The following tips are designed to help trainees or inexperienced neurologists to reach the right answer in a time-efficient manner. The tools required are easily carried. The list is personal and idiosyncratic; other experienced neurologists may feel they can improve on it. Some tips are very simple and most trainees will know them already, but experience shows that not all do. Expert clinicians use the examination to test hypotheses and solve problems: for this to work you need to ‘think on your feet’ and adapt the examination to the circumstances. This includes confirming abnormalities in detail when a screening test is positive. Likewise, any unexpected abnormality on examination must be confirmed, with its relevance being determined in the context of the history and the overall clinical presentation. Hold up a red object such as the top of a hatpin and cover each of the patient’s eyes in turn. Ask whether the colour seems washed out or dulled in one eye compared with the other. Clearly, this detects asymmetrical colour desaturation. Its advantages are that it is quick and reasonably sensitive. It can be included in the examination with minimal loss of time even when the chance of a positive response is quite low. Naturally, a positive response or a history suggesting that optic neuropathy is likely should provoke a more detailed assessment for evidence of optic neuritis. Other signs of old optic neuritis include the following: 1. Pale optic discs (subtle changes may be difficult for the inexperienced). 2. Impaired colour vision when tested formally with Ishihara charts (more time-consuming). 3. Afferent pupillary defect (quick, effective and well known, but subtle changes may be difficult to see). 4. Subtle central or paracentral field defects (not easy to detect at the bedside by ordinary methods). Testing visual fields with a laser pointer can be helpful. …

中文翻译：

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给学员的提示：临床检查的一些实用技巧

以下提示旨在帮助受训者或缺乏经验的神经科医生以省时的方式找到正确的答案。所需的工具很容易携带。这份清单是个人的和特殊的；其他有经验的神经科医生可能会觉得他们可以改进它。一些技巧非常简单，大多数学员已经知道，但经验表明并非所有人都知道。专家临床医生使用检查来检验假设并解决问题：为此，您需要“独立思考”并根据情况调整检查。这包括在筛查测试呈阳性时详细确认异常。同样，必须确认检查中出现的任何意外异常，并根据病史和整体临床表现确定其相关性。举起一个红色物体，如帽子的顶部，依次遮住患者的每只眼睛。询问与另一只眼睛相比，一只眼睛的颜色是否看起来褪色或暗淡。显然，这检测到不对称的颜色去饱和。它的优点是速度快且相当灵敏。即使在积极响应的机会非常低的情况下，它也可以以最少的时间损失包含在检查中。当然，如果阳性反应或病史提示可能存在视神经病变，则应该对视神经炎的证据进行更详细的评估。陈旧性视神经炎的其他迹象包括： 1. 苍白的视盘（对于没有经验的人来说可能很难有细微的变化）。2. 使用 Ishihara 图表进行正式测试时色觉受损（更耗时）。3.传入性瞳孔缺陷（快，有效且众所周知，但可能很难看到细微的变化）。4.细微的中心或旁中心场缺陷（在床边用普通方法不易发现）。使用激光笔测试视野会有所帮助。…