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How to take an exam > neuro exam > Flashcards

neuro exam Flashcards

1
Q

two ways of examining

A

gait –cranial nerves –upper
limbs –lower
limbs

cranial
nerves – upper
limbs –lower
limbs –gait

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2
Q

CN1 test?

A

Have you noticed a recent change in your sense of smell or taste?
* Use bedside products (orange, coffee, chocolate)
* Test each nostril separately

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3
Q

cn2 test?

A

visual acuity –visual
inattention –visual fields– light reflex accommodation– fundoscopy

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4
Q

how to test visual acuity

A

Test each eye separately
* (spectacles)
* Snellen chart
* Read newspaper / magazine / finger counting

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5
Q

how to test visual fields

A

Assessed by confrontation using
a red pin
* Test each eye separately

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6
Q

how to test light reflex

A

Direct and consensual
* Use a bright pen torch

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7
Q

how to test accomodation

A

Observed by watching the pupil
as gaze is shifted from a distant
object to a near object

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8
Q

LR6SO4

A

Lateral rectus - sixth nerve, abducens
Superior oblique- fourth nerve, trochlear

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9
Q

how to test cn5

A

Sensation to anterior 2/3 of tongue
* Motor fibres to muscles of mastication
* Jaw jerk
* Corneal reflex – not performed

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10
Q

cn7 test

A

Raise your eyebrows, shut your eyes tight and don’t let me open them,
puff out your cheeks, purse your lips and smile (show me your teeth)

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11
Q

cn8 test?

A

2 divisions - cochlear (hearing) and vestibular (balance)
* Test hearing- whisper a number on one ear whilst covering the other.
Ask them to repeat it.
* If a hearing abnormality is suspected, perform Rinne’s and Weber’s
tests (refer to handbook)

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12
Q

cn9 and cn10 test?

A

Open mouth wide and assess whether the uvula is in the midline at rest
* Say ‘aah’ and note any asymmetry of movement. The uvula will deviate
away from the side of a glossopharyngeal nerve palsy
* Ask whether any difficulty swallowing (gag reflex is not performed) – CN 9
afferent, CN 10 efferent
* (Ask to cough. A bovine (non-explosive) cough suggests a vagal nerve palsy)
* Note any hoarseness of the voice

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13
Q

cn11 test

A

Innervation to sternocleidomastoid and trapezius
* Sternocleidomastoid – ask to turn head again resistance and palpate
the contralateral sternomastoid muscle
Trapezius – ask to shrug shoulders against resistance

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14
Q

cn12 test?

A
  • Inspection at rest
  • Observe for tongue fasciculations
  • Ask to push tongue inside mouth against cheek
  • Move tongue side to side
  • Tongue is deviated towards the side of the lesion
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15
Q

UMN weakness may exhibit

A
  • Increased tone (spastic)
  • Pyramidal weakness
  • Brisk reflexes
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16
Q

LMN weakness may exhibit

A
  • Muscle wasting and
    fasciculations
  • Decreased tone
  • Depressed or / absent reflexes
17
Q

systematic approach to limb exam

A

Tone Power Reflexes Coordination Sensation

18
Q

how to test tone

A

Passively move each joint
* Hypertonia, normal or hypotonia
* Hypertonia – spasticity or rigidity
Spasticity – velocity dependent, UMN lesion
Rigidity – same irrespective of speed of movement, parkinsonism

19
Q

how to grade muscle power

A

0- no contraction,no movement
1- flicker or trace concentration
2- active movement with gravity eliminated
3- active movement with gravity
4- active movement against gravity and resistance
5- normal power

20
Q

approach to limb weakness

A
  • Unilateral or bilateral
  • Proximal or distal or global
  • Pyramidal weakness
  • Isolated lesion of nerve root or nerve or muscle
21
Q

how to test reflexes?

A
  • Present or absent
  • If present – depressed or increased (brisk)
  • Reinforcement
  • In lower limb examination – remember to examine the plantar reflex
    (lateral border of foot towards big toe)
22
Q

how to test limb coordination?

A

Upper limbs
Tremor and dysmetria
Finger-nose test
Fine motor skills
Rapid alternating hand movements (dysdiadochokinesis)
* Lower limbs
Heel-shin test

23
Q

how to test sensation?

A

2 parts – dorsal column and spinothalamic tract
* Vibration and joint position test
128 Hz tuning fork
* Light touch and pinprick
Dermatomes

24
Q

how to test gait?

A
  • Walk normally, then heel to toe
    (walk normally, then stand with feet together, then in tandem, then
    heel to toe)
  • Posture, balance, stride, arm swing
  • Pattern recognition
  • Romberg’s test
25
Q

types of gait patterns

A

Hemiplegic
* Spastic
* Ataxic
* Apraxic / Festinant / Shuffling
* High steppage
* Waddling
* Antalgic

26
Q

how to undertake rombergs test?

A
  • Stands with feet together, arms outstretched in front and hands
    supinated
    (If unable do this with the eyes open – cerebellar lesion)
  • If can maintain the position with the eyes open but loses balance
    when eyes are closed - loss of proprioceptionvv

How to take an exam (4 decks)

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