Basic Neuro Exam OSCE Flashcards
Use this protocol for general neuro screening
- mental status
- CN
- motor
- sensory
- reflexes
What does mental status include?
level of alertness, appropriateness of responses, orientation person place time
Testing Olfactory CN I
- use familiar and non irritating odors
- pt close one nostril and smell thru other
Testing Optic CN II
- visual acuity - snellen eye chart, 20 ft away
- visual fields - wiggle finger test
- light reaction - shine light, check direct constriction (CN II) AND consensual rxn (CN III)
Testing Oculomotor CN III
- ptosis
- Near rxn (accommodation)
- H test (normal = EOM intact)
- nystagmus
Testing Trochlear CN IV
SO4
- nystagmus
- H test (normal = EOM intact)
Testing Abducens CN VI
LR6
- nystagmus
- H test (normal = EOM intact)
Testing Trigeminal CN V
MOTOR
- palpate temporal/masseter m.
- move jaw side-side
SENS
- test forehead, cheeks, jaw pain sens (switch blunt end vs point end –> ask if sharp vs. dull)
- Corneal Reflex - take cotton swab and touch lateral to iris, CN V sensation (blinking absent both eyes w lesion), CN VII is blinking (blinking absent w ipsilat eye of lesion)
Testing Facial CN VII
Motor - raise eyebrows, squeeze eyes tight, puff your cheeks out, smile, puff your cheeks out
Sens- ant 2/3 tongue
Parasymp- secretions of saliva and tears
Bell’s Palsy vs. Central 7
Bells - upper and lower face
Central 7 - lower face
Testing Vestibulocochlear CN VIII
- Whisper test - stand 2 ft behind pt, exhale full breath then whisper combo 3 numbers/letters, ABNORMAL = 4/6 incorrect, confirm w weber and rinne if abnormal
- Weber and Rinne Test - sensorineural or conductive hearing loss, learning next semester
(Finger rub test is NOT mentioned in OSCE?? but in parrots lecture)
Vestibular division - balance (not typical w standard neuro exam)
Testing Glossopharyngeal CN IX
Motor - swallowing, phonation
Sens - nasopharynx, gag reflex, post 1/3 tongue
Parasymp - secretion salivary glands, carotid reflex
Testing Vagus CN X
- phonation
- swallowing
- gag reflex
- soft palate elevation (ahhhh w light, deviate ipsilat)
Testing Spinal Accessory CN IX
- traps - shrug against resistance (periph n disease = fasiculations, atrophy, weakness. paralysis = scapula down and out)
- SCM - head side-side against resistance
Muscle Strength Scale
0 = no muscle contraction 1 = barely detectable muscle contraction 2 = active movement, no gravity 3 = active movement against gravity 4 = active movement against gravity w some resistance 5 = active movement against gravity w full resistance w/out fatigue
Testing Major Muscle Groups (strength testing)
UE:
- shoulder shrug
- flex ext elbow
- flex ext wrist
- hand grip
- finger abduction
- opposition thumbs
LE:
- flex ext adduct hip
- flex ext knee
- plantar/dorsiflex ankle
Cerebellar Testing
- Rapid Alternating Movements (abnormal = dysdiokinesia)
- FNF
- HTS
Gait Testing
- Casual gait
- Tandem gait (heel to toe straight line, note ataxia)
- Heel walk then Toe walk (plantar/dorsiflexion)
- inability heel walk = CST damage - Hop in one place on leg (strength, cerebellar, position)
- Shallow knee bend one ach leg (hip ext, quads)
Romber Test
- feet together, close eyes 30-60 sec
- proprioception test
loss of balance eyes open = cerebellar ataxia
loss of balance eyes closed = + Romberg
Pronator Drift
- close eyes 20-30 sec, arms out, palms up, tap briskly downward
+ test = arm turns inward and down
normal = arm bounces back up after downward tap
Dermatomes
- pain and temp - spinothalamic
- position vibration - post columns
- light touch - both
more detail in OSCE
Hyperactive vs. Hypoactive Reflexes
Hyper - CNS lesion
Hypo - PNS lesion
Abdominal Reflex
T10-T12
- stroke towards umbilicus –> musc contract
Anal Reflex
S2- S4
- anal wink
- absent can indicate cauda equina
Plantar Response (Babinski)
L5- S1
- stroke plantar surface laterally, heel to toe direction
normal = plantarflexion abnormal = dorsiflexion
Kernig’s Sign
flex pt at hip and knee, straighten knee
+ sign = pain and inc resistance to extending knee
