Neuro Examination Flashcards
What are the sections of the NS?
- Higher Mental Functions (GCS, Mini Mental State)
- Cranial Nerves
- Limbs
Cranial 2= Optic Nerve
-Visual Acuity using Snellen Chart
=glasses if needed, cover left eye and read out letters on chart
=Record lowest line of print they can read and repeat on other side
-Pupillary responses using pen torch
=look at target (finger)- equal, irregulates
=stare into distance and directly shine light into eye (constriction)
=consensual reflex (shine light into right eye but notice response in left eye and vice versa)
-Accommodation reflex, not tested routinely
-Visual fields
=Opposite patient and on their level
=look straight at nose and see all of face
=cover up right eye and straight into eye and show target (finger) and say when you can see the finger out of corer of eye
=move finger in 4 arch (2 for each eye) starting behind patient introducing into field of vision
-Ophthalmoscope
Cranial Nerves 3,4,5= Oculomotor, Trochlear and Abducens (innervate external ocular muscles)
-Look at target for ptosis, deviation of eyes (squints), nystagmus
=instruct to look at target and follow with just eyes (H)
=Up gaze and down gaze
Cranial 5= Trigeminal Nerve
-Motor= mastication muscles, not routine
-Sensory innervation face
=light touch (cotton wool) and pin prick sensation, comparing each side
=3 places (forehead, cheek and chin)
Cranial 7= Facial nerve
- Raise eyebrows to roof
- Screw eyes tight shut that cannot be overcome
- Show teeth
- Puff cheeks out
- minor degree of asymmetry normal
Cranial 8= Vestibulocochlear Nerve
-Otoscope
Cranial 9,10,11 nerves= Glossopharyngeal, Vagus, and Accessory
- Speech (during history note dysarthria) and swallowing
- Coughing (quality, normal)
- Give small amount of water to check it occurs normally and safely
- Movement of soft palate, look in mouth, use tongue depressor and say Ah to observe uvula
- Gag reflex unpleasant for patients
Cranial 12= Hypoglossal nerve
- Open mouth, looking for wasting and abnormality of tongue with pen light
- Poke tongue out (observe for deviation) and waggle from side to side
Start of limb examination
-Inspect for scares, rashes, abnormal postures and movements (tremors), wasting/ fasciculations
Muscular tone of upper limbs
-Take hand to assess elbow and wrist
=passively flexing, extending and rotating wrist
=Idiosyncratic so cannot be predicted
Power testing of upper limbs
*Proximal to distal
-Shoulder abduction
=Deltoid, axillary nerve, C5
=Make pair of wings, should not be able to overcome with downward pressure
-Elbow flexion
=biceps/ Brachioradialis, musculocutaneous and radial nerves, C5/6
=Try to pull elbows straight, should not occur
-Elbow Extension
=Triceps, radial nerve, C7
=Straighten against resistance
-Wrist extension
=External carpi radialis longus/ external carpi ulnaris, radial nerve, C6/7
=Make fist and cock back, cannot overcome
-Finger extension
=External digit, radial nerve, C7
=Straighten fingers out together, not overcome downwards
-Finger flexion
=Flexor digit superficialis/ profundus, median/ ulnar nerves, C8
=Grip our fingers tightly, not able to uncurl fingers
-Finger abduction
=Dorsal interossei, ulnar nerve, T1
=Spread fingers wide, not able to overcome
-Thumb abduction
=Abductor pollicis brevis, median nerve, T1
=Lift thumb skywards, cannot push into palm of hand
Muscular tone of lower limbs
- Recumbent on seat
- Rock leg from side to side (witness foot movement)
- Flipping leg up so floppy
- Clonus at ankle= pulling foot up hard
Power testing of lower limbs
-3 joints (hip, knee, ankle)
-Hip flexion
=iliopsoas, femoral nerve, L1/2
=Left leg to touch hands, cannot overcome at thigh
-Hip extension
=gluteus max, sciatic nerve, L5/S1
=Place hand under heel and patient push down hard into bed
-Knee flexion
=Hamstrings, sciatic S1
=Bend knee fully and try straighten against resistance
-Knee extension
=Quadriceps, femoral nerve, L3/4
=Place hand beneath popliteal fossa, try and break movement downwards before locks
-Ankle dorsiflexion
=Tibialis anterior, common peroneal nerve, L4
=Cock foot up towards them and apply resistance
-Ankle plantarflexion
=Gastrocnemius/ soleus, tibial nerve, S1/2
=Press down hard on accelerator against resistance
Upper limb reflexes
- Relax arms, compare left and right
- Bicep jerk (C5)
- Supinator jerk (C6)
- Triceps jerk (C7)
- Look for contraction
Lower limb reflexes
-Knee jerk (L3/4)
=Bring knee up, support behind knee to bear weight, look at quadriceps
-Ankle jerk (S1/2)
=bottom of foot, Achilles tendon
