Makindo Medical Notes

Related Subjects: |Breast Anatomy and Examination (OSCE) |Shoulder examination(OSCE) |Testicular examination(OSCE) |Hernia Examination (OSCE) |Rectal examination (OSCE) |Liver Examination (OSCE) |Cerebellar Examination (OSCE)

👋 Introduction

• 🧼 Hand Hygiene: Wash your hands thoroughly.
• 🙂 Introduce Yourself: Confirm patient’s name & DOB, explain the exam.
• ✅ Consent & Comfort: Gain consent, ensure a quiet, well-lit room with privacy.

🛠️ Equipment Needed

• Gloves (optional)
• Pen & paper 📝 (for drawing tasks, documentation)
• No specialist equipment required

📊 Background: Key Cerebellar Signs

1️⃣ General Observation

• Posture & stance 🚶: look for ataxia, wide-based gait.
• Visible tremors, head titubation (nodding), irregular limb movements.

2️⃣ Cranial & Ocular Exam 👀

• Eye movements: Ask patient to follow finger in “H” → look for nystagmus (gaze-evoked vs primary position).
• Scanning speech: Ask patient to say “British Constitution” → listen for irregular syllabic rhythm.

3️⃣ Upper Limb Tests 💪

• Finger–nose: Dysmetria or intention tremor?
• Rapid alternating movements: Dysdiadochokinesia?
• Rebound phenomenon: Push down arms then release → overshoot?
• Pronator drift: Palms up, eyes closed → watch for drift.

4️⃣ Lower Limb Tests 🦵

• Heel–shin: Run heel down shin → smooth vs irregular zigzag.
• Gait: Wide-based, staggering?
• Tandem gait: Heel-to-toe walk → unsteadiness suggests cerebellar disease.
• Romberg: Eyes closed → if sway worsens = sensory ataxia (NOT cerebellar).

5️⃣ Additional Signs 🌟

• 🎯 Intention tremor → worsens near target.
• 🛌 Hypotonia → soft “floppy” resistance on passive limb movement.

6️⃣ Closure 🙏

• Thank patient, redress, wash hands 🧼.
• Present findings: “This patient has ipsilateral cerebellar signs (dysmetria, nystagmus, scanning speech) consistent with …”
• Suggest further: cranial nerves, full neuro exam, MRI brain, bloods (B12, autoimmune screen), genetic tests if inherited.

💡 OSCE Pearls

• Always differentiate sensory vs cerebellar ataxia with Romberg. • Test scanning speech explicitly (examiners love this!). • Nystagmus → note direction & type (gaze-evoked vs primary). • Compare sides carefully. • Kneel at eye level for heel–shin test.

⚠️ Common Pitfalls

• Confusing Romberg (sensory) with cerebellar ataxia.
• Rushing → missing subtle nystagmus or speech abnormalities.
• Not explaining manoeuvres → poor patient cooperation.

📚 References

• Stanford Medicine 25 – Cerebellar Examination
• Geeky Medics: Cerebellar Exam
• StatPearls – Cerebellar Signs