CNS EXAM

Question 1

First Step

Answer 1

Introduce and wash hands

Question 2

Step 2

Answer 2

Inspection: pt overall

apperance and bx
Mood 
Thoughts/Perception 
Speech 
Cognition Status

Question 3

How to inspect patient’s overall appearance and bx?

Answer 3

Checking LOC, posture/motor activity, grooming/hygeine, facial expression and affect

Question 4

How to inspect patient’s overall mood

Answer 4

check affect

Question 5

How to inspect patient’s overall thoughts & perceptions

Answer 5

checking though processes, thouhgt content, perception, insight and judgment

Question 6

How to inspect patients overall Speech?

Answer 6

checking quality, rate, volume, articulation, fluency and language

if fluency is abnormal, we will conduct aphasia testing

Question 7

How do we preform aphasia testing (4)

Answer 7

4 components

Word Comp: give pt a 3 stage command w/o pausing
ex: stand up, hop on 1 leg and say “dr b is the best professor ever”

Repitition: ask pt to repeat phrase “no ifs, ands, or buts”

Naming: ask pt to identify 2 different objects

Reading comp: show pt paper with task printed, ask pt to do that task

Writing: ask pt to write a sentence + give a specific noun to use in the sentence
Ex: “Write a sentence using the noun

Question 8

How do we inspect patients overall cognition status?

Answer 8

checking
orientation: time, place, person, event
Attention: spell 5 letter word backwords and forwards
New learning ability: 3 words repeated immediatly and then recalled 3 mins later
**need to set actual timer***
Higher function: draw a clock with all numbers, hands at 12:30

Question 9

CN 1 exam

Answer 9

Olfactory nerve

Have pt discern b/w two different smells

Question 10

CN 2 exam

Answer 10

Optic nerve
1. VA: using chart, both eyes seperatlely, then together

2. Check fundi - right hand, right eye to right eye

Question 11

In CN 2 exam what are we checking the fundi for?

Answer 11

assess for a-v anomilies, cotton wool spots, exudates, hemorrhage, optic disc margins and physiologic cupping

Question 12

CN 2 +3 exam

Answer 12

Optic + Occulomotor

Pupillary reaction-direct and consensual
Near reaction in each eye seperatley

Question 13

CN exam 3,4,6

Answer 13

Occulomotor, trochlear, abducens
Extra-occular movements + convergence
CORNEAL LIGHT REFLECTION-SHINE LIGHT IN EYE

Question 14

CN 5 exam

Answer 14

Trigeminal
checking v1,v2,v3 branches
Motor: palpatae masseter, temporal muscles b/l w clenched teeth

Sensory: preform light touch WITH PT EYES closed
pt says “now”
ask if sides feel different from e/o

Question 15

CN 7 Exam

Answer 15

Facial Nerve

Motor: frown, raise eyebrows, open smile, closed smile, eyes closed/resistance, puff cheeks

Question 16

CN 8 Exam

Answer 16

Acoustic
Preform Finger Rub
Preform RInne, Weber

Question 17

CN 9 Exam

Answer 17

Glossopharyngeal

Motor: observe pt swallow + state gag reflex is motor component

Question 18

CN 10 Exam

Answer 18

Vagus

Motor: use ext light source to observe rise of uvula as pt says “ahh”

Sensory: verbalize articulation + clarity of speech are assessed throughout exam

Question 19

CN 11 Exam

Answer 19

Spinal Accessory
Trapezii- instruct pt to shrug shoulders upward against resistance
SM-instructs pt to turn and push head against resistance of examniners hand

Question 20

CN 12 Exam

Answer 20

Hypoglossal
Motor: ext light source-observe tounge in neutral and protruded position

Asses tounge for fasciculation and deviation from midline

Motor: have pt push tounge against inner check and resist examiner push on outisde—preform b/l

Question 21

Sensory Specials-light tough

Answer 21

PREFORM B/L

UE: shoulders, med/lat forearm, thumbs, 5th finger
LE: front thighs, med/lat calves, great toes, little toes

Question 22

Sensory Specials- Sharp Dull

Answer 22

Preform B/L
UE: shoulders, med/lat forearm, thumbs, 5th finger
LE: front thighs, med/lat calves, great toe, little toe

Question 23

Sensory Specials-Vibratory Sense

Answer 23

pt eye closed
can you feel this, describe the sensation and ask pt to tell you when it stops

AT DIP of index finger AND great toe b/l

Question 24

Discrimination Exam (3 parts)

Answer 24

1. Stereognosis–pt eye closed, diff object for each hanf
   2: graphethesia- pt eye closed, diff #/letter for each hand

3: proprioception: have pt identify up or down at index finger and great toe b/l hold digit at DIP laterally

Question 25

Coordination Exam

Answer 25

RAM hands on thighs

Question 26

PTP movements

Answer 26

Finger to nose to clinician finger

-pt eye open, arms fully extended, clinicians finger moves 3 positions each side, pt must change hands for opposite side

Question 27

Deep Tendon Reflexes

Answer 27

UE: Bicep, Tricep, Brachioradialis
LE: Patellar, ANkle
CHECK ANKLE FOR CLONUS

Question 28

Romberg Exam

Answer 28

pt stand w feet together, arm at side, observe pt with eyes open, then closed

state observing for swaying and maintence of upright posture x 30 seconds

Question 29

Pronator Drift Exam

Answer 29

Pt stands w/ feet together, arms extended with palms up, eyes closed for 30 seconds,

state observing for arm drift w ext….tap forarms briskly and verbalize assesmnet for smooth and rapid return

Question 30

GAIT

Answer 30

BAREFOOT

TANDEM/STRAIGHT LINE
WALK AWAY FROM CLINICAN ON TOES
WALK TOWARD CLINICAN ON HEELS

SHOES/SOCKS OFF
LOWER LEG EXPOSED