85 Bulbar palsy Instruction Examine this patient’s cranial nerves. Ask the patient a few questions. Test this patient’s speech. Salient features History • Ask the patient about nasal regurgitation, dysphagia • Slurring of speech (patient may sound as if they have been intoxicated) • Difficulty in chewing and swallowing • Choking on liquids. Examination • Nasal speech lacking in modulation and great difficulty with all consonants • Wasting of the tongue with fasciculations (see Fig. 69.1) • Weakness of the soft palate: ask the patient to say ‘aah’ • There may be accumulation of the saliva • Fasciculation elsewhere (particularly trunk muscles). Proceed as follows: • Check the jaw jerk (normal or absent) • Tell the examiner that you would like to do the following: • Check gag reflex Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Wallenberg’s syndrome (lateral medullary syndrome) Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Bulbar palsy Full access? Get Clinical Tree
85 Bulbar palsy Instruction Examine this patient’s cranial nerves. Ask the patient a few questions. Test this patient’s speech. Salient features History • Ask the patient about nasal regurgitation, dysphagia • Slurring of speech (patient may sound as if they have been intoxicated) • Difficulty in chewing and swallowing • Choking on liquids. Examination • Nasal speech lacking in modulation and great difficulty with all consonants • Wasting of the tongue with fasciculations (see Fig. 69.1) • Weakness of the soft palate: ask the patient to say ‘aah’ • There may be accumulation of the saliva • Fasciculation elsewhere (particularly trunk muscles). Proceed as follows: • Check the jaw jerk (normal or absent) • Tell the examiner that you would like to do the following: • Check gag reflex Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Wallenberg’s syndrome (lateral medullary syndrome) Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join