ABSTRACT
4. General examination
Start with the arms: look for a ‘pill-rolling’ resting tremor and then check tone. There may be lead-pipe rigidity and, if tremor is superimposed, cogwheel rigidity.
Next do a glabellar tap. To do this, repeatedly tap the patient’s mid-forehead between the eyebrows with the tip of your finger. In people experiencing parkinsonian side-effects, the patient may demonstrate a glabellar tap sign, in which he/she continues to blink. False positives are fairly common, however.
Examine the tongue. Ask the patient to stick out the tongue for a few seconds. Look for any fasciculation
Posture. Ask the patient to stand. Observe whether he/she is stooped (parkinsonian).
Check for truncal stability. Slightly nudge the patient forwards and backwards and from side to side. In parkinsonism there is a tendency for the patient to lose their balance because of slow correcting movements.
Check the limbs for cogwheel rigidity
Lastly ask the patient to write a sentence. Observe for micrographia.
