Neuro H&P Review

Question 1

Three important questions should govern your neurologic exam:

Answer 1

○ Is the mental status intact?
○ Are right-sided and left-sided findings symmetric?
○ If the findings are asymmetric or otherwise abnormal, does the
causative lesion lie in the CNS or PNS?

Question 2

Assess your patient’s Orientation to:

Answer 2

○ Person - “What is your name?”
○ Place - “Where are we right now?” (Get specific)
○ Time - “What is today’s day and date?”
○ Situation - “Why are you here right now?”

Question 3

Assess your patient’s Attention Span:

Answer 3

○ Serial 7’s - “Count backwards by 7 starting at 100”
○ “Spell the word WORLD backwards.”

Question 4

CN I:

Answer 4

The Olfactory Nerve
○ Test sense of smell by presenting a
familiar and non-irritating odor

Question 5

CN II:

Answer 5

Test Visual Acuity-
○ Using a Snellen or Rosenbaum eye chart,
assess the patient’s visual acuity
Test Visual Fields by Confrontation

Question 6

Testing CNs II and III:

Answer 6

Pupillary Reaction
○ Inspect the size and shape of the pupils,
comparing one side with the other
○ Using a Penlight or flashlight, test the
pupillary reaction to light

Question 7

Testing CNs III, IV, and VI:

Answer 7

Extraocular Movements
○ Assess extraocular movements in the six cardinal directions of gaze and
look for loss of conjugate gaze in any of the six directions

Question 8

CN V:

Answer 8

The Trigeminal Nerve-
○ To assess the Motor portion of the nerve, have the patient clench their teeth and assess temporalis and masseter muscles by palpation
○ To assess the Sensory portion of
the nerve, assess sharp/dull (pain)
sensation and light touch
sensation in all three branches of
the nerve (V1, V2, and V3)

Question 9

CNs V and VII:

Answer 9

The Corneal Reflex-
○ To assess the Corneal Reflex arch that exists
between CN V and CN VII, touch the cornea of
the eye with a very light wisp of cotton

Question 10

CN VII:

Answer 10

The Facial Nerve-
○ Assess facial symmetry and various facial movements

Question 11

CN VIII:

Answer 11

Assess Auditory Acuity-
○ While standing about 3-6 feet behind your patient, assess hearing
bilaterally using the Whispered Voice test
○ If hearing loss is present, you may choose to
assess further by determining if the hearing
loss is conductive or sensorineural using the
Weber and Rinne tests

Question 12

CNs IX and X:

Answer 12

Soft Palate, Voice, and Gag-
○ Listen to the patient’s voice, assessing for
hoarseness that can happen with unilateral
vocal cord paralysis.
○ Have the patient say “ah” and watch the
soft palate elevate. If one side fails to
elevate, the uvula points to the unaffected
side- Don’t get this backwards!
○ Test the gag reflex by lightly touching the
back of the throat on each side in turn.

Question 13

CN XI:

Answer 13

Spinal Accessory Nerve-
○ Ask the patient to turn his/her head to each side against your hand to assess the strength and symmetry of contraction of the opposite
sternocleidomastoid muscle.
○ As the patient to shrug both shoulders
upward and push down with your hands

Question 14

CN XII:

Answer 14

The Tongue-
○ Assess the tongue at rest and look for any atrophy or
fasciculations that would indicate CN XII nerve damage

Question 15

If the Lower Motor Neuron is lost, _____

Answer 15

flaccid muscle
weakness will develop (lack of tone)

Question 16

If the Upper Motor Neuron is lost, ______

Answer 16

spastic muscle weakness will develop (too much tone).

Question 17

______, which can be seen with Parkinson’s Disease and some disorders of Upper Motor Neuron

Answer 17

Cogwheel Rigidity

Question 18

There are multiple ways to assess
coordination, and one of them is _____

Answer 18

Point-to- Point movements.

Question 19

Two-Point discrimination should be _____ or less on the finger pads.

Answer 19

5mm