With numbness and tingling, the key discriminating features are the characteristics of the sensory

changes and especially the distribution of sensory deficit.

A)Main questions during interview

Where on your body did you feel these changes? Point to them, trace them, are they like the other side
of your body?
Describe the sensation, how it changed, and in the other area how the sensation changed
Have you noticed any weakness in your leg?
How much do you drink? Males, last time you had 5 drinks a day. Females, 4 drinks a day.

B)Bonus
Origin [When it first happened]
Duration [How long it happened
Aggravating factors
Relieving factors
Timing [Does it come and go, spreading]
Severity [Rate it]
History of previous trauma
Any other conditions that they have
Medications
Smoking
Family history
Allergies
Hospitalizations

Review of systems
Treated for cancer -> Neuropathy from chemo
MS
Immunosuppressor -> Neuropathy from meds
Infections -> HIV, syphilis, TB
Surgery in spine or aorta -> Possible operative trauma
Vegetarian -> B12 deficiency
Sexual partners -> HIV
Diabetes -> Diabetic neuropathy
Toxic chemicals

C) PE

Check gait and make them walk across room

Romberg test [Close their eyes and stand still]

Actively Check tone and bulk & strength in arms legs :

1) shoulder abduction
2)Elbow flexion + extension
3)Wrist flexion + extension
4)Hip flexion
5)Knee flexion + extension
6)Foot plantar flexion/dorsiflexion

Check reflex:
1)Biceps [C5,C6] Anterior elbow strike with finger in the way
2)Triceps (C6-C7) Posterior of elbow strike
3)Brachioradialis (C5-C6) 1-2 inch above Wrist strike
4)Patellar [L2,L3,L4] Knee strike
5)Achilles [S1] Heel strike

Check sensation with cotton swab of specific area

Check vibration using tuning fork over ankle or toe

Hold their great toe and make them close their eye -> move it up or down and make them guess where
it is

Finger to nose and heel to shin tracking

Plantar response