Neuro examination

Question 1

What to ensure before exam?

Answer 1

PRivate environment wash hands consent introduce self ask about pain, ensure possitioned well and exposed

Question 2

What to look for in neuro exam?

Answer 2

Gait and ability to move, look for tremmors fasciculations, deformity scars and muscle wastings, signs like walking aids.

Question 3

What is pronator drift?

Answer 3

Keep hands out with palms up if cant hold up then contralateral pyramidal UMN lesion present if raises ipsilateral cerebellar lesion instead

Question 4

What features to assess in exam?

Answer 4

Tone Power reflexes sensation coordination

Question 5

Firstly assess tone?

Answer 5

get them to relax, assess rigiditay or flacidity decreased or increased. increases UMN issue less is LMN lesion

Question 6

How to assess tone of upper limb?

Answer 6

Hold and support elbow and hand and move al the joints

Question 7

How to assess tone of lower limb?

Answer 7

Lift knees and drop internal external rotate knees, flex and extend ankle and assesse for muscles

Question 8

How to assess power of muscle?

Answer 8

1-5 0=no muscle contraction 1-= contraction by no movement 2= move but not against gravity 3= move against gravity 4 = move against examiner by weak 5 normal

Question 9

How to assess power all around?

Answer 9

Start proximally adduction abduction elbow flexion and extension, at wrist flexion etension, at fingers abduction and can do finger extension and flexions at thumbe extension and opossition. Hip flexion extension, abduction adduction At knee flexion extension, ankle dorsiand plantarflexion inversion and eversion.

Question 10

Which reflexes to assess?

Answer 10

biceps, triceps and supinator knee and ankle jerks,

Question 11

How to use tendon hammer?

Answer 11

relax and let fall against gravity to own handds

Question 12

How to grade reflexes?

Answer 12

Increased Normal diminished absent

Question 13

What is reinforcement for reflexes?

Answer 13

clench jaw for lower limbs interlock fingers

Question 14

What is planntar response?

Answer 14

Babinski sign flexion of toe is normal

Question 15

What forms of sensation to assess?

Answer 15

Fine touch cotton wool, also with neruotip for pain, vibration with 128Hz tuning fork. proprioception asking if up or down, temperature wiht cold oject

Question 16

What to do to ensure get good sensation result?

Answer 16

Don’t do in ordered pattern or rythm

Question 17

Where to test for sensation?

Answer 17

Main dermotomes an glove and stockings distribution

Question 18

How to assess vibration sensation?

Answer 18

128Hz tuning fork place on boney prominence ask if can feel then tell when stops vibrating

Question 19

How to asses coordination?

Answer 19

Finger nose test, make complex by moving finger, assess for rapid alternating movement, ask to do heel to shin test down leg. Romburgs test stand and close eyes if lose balance test is positive assess gait

Question 20

How to complete upper and lower limb neur exam?

Answer 20

cranial nerves

Question 21

How to examine first cranial nerve?

Answer 21

Olfactory nerve to smell scented things

Question 22

How to examin 2nd cranial nerve?

Answer 22

Optic nerve, look at pupils size shcape and reactivity to eye check direct and indirect be aware it also assesses others. check for accommodation.

Question 23

What is swinging torch test?

Answer 23

Where you swing it between eyes looking for accommodation affterent pupilliary defect

Question 24

How to test 3rd 4th 6th CN?

Answer 24

Use H shape and look at one eye and other checking can do all movements ask if see double test convergance

Question 25

How to examine 5th CN?

Answer 25

Sensory opthalmic maxiallary and mandibular divisions, corneal reflex cotton wool on the eyeball, motor mastication muscles fel for them when clenching. Jaw jerk reflex,

Question 26

How to examin facial nerve 7th?

Answer 26

Raise eyebrows, screw eyes up, show teeth smile lips together,

Question 27

How to test 9th 10th cranial nerve?

Answer 27

Assess swallowing look at pharengeal arches say ah, check speech.

Question 28

How to assess 12th CN?

Answer 28

Check for wasting, symetry tone, wiggle tongue,

Question 29

How to assess 11th?

Answer 29

shrug shoulders turn head to side

Question 30

How to examine 8th CN?

Answer 30

whisper into ears. rinnes test conductive hearing test and weibers test, Hedsverse test ask neck or back pain. turn head then rapidly back to middle looking at eyes, alos dickshallpike test lay back quickly with head turns look for nystagmus