Neuro examination Flashcards
What to ensure before exam?
PRivate environment wash hands consent introduce self ask about pain, ensure possitioned well and exposed
What to look for in neuro exam?
Gait and ability to move, look for tremmors fasciculations, deformity scars and muscle wastings, signs like walking aids.
What is pronator drift?
Keep hands out with palms up if cant hold up then contralateral pyramidal UMN lesion present if raises ipsilateral cerebellar lesion instead
What features to assess in exam?
Tone Power reflexes sensation coordination
Firstly assess tone?
get them to relax, assess rigiditay or flacidity decreased or increased. increases UMN issue less is LMN lesion
How to assess tone of upper limb?
Hold and support elbow and hand and move al the joints
How to assess tone of lower limb?
Lift knees and drop internal external rotate knees, flex and extend ankle and assesse for muscles
How to assess power of muscle?
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
How to assess power all around?
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.
Which reflexes to assess?
biceps, triceps and supinator knee and ankle jerks,
How to use tendon hammer?
relax and let fall against gravity to own handds
How to grade reflexes?
Increased Normal diminished absent
What is reinforcement for reflexes?
clench jaw for lower limbs interlock fingers
What is planntar response?
Babinski sign flexion of toe is normal
What forms of sensation to assess?
Fine touch cotton wool, also with neruotip for pain, vibration with 128Hz tuning fork. proprioception asking if up or down, temperature wiht cold oject
What to do to ensure get good sensation result?
Don’t do in ordered pattern or rythm
Where to test for sensation?
Main dermotomes an glove and stockings distribution
How to assess vibration sensation?
128Hz tuning fork place on boney prominence ask if can feel then tell when stops vibrating
How to asses coordination?
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
How to complete upper and lower limb neur exam?
cranial nerves
How to examine first cranial nerve?
Olfactory nerve to smell scented things
How to examin 2nd cranial nerve?
Optic nerve, look at pupils size shcape and reactivity to eye check direct and indirect be aware it also assesses others. check for accommodation.
What is swinging torch test?
Where you swing it between eyes looking for accommodation affterent pupilliary defect
How to test 3rd 4th 6th CN?
Use H shape and look at one eye and other checking can do all movements ask if see double test convergance
How to examine 5th CN?
Sensory opthalmic maxiallary and mandibular divisions, corneal reflex cotton wool on the eyeball, motor mastication muscles fel for them when clenching. Jaw jerk reflex,
How to examin facial nerve 7th?
Raise eyebrows, screw eyes up, show teeth smile lips together,
How to test 9th 10th cranial nerve?
Assess swallowing look at pharengeal arches say ah, check speech.
How to assess 12th CN?
Check for wasting, symetry tone, wiggle tongue,
How to assess 11th?
shrug shoulders turn head to side
How to examine 8th CN?
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
