Eyes: pupils, redness, acuity, fields, fundoscopy to look for papilloedema (↑intracranial pressure) or haemorrhages
Feel sinuses and temporal arteries for pulsation/tenderness
Neck stiffness: passively turn head side to side and touch ears to shoulder
Brudzinski’s sign (passive flexion of neck causes involuntary flexion of knee and hip)
Kernig’s sign (pain on passive knee extension with hip fully flexed)
Motor neuro exam: tone, power, reflexes
Cranial nerves exam
FBC, CRP, U&Es
ESR (if >55 years)
Blood cultures if pyrexial
Test your knowledge
You assess a patient with a sudden onset severe headache, that reached its peak within 60 seconds. What are you concerned about and which investigations would you request?
A patient presents with tearing chest pain, radiating from the front of their chest to the back. What are you concerned about? Are there any clinical signs that may support the diagnosis? Which investigation would be definitive?
You assess a diabetic patient with abdominal pain. You suspect DKA. What are the diagnostic criteria? What is the initial management?