Basic Neuro Exam

Question 1

Cranial Nerve Functions

Answer 1

Some
Say 
Marry
Money
But 
My 
Brother
Says 
Big 
Brains 
Matter
More

Question 2

Cranial Nerves with Parasympathetic function

Answer 2

Optic - pupillary constriction
Facial - tears/saliva
Glossopharyngeal - saliva, carotid reflex
Vagus - secretion of digestive enzymes, carotid reflex, involuntary action of heart, lungs, digestive tract

Question 3

CN I: Olfactory

Answer 3

Anosmia - loss of smell
Test - whatever is on hand
“CN I grossly intact; detect smell”

Question 4

Aniscoria

Answer 4

Pupil asymmetry - present in up to 20% of population

Consistent in varying light = normal

Question 5

Miosis

Answer 5

pupil constriction

Parasympathetic stimulation, light, looking at near object

Question 6

Mydriasis

Answer 6

Pupil dilation

Sympathetic stimulation, dark, looking at far object

Question 7

Pupillary reaction

Answer 7

Direct - light on retina (afferent CN II) = constriction of ipsilateral pupil (efferent CN III)
Indirect - light on retina (afferent CN II) = constriction of contralateral pupil (efferent CN III)

Question 8

Pupillary reaction to accommodation

Answer 8

Pupils constrict when focused on near object

Question 9

Relative afferent pupillary defect

Answer 9

Marcus Gunn pupil
due to optic nerve or severe retinal disease
Direct response absent, indirect response intact (CN III)
DDx - optic neuritis, severe glaucoma, retinal detachment, retinal infection

Question 10

Intact to accommodation by not light

Answer 10

Argyll Robertson - Prostitute Pupil
Hallmark of neurosyphilis
Pupils typically small at baseline, nonresponsive to light, constrict for accommodation

Question 11

Horner’s syndrome

Answer 11

Oculosympathetic paresis
Ptosis - droopy eyelid
Miosis - pupil constricted
Anhydrosis - no sweat on that side of face
DDx - carotid a. dissection, pancoast tumor, nasopharyngeal tumor, brachial plexus injury

Question 12

CN IV palsy

Answer 12

Inability to bring eye in and down
Leads to vertical diplopia with reading/near vision
Tilt head AWAY from affected eye

Question 13

Saccades

Answer 13

Normal jumping movements of eye with voluntary scanning

Question 14

Nystagmus

Answer 14

Slow drift away from focus with FAST* beat correction back to focus
Cerebellar - lateral; fast phase toward lesion side
Vertical - lesion of midbrain

Question 15

Hypersensitivity to sound

Answer 15

CN VII innervates stapedius

Question 16

UMN lesion to face

Answer 16

facial drooping sparing forehead

Question 17

LMN Lesion to face

Answer 17

facial drooping including forehead

Question 18

Conductive hearing loss

Answer 18

Inefficient conduction from outer ear to ear drum to ossicles

Question 19

Sensorineural hearing loss

Answer 19

Damage to inner ear apparatus or CN VIII

Question 20

Rinne test

Answer 20

vibrating handle against mastoid until sound fades; move to meatus
Positive: louder sound on air conduction

Question 21

Weber test

Answer 21

vibrating handle against midline of skull
Positive: sound equal on both ears
Louder - one ear lateralizing

Question 22

C2

Answer 22

back of head

Question 23

C6

Answer 23

thumb

Question 24

C7

Answer 24

index/middle finger

Question 25

C8

Answer 25

ring/little finger

Question 26

T1

Answer 26

anterior axilla

Question 27

T4

Answer 27

nipple

Question 28

T10

Answer 28

umbilicus

Question 29

L3

Answer 29

medial knee

Question 30

L4

Answer 30

medial malleolus

Question 31

L5

Answer 31

Dorsum 3rd MTP joint

Question 32

S1

Answer 32

Lateral Heel

Question 33

S2

Answer 33

Popliteal fossa

Question 34

S3

Answer 34

Ischial tuberosity

Question 35

S4

Answer 35

Perianal area

Question 36

Stereognosis

Answer 36

Identification of objects by touch | Inability - tactile agnosia (parietal lobe)

Question 37

Graphesthesia

Answer 37

write letter on palm

Question 38

Two Point Discrimination

Answer 38

``` Tongue 1 mm Lips 2-3 mm Fingers 2-4 mm Dorsum of fingers 4-6 mm Palm 8-12 mm Back of hand - 20-30 mm Dorsum of foot - 30-40 mm ```

Question 39

Deep Tendon Reflexes

Answer 39

``` Biceps C5/C6 Brachioradial C5/C6 Triceps C6/C7*/C8 Patellar L2/L3/L4 Achilles S1*/S2 ```

Question 40

DTR Scoring

Answer 40

``` 0 - no response 1 - sluggish 2 - active/expected 3 - brisker 4 - hyperactive, clonus ```

Question 41

Motor assessment

Answer 41

``` 0 - no movement 1 - trace movement 2 - full ROM w/out gravity 3 - full ROM against gravity 4 - full ROM against gravity with resistance 5 - Normal ```

Question 42

Upper extremity weakness

Answer 42

damage in C-spine or higher

Question 43

Lower extremity weakness

Answer 43

damage to L-spine/sacrum or higher