ICS-Neurologic Exam Flashcards
A 65 year old man with a history of diabetes and hypertension presents with difficulty speaking, right face and right arm weakness. What physical exam maneuvers would you like to do on this patient?
“No ifs, ands, or, buts”. Object identification.
What to ask on mental status in a screening exam of a younger person w/o cognitive complaints.
Attention & language (during history), memory (John Brown, 42 Market St., Chicago, IL, repeat in 5 minutes). Visuospatial function (clock face), Executive function (name as many animals as possible in a minute, should be 10+).
Patient presents with visual complaints in a screening exam. What physical exam tests will you do?
Visual acuity card. Visual fields (covering one eye, how many fingers did I hold up?). Fundoscopic exam (CN II).
What are you testing for with double simultaneous stimulation?
CN II: Neglect and absolute field cut.
What physical exam test can you do to test CN II and III at the same time?
Pupillary light reflex and swinging flashlight test. Afferent = CN II. Efferent = CN III, parasympathetic & sympathetic.
What test is specific for pupillary afferent defect?
Swinging light reflex. When you shine the light in the eye that had optic neuritis, not enough light gets in and both pupils get larger.
What are you looking for when you test all cardinal directions? What nerves is this testing?
Slow tracking: looking for nystagmus and how far eyes are moving (symmetrical when moving?). Saccade: look at nose and finger repeatedly. This is testing CN III, IV and VI.
How do you test CN V?
Broken Q tip to different regions supplied on the face. As patient to qualify difference they feel on each side of the face.
How do you test CN VII?
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How do you test CN IX and X?
Say “Ah” and gag reflex (make sure to touch each side for gag reflex)
How do you test CN XI?
Shrug shoulders. Turn head each way.
How do you test CN XII?
Stick tongue out, move it side to side.
What symptoms will manifest during the MSK exam of a patient with an upper motor neuron lesion?
Flexors are stronger than extensors.
What muscles do you test in the musculoskeletal exam?
Deltoid (C5), Biceps & Extend Wrist (C6), Triceps & Flex Wrist (C7), Abductor Pollicis (C8) and Finger Abduction (T1). Hip flexion, knee flexion/extension, ankle plantar/dorsiflexion.
How do you test the posterior column in a patient?
VIBRATION: Tuning fork on bone in big toe and progressively move up leg until patient feels vibration. Tuning fork on bone of finger. PROPRIOCEPTION: close patient’s eyes, isolate DIP joint of patient’s fingers and toes with your fingers to the side of the joint and ask patient to tell you if you are moving his finger up or down.
