-basically to be rolled out when a more global presentation of weakness, paresthesias where DDx might include polyneruopathy, ALS, myastenia, myopathy

BULBAR:

• Dysphonia/Dysarthria (noticed any change in voice/speach)
• Dysphagia (choking on foods, coughing at meal times, last one to finish eating at a family dinner)
• Diplopia (blurry/double vison – especially with reading, watching TV, driving = sustained gaze)

MOTOR:

• Muscle twitches (fasciculations) – demonstrate for patient how an isolated muscle moves
• Exercise tolerance – taken through exercise history. What done for exercise? How different now vs. before. Has this gone down?
• Myalgia (exertional)
• Cramps (like a “charlie horse”) – during the day or nocturnal only?
• Weakness (differentiate from pain)   
•            Legs (e.g. going up and down stairs, getting out of chairs, able to jog)
•            Arms (e.g. take a stack of dishes and put them on the top shelf)
• Muscle (not mental) fatigue – variant question on exercise tolerance. If they do have muscle fatigue does it get better after a brief rest?
• Pigmenturia – has urine ever turned brown or black like tea or coke
• Myotonia – cramp in your hands where it is hard to let go of something

SENSORY:

• Balance – tripping or falling more than usual? Had any falls in the last months?
• Paresthesia(tingling) , Numbness – hands, feet, timing
• Burning/shooting pain

AUTONOMIC

• Erectile dysfcn
• Postural hypotension
• Palpitations
• Hypo/hyperhydrosis – changes in the way you sweat? very sweaty or very dry skin?
• Dry eyes (dry to the point it feels like something is in your eye?)
• Dry mouth
• Bladder  (retention/urgency/incontinence)
• Bowel (severe constipation/incontinence)

OTHER RELATED

• Migraines/headache
• Rashes
• Arthralgias/arthritis
• Cardiovascular complaints
• Systemic B symptoms