Neuro

Question 1

5 Components of Neuro Assessment

Answer 1

1. Mental Status
2. Cranial Nerves
3. Motor
4. Sensory
5. Reflexes

Question 2

Mental Status Examination: 5 Components

Answer 2

1. Appearance and behavior
2. Mood and affect
3. Speech and thought processes
4. Thought content and perceptual abnormalities
5. Sensorial, cognitive, and intellectual functioning

Question 3

CN I

Answer 3

Olfactory (sensory)
*smell

1. Test non irritating smells

Question 4

CN II, III

Answer 4

Optic and Oculomotor

• Visual Acuity (sensory)
• visual fields, ocular fundi
• pupillary reactions

II.
1. Test visual fields by confrontation

II & III

2. size and shape of pupils
3. pupillary reactions to light
4. Near response (pupillary constriction: pupillary constrictor muscle, convergence: medial rectus muscles, accommodation: ciliary muscle)

Question 5

CN III, IV, VI

Answer 5

III. Oculomotor (motor)
*pupillary reactions

IV. Trochlear (motor)
VI. Abducens (motor)
*extraocular movements (6 cardinal directions)

NOTE: diplopia, nystagmus, ptosis

Question 6

CN V

Answer 6

Trigeminal (motor)

• corneal reflexes, facial sensation, jaw movements
• voice

1. palpate temporal and masseter muscles
2. sharp/dull on forehead, cheeks, chin
3. corneal reflex (not appropriate if contact lenses in place)

Question 7

CN VII

Answer 7

Facial (motor/sensory)

• facial movements
• voice

1. Raise eyebrows
2. Frown
3. Close eyes tightly and resist opening
4. Show upper/lower teeth
5. Smile
6. Puff out both cheeks

Question 8

CN VIII

Answer 8

Acoustic and Vestibular (sensory)
*hearing

1. whisper test
2. if positive, Rinne (air and bone conduction) and Weber (lateralization) tests)

Question 9

CN IX, X

Answer 9

IX. Glossopharyngeal (sensory/motor)
X. Vagus (sensory/motor)
*swallowing & rise of palate, gag reflex
*voice & speech

1. Note voice quality
2. Swallowing difficulty?
3. Say “ah” & note movement of soft palate and uvula
4. Gag reflex if patient is willing

Question 10

CN XI

Answer 10

Spinal Accessory (motor)
*shoulder/neck movements 

1. Shrug shoulders
2. Rotate neck against resistance, both directions

Question 11

CN XII

Answer 11

Hypoglossal (motor)
*tongue symmetry, position, movement

1. Word articulation
2. Protrude tongue
3. Move tongue side to side
4. If ambiguous, push tongue against inside of each cheek as you palpate each cheek

Question 12

Brudzinski Sign

Answer 12

Flex neck. Flexion of hips and knees is positive.

Question 13

Kerney Sign

Answer 13

Flex patient’s leg at hip and knee, then extend leg to straighten knee.

Pain and increased resistance to extension are positive. Discomfort is normal.

Question 14

Nuchal Ridigity

Answer 14

Flex neck forward using hands behind head until chin touches chest

Neck normal supple

Question 15

Straight Leg Test

Answer 15

Evaluates for lumbosacral radiculopathy

Raise patient’s relaxed straightened leg
Positive if pain radiates into ipsilateral leg

Question 16

Asterixis

Answer 16

Sign of metabolic encephalopathy

Question 17

Doll’s Eyes Movements

Answer 17

Oculocephalic Reflex

Hold eyelids open
Move head to one side
Eyes should move to the opposite side

If reflex present, brain stem intact

Question 18

Oculovestibular Reflex

Answer 18

HOB at 30 degrees
Ice water injected into ear
Intact brainstem: eyes drift toward irrigated ear

Question 19

Decorticate Rigidity

Answer 19

Upper arms flexed tight to sides, elbows, wrists, fingers flexed.

Legs extended and internally rotated. Feet plantar flexed.

Question 20

Decerebrate Rigidity

Answer 20

Jaws clenched.

Neck extended.

Arms addicted and stiffly extended at elbows. Forearms pronated. Wrists and fingers flexed.

Legs stiffly extended at knees. Feet plantar flexed.