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
