Neuro

Question 1

Cranial nerves optic nerve

Answer 1

Nerve 2

• Pupillary reflexes and accommodation
• visual acuity with Snellen chart (6m away)
• visual fields
• offer fundoscopy
• colour vision

Eye movements are 3/4/6

Question 2

Which nerves do you test for vision

Answer 2

Cranial nerves 2,3,4,6

Question 3

How to test trigeminal nerve

Answer 3

Sensory:
- Light and sharp touch sensation in 3 divisions: ophthalmic, maxillary and mandibular
- offer corneal reflex (with cotton wool)

Motor:
- mastication muscles- temporalis, massater, pterygoids
- clench teeth while palpating, then open jaw vs resistance and jaw side to side

Question 4

How to test facial nerve

Answer 4

Nerve 7

Muscles of facial expression: frontalis, orbicularis oculi, orbicularis oris, buccinators

Eyebrow raise vs res
Eyes tight shut vs res
Show teeth and purse lips
Blow out cheeks vs res

Question 5

Is Rinne’s test normal in positive or negative test

Answer 5

POSITIVE RINNES TEST IS NORMAL (A>B)

Question 6

How to interpret Weber’s test

Answer 6

(If asked positive is normal but unsure)

If sound localises to one ear it means there is either:
- ipsilateral conductive hearing loss
- contralateral sensorineural hearing loss

Confirm with rinne’s test- ipsilateral negative rinne’s test

Question 7

How to test cranial nerves 9 10 and 12

Answer 7

9= glossopharyngeal, 10= vagus, 12= hypoglossal

G+V
- Ask to cough- equal
- Say aaaah- equal rise of the soft palate
- Offer gag reflex

Hypoglossal
- stick tongue out - look for wasting and fasciculation
- tongue side to side
- tongue in cheek vs resistance
If abnormal the tongue deviates TOWARDS the lesion

Question 8

How to test nerve 11

Answer 8

Accessory nerve

Trapezius and sternocleidomastoid

Shrug shoulders vs resistance
Turn head to one side vs res

Question 9

How to interpret tone

Answer 9

Increased:
- UMN= ‘clasp-knife’ spasticity= initial resistance then sudden reduction in resistance
- basal ganglia= ‘lead pipe’ rigidity= sustained resistance
- parkinson’s= ‘cog-wheel’ rigidity= tremor superimposed on lead pipe

Decreased:
- lower motor neurone/ cerebellar lesion

Question 10

Which nerves for patella and ankle jerk reflexes

Answer 10

Patella= L3/4

Ankle jerk= S1/2

Question 11

How to perform and interpret babinski reflex

Answer 11

Scratch lateral side of heel then underneath toes

Usually will flex, if big toe extends then UMN lesion

Question 12

How to perform and interpret romberg’s test

Answer 12

Stand with eyes open and feet apart

Feet together THEN close eyes

Unsteady= positive= sensory ataxia

If unsteady with eyes open= cerebellar lesion

Question 13

How to assess and interpret pronator drift

Answer 13

Extend arms with palms up and close eyes

If there is an UMN lesion the affected arm will pronate and fall (positive)