Neuro Exam

Question 1

General components of neuro exam

Answer 1

1. Mental status
2. CN
3. Motor fxn
4. Sensation
5. Reflexes
6. Coordination
7. Gait

Question 2

Mental status exam technique

Answer 2

-orientation: person, place, time
 Mental status is addressed in the history and monitored as patient demonstrates the ability to follow directions during examination
 The MMSE (Mini-Mental State Exam)
 A more detailed mental status exam requires more time, and should evaluate level of consciousness, attention, memory, language, visuospatial skills, executive function, and emotion and personality

Question 3

Cranial nerves

Answer 3

CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Vestibulocochlear
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal

Question 4

CN I - VI tests

Answer 4

 CN I: smell, check one nostril at a time
 Optic; CN II: Visual acuity/Visual fields by confrontation
 Funduscopic Exam
 Oculomotor, Trochlear, Abducens; CN III, IV, VI:
 Eyelids for drooping (ptosis)/Pupillary size, shape, reaction to light and accommodation/extraocular movements/convergence
 Trigeminal; CN V:
 Face for muscle atrophy or tremor/muscles of mastication/superficial touch and pain all three branches.

Question 5

Fundoscopic exam technique

Answer 5

  Red Reflex
  Lens
  Retina for color, veins/arteries, AV nicking
  Optic disc for margins, color, edema
  Physiologic cup for color and size
  Macular/fovea for color, edema

Question 6

CN VII - CN XII tests

Answer 6

 Facial, CN VII:
 Symmetry of facial expressions: raise eyebrows/squeeze eyes shut/puff up cheeks/show teeth/smile/frown.
 Acoustic, CN VIII:
 Gross hearing to finger rub, Weber(lateralization)/Rinne (conduction)
 Glossopharangeal; CN IX:
 Gag reflex/Swallow
 Vagus; CN X:
 Palate and uvula movement/Speech
 Spinal Accessory; CN XI:
 Trapezius and sternocleidomastoid muscle strength
 Hypoglossal; CN XII:
 Tongue resting in mouth/movement and strength/fasciculations

Question 7

UE motor fxn exam

Answer 7

 Upper Extremity
 Bulk: Inspect for atrophy/hypertrophy and symmetry
 Tone: Assess tone by passive range of motion
 Strength: Test strength against resistance
 Shoulder abduction
 Forearm Flexion/Extension
 Wrist Flexion/Extension
 Grip strength
 Finger abduction
 Pronator drift for subtle weakness
 Involuntary Movements

Question 8

LE motor fxn exam

Answer 8

 Bulk: Inspect for atrophy/hypertrophy and symmetry
 Tone: Assess tone by passive range of motion
 Strength: Test strength against resistance
 Hip flexion/extension
 Knee flexion/extension
 Ankle dorsiflexion/plantar flexion
 Great Toe dorsiflexion/plantar flexion
 Involuntary Movements

Question 9

Sensory exam

Answer 9

 Light touch (fingertip, tissue, cotton ball)
 Pinprick (sharp vs. dull)
 Temperature (cool surface of tuning fork)
 Vibration (low pitch 128 Hz tuning fork)
 Proprioception/Position (great toe movement, Romberg)

Question 10

Reflex testing

Answer 10

  Biceps tendon
  Triceps tendon
  Brachioradialis tendon
  Patellar tendon
  Achilles tendon
  Babinski sign or plantar response

Question 11

Coordination testing

Answer 11

 Rapid alternating movements
 Finger to nose maneuver
 Heel to shin testing

Question 12

Gait testing

Answer 12

 Regular walking (casual gait): stance, body movement, posture
 Heel walking
 Toe walking
 Tandem gait (heel to toe)