessments, tested in a systematic fashion:

Inspect

Observe the patient’s limbs while seated.  Ask the patient to hold out their arms and examine for any drift.

Dysdiadochokinesis

Alternating clapping the palmar and dorsal surfaces of one hand on the other, looking for incoordination.

Intention tremor

Ask your patient to repeatedly touch their nose then your finger, held at arm’s length.  You are looking for an intention tremor that increases in amplitude as the patient nears your hand, or past pointing.

Speech

Ask your patient to say the words “British constitution” and “baby hippopotamus” – you are screening for a staccato speech pattern.

Nystagmus

One to three beats is normal.  Sustained beats of nystagmus suggest pathology.

Gait

Patients with cerebellar pathology show impaired gait, as though drunk.  This is broad based or staggering.  They may also show impaired heel-shin coordination, and will be unable to conduct a heel-toe walk.

Truncal stability

Ask your patient to close their eyes then very carefully challenge their posture with a gentle push, as shown in the video.  Do not injure your patient – instant fail![/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”To complete my examination I would like to examine the rest of the patient’s neurological system.  This patient has a normal cerebellar examination.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]