Nero Exam Flashcards
mental status
- Level of alertness
- Appropriateness of responses
- Orientation to person, place, time
- Congruency of mood
Olfactory - smell
• Use familiar & non-irritating odors
• Have pt compress 1 nostril & sniff through the other
• A person normally perceives odor on each side & can often identify them
• Loss of smell can occur w/ sinus conditions, head trauma, smoking, aging, use of
cocaine & Parkinson’s disease
Optic - visual acuity pocket card, visual fields by confrontation, light reaction
• Visual acuity w/ Snellen eye chart – Position pt 20ft from chart
o Legally blind at 20/200
• Test visual fields by confrontation – wiggling fingers at edge of field asking pt if they see
it
o Blindness = homonymous & bitemporal hemianopsia, quadrantic defect, etc.
• Light Reaction – shining light into eye checking for direct reaction & consensual
reaction in other eye. Sensory CN II, constriction CN III
Oculomotor, Trochlear, Abducens - cardinal signs of gaze, light reaction, consensual pupillary dilation/constriction, near reaction, pupillary constriction, extra ocular mm
• Cardinal Signs of Gaze – 6 eye mov’t testing CN III, IV, VI (LR6, SO4, R3)
• Look for loss of conjugate mov’t leading to diplopia. Determine whether it’s monocular
or binocular if present
• Check for nystagmus (direction of the quick component)
• Near Reaction – pt shift gaze from far object to near one, pupils constrict. Tests CN III
and accommodation
• CNIII – check eyelid for ptosis
Trigeminal - sensory and motor
Motor
• Palpate the temporal & masseter m & ask pt to clench their teeth. Note the strength of
m contraction. Ask pt to move jaw side to sided testing lateral pterygoids.
o u/l weakness – CNS pontine lesion
o b/l weakness – cerebral hemispheric disease since b/l cortical innervation
Sensory
• Test forehead, cheeks, jaw on each side for pain sensation. Pt eyes should be closed.
Use a safety pin or other sharp object, occasionally substituting blunt end for point as
stimulus. Ask pt if it is sharp or dull & be sure to compare sides.
• If abnormality found, confirm by temp sensation. Touch skin w/ either hot or cold
stimuli & ask pt to report which they feel.
• Light touch tested by using a fine wisp of cotton & asking pt to respond when you
touch their skin
o CNS patterns of stroke –facial & body sensory loss on same side but from
contralateral cortical or thalamic lesion; ipsilateral face but contralateral body
sensory loss in brain stem (i.e. L cortical or thalamic lesion = R facial/body sensory
loss; L brain stem lesion = L facial & R body sensory loss)
o Isolated facial sensory loss in peripheral in disorders like trigeminal neuralgia
Facial - mm of facial expression
Inspect face during rest & conversation to note any asymmetry & observe any ticks or
other abnormalities
Motor – facial expression:
• Raise both eyebrows, frown, close both eyes tight so that you cannot open them, test
muscular strength by trying to open them, show both upper & lower teeth, smile, puff
out both cheeks
o Bell’s palsy – affects both upper & lower face, loss of taste, hyperacusis, ↑ or ↓
tearing, CN7 lesion
o Central lesion – affects mainly lower face
o Widened palpebral fissure and nasolabial fold indicative of weakness.
Sensory – taste for salty, sweet, sour & bitter substances on the ant 2/3 tongue
Parasympathetic – secretion of saliva & tears
vestibulocochlear
Cochlear division – hearing
• Whisper test or audiograms – check if hearing loss. If present, do Weber and Rinne
tests
• Weber’s test (sensorineural damage/lateralization) – strike a tuning fork and place on
the middle of the forehead, diminished tone in the affected ear indicates sensorineural
loss. A louder tone in the affected ear indicates conductive deafness (disease in the
ossicles in the middle ear).
• Rinne’s test (air & bone conduction) – Strike a tuning fork and place it on the mastoid
process. When the tone is gone, place it over the external auditory meatus, the
patient should hear the tone again, if not, conduction deafness is present.
Vestibular division – balance
• Rarely included in usual neuro exam
glossopharyngeal
CN IX
• Motor – voluntary m for swallowing & phonation
• Sensory – sensation of nasopharynx, gag reflex & taste for post 1/3 tongue
• Parasympathetic – secretion of salivary glands & carotid reflex
• Testing:
o Tasting – CN IX tested w/ CN VII
o Motor function & gag reflex of CN IX tested w/ CN X
vagus
CN X
• Motor – voluntary m for swallowing & phonation
• Sensory – sensation behind ear & part of external ear canal
• Parasympathetic – secretion of digestive enzymes, peristalsis, carotid reflex,
involuntary action of heart, lungs & digestive tract
• Testing:
o Inspect palate & uvula for symmetry
Fails to rise w/ b/l lesion, deviate to normal side w/ u/l lesion
o Observe for difficulties w/ swallowing
o Test for gag reflex – absence = lesion CN IX or perhaps X
o Evaluate for presence of nasal tone & hoarseness of voice (may be presenting sx)
o Water Test – Have pt swallow water. Abnormal if coughing/choking occurs. High risk
if volume of water returned to cup is less than original volume and no swallowing
was observed or palpated.
spinal accessory
Motor –head & shoulder movement & some actions for phonation
• Look from behind for fasiculations & compare side to side
• Check for trapezius m strength by shrugging shoulders against resistance
o Trap weakness w/ atrophy & fasciculations = peripheral n disorder. In paralysis, the
shoulder droops, & scapula is displaced downward & laterally
• Check SCM m strength by turning head to each side against resistance (Contraction of
L SCM turns head to R).
hypoglossal
Motor –tongue movement for lingual speech sound articulation (“L, T, D, N”)
• Inspect tongue for symmetry, tremors, & atrophy
• Check tongue movement towards nose & chin
• Check tongue strength when pressed against cheek
• Evaluate quality of lingual sounds
• CN XII lesion results in tongue deviation to the weak side (“licks its wounds”).
mm strength UE
- Shoulder shrug – trapezius (CNXI)
- Flexion (C5,6) & extension (C6,7,8) at elbow
- Flexion and extension at wrist (C6,7)
- Hand grip (C7,8,T1)
- Finger abduction (C8,T1)
- Opposition of thumb (C8,T1)
mm strength LE
• Hip – Flexion (L2,3,4 – psoas and iliacus), extension (S1 – glut max), adduction (L2,3,4)
& abduction (L4,5,S1)
• Knee – Flexion (L4,5,S1,2 –hamstrings) & extension (L2,3,4 –quads)
• Ankle – Plantar (S1 – gastrocnemius ) & dorsiflexion (L4,5 – tibialis anterior)
tandem gait
walking heel to toe in a straight line
may reveal ataxia
walk on toes then heels
sensitive tests, respectively, for plantarflexion &
dorsiflexion of ankles, as well as balance
May reveal distal m weakness in legs. Inability to heel-walk –sensitive test for CST
damage
