Neuro Exam Flashcards
Do a cranial nerve exam!
I - describe in words. patient closes eyes and holds one nostril closed. try different smell in each nostril
II - visual acuity (cover one eye at a time), visual fields, pupillary light reflexes (direct and consensual reaction, swinging flashlight test) ,
III, IV, VI - extraocular mvmts (and convergence- should constrict)
V - test sensation in V1, V2, V3 divisions and compare both sides, test temporalis and masseter muscle by have pt bite down while palpate
VII - ask pt to raise eyebrows, close both eyes and resist attempt to open, smile with both upper and lower teeth, puff out cheeks, frown
VIII - finger rub test
IX, X - say this outloud. ask pt to swallow, pt say “ah” and assess for symmetric mvmt of soft palate and pharynx with uvula staying in midline
XI - ask pt shrug shoulders against resistance, turn head against resistance while palpate sternocleidomastoid on opposite side
XII - ask pt to stick out tongue and move side to side (assess symmetry and deviation)
Perform a neurological motor exam!
- Inspection: asymmetry in muscle bulk, atrophy, fasciculations, abnormal mvmts. Compare L to R, proximal to distal
- Tone: resting tension in relaxed muscle. both upper and lower extremities
- Pronator Drift: both arms straight forward, palms up. close eyes and observe for 10-20 seconds. POS = arm pronates and drift down, often w/ flexion at fingers and elbow
- Strength: compare one side to the other
- UE: shoulder abduction, elbow flexion and extension, wrist extension and flexion, finger extension, finger abduction, hand grip, thumb opposition
- LE: hip flexion and extension, hip abduction and adduction, knee extension and flexion, ankle dorsiflexion and plantarflexion, great toe dorsiflexion
- Deep tendon reflexes:
- biceps
- brachioradialis
- triceps
- patellar
- achilles + ASSESS CLONUS
- Babinski reflex/plantar response: stroke lateral aspect of the sole from the heel to bottom of foot curving medially across the ball. normal = big toe should plantarflex. abnormal = dorsiflexion of big toe with fanning of other toes –> lesion in corticospinal tract
Do a neurological sensory exam!
Patients eyes should be closed unless otherwise specified!
- Light touch: ask pt to respond whenever a touch is felt. test sampling of dermatomes, comparing sides.
- Pain/sharp: use special neuro tips or broken tongue depressor or wooden qtip.
- Touch sharp end to pt fingertip and ask does this feel sharp?
- Test various dermatomes in upper and lower extremities, comparing sides. Test toes to knees then from fingertips proximally.
- Temperature: can omit if pain sensation is normal. use tuning fork heated or cooled by water. ask pt to identify hot or cold while touching skin
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Vibration: use low pitched tuning fork (128 Hz), place on distal IP joint of big toe or finger. place finger under toe so can also feel vibration. insruct pt to tell you when vibration no longer present.
* if abnormal sensation, move proximally until sensory level is determined and then repeat on opposite side. -
Position sense/proprioception: move distal phalanx. hold medial and lateral aspects of distal phalanx and hold it away from other toes to avoid friction. then move phalanx up and tell pt “this is up” and move phalanx down and tell pt “this is down.” with pts eyes closed, ask them to identify the direction. test each big toe, left and right.
* if impaired, test thumbs as well. - Discriminative sensations: ONLY HELPFUL IF TOUCH AND POSITION SENSES ARE INTACT OR MINIMALLY IMPAIRED.
- stereognosis: tests ability to identify object by feel. place familiar object in pt’s hand (coin, key, paper clip, pencil) and ask to identify
- graphesthesia/number identification: with pt’s eyes closed, use blunt end of pencil or pen to draw large number in pt’s palm. number should face the pt
- two point discrimination: using the sides of two pins or the two ends of an open paper clip, touch the patient’s finger pads in two places simultaneously. alternate irregularly with one point touch. ask pt to identify “one” or “two”. start wih finger pads.
- monofilament test: press monofilament at 6 sites on plantar surface of each foot until it buckles. great toe, 5th toe, 1st metatarsal head, 3rd metatarsal head, calcaneus
Do a cerebellar function/coordination test?
- rapid alternating movements: pt takes hand and strikes thigh with palm down, then raise hand and turn over and strike with palm up. repeat as rapidly as possible. repeat with other hand. (another technique is pt touch thumb and index finger together as fast as possible and repeat with other hand)
- finger to nose: pt hold arm up in batwing position, then with elbow up have pt touch their own nose and examiner’s finger alternatively as accurately, quickly, smoothly as possible. examiner holds finger at fully extended arm’s length from pt. watch for tremor. REPEAT ON OPP SIDE.
- heel to shin: ask pt to lie on back then slide heel of the foot on the opposite shin from knee to big toe. should be smooth motion with heel staying on shin
- gait: regular walk, heel-to-toe (tandem gait) in straight line, walk on toes, walk on heels
- Romberg test: pt stand in front of examiner with pt’s feet together and eyes closed. positive = pt becomes unstable. be prepared to catch/steady the pt!!
Perform Spurling’s neck compression maneuver
Extend neck and rotate to affected side then compress straight down (the compression should not be done if the symptoms are provoked just being placed in this position)
Positive sign = pain in the affected nerve root distribution due to compression of neuroforaminae
Perform straight leg raise
Patient supine, leg straight, passively flex leg at the hip. Dorsiflexing the foot will increase sensitivity of test
Positive sign = pain in radicular pattern radiating into the ipsilateral lower limb
