Neuro Examinations Flashcards
Cerebellar examination - ispection
around the bed - mobility aids
posture - truncal ataxia
Cerebellar examination - gait
stance
stability
tandem walking
Romberg’s test
Cerebellar examination - head
Speech - slurred, staccato speach
Nystagmus - H test
Dysmetric saccades
Impaired smooth pursuit
Cerebellar examination - arms
finger to nose test
rebound phenomemnon
tone
dysdiadochokinesia
Cerebellar examination - legs
knee jerk reflex (L3, L4)
heel to shin test - coordination
Lower limb neuro exam - inspection
over serve around the bed - walking stick, wheelchair
Scars Wasting Involuntary movements Fasciculations Tremor
Gait
Romberg’s test
Lower limb neuro exam - tone
leg roll
leg lift
ankle clonus
Lower limb neuro - power
hip - flexion, extension, abduction, adduction
knee - flexion, extension
ankle - dorsiflexion, plantar flexion, inversion, eversion
big toe - extension
Lower limb neuro - reflexes
knee jerk (L3/4) ankle jerk (L5/S1) plantar/babinski reflex (S1)
Lower limb neuro - sensation
light touch (dorsal/posterior columns and spinothalamic tracts)
pin prick sensation (spinothalamic tracts)
vibration sensation (doral/posterior columns)
Lower limb neuro - proprioception
toe up and down
dorsal/posterior columns
Lower limb neuro - coordination
heel to shin lest
Upper limb neuro - inspection
walking aids catheter scars wasting involuntary movements fasciculations tremor
pronator drift
Upper limb neuro - tone
move each major joint (smooth, tone, spasticity, rigidity)
Upper limb neuro - power
shoulders - abduction (C5), adduction (C6/7)
elbow - flexion (C5/6), extension (C7)
wrist - extension (C6), flexion (C6/7)
fingers - extension (C7), abduction (T1)
thumb abduction (C8/T1)
Upper limb neuro - deep tendon reflexes
biceps reflex (C5/6) triceps reflex (C7) supinator reflex (C6)
Upper limb neuro - sensation
light touch (doral/posterior columns and spinothalamic tracts
pin prick sensation (spinothalamic tracts)
vibration sensation (dorsal posterior columns)
Upper limb neuro - proprioception
(dorsal/posterior columns)
finger up and down
Upper limb neuro - coordination
finger to nose test
dysdiadochokinesia
UMN lesion signs
no fasciculation or wasting
pronator drift may be present
increased tone (spasticity) ± ankle clonus
pyramidal pattern of weakness
hyperreflexia
upping babinski reflex
LMN lesion signs
wasting and fasciculation
no pronator drift
hypotonia or normal
different patterns of weakness
hyporeflexia or areflexia
normal downing babinski reflex
Cranial nerve examination - general inspection
general appearance - comfortable at rest?
obvious facial asymmetries?
position of eyes
ptosis
abnormality of speech or voice
signs around the bed e.g. hearing aid, glasses
Cranial nerve examination - (I) olfactory nerve
any change in sense of smell?
Cranial nerve examination - (II) optic nerve
PUPILS: size, shape, symmetry
VISUAL ACUITY: snellen chart
PUPILLARY REFLEXES: direct, consensual, swinging light test, accommodation reflex
COLOUR VISION: ishihara charts
VISUAL FIELDS: wiggle finger
FUNDOSCOPY: prep, red reflex, move in closer
Cranial nerve examination - (III, IV, VI) oculomotor, trochlear, abducens nerves
ptosis
eye movements
cover test
Cranial nerve examination - trigeminal nerve (V)
sensory - forehead, cheek, jaw (light touch and pin prick)
motor - assess masseterbulk and try to close jaw
reflexes - jaw jerk, corneal reflex
Cranial nerve examination - facial nerve (VII)
raised eyebrows closed eyes blown out cheeks smiling pursed lips closed lips
hearing changes?
taste changes?
Cranial nerve examination - vestibulocochlear nerve (VIII)
gross hearing test
rinne’s test
weber’s test
Cranial nerve examination - glossopharyngeal and vagus nerves (IX and X)
symmetry of soft palate and uvula say aaahhhh gag reflex cough swallow
Cranial nerve examination - accessory nerve (XI)
shrug shoulders
turn head
Cranial nerve examination - hypoglossal nerve (XII)
wasting or fasciculations of tongue
protrude tongue - deviation?
hand on cheek tongue against it
