Neuro Observed Exam Flashcards
MENTAL STATUS
MENTAL STATUS
judgment
situation explanation - ex: what to do with a letter found on the ground by a mailbox
orientation
person, place, time
intellect
name 5 continents
short term / working memory
recall of 3 words at start and end of exam; chair, wall, clock
long term memory
recall remote life event - childhood trip / pet
appearance
hygiene and appropiate dress - state aloud
calculation
serial 3s, count back from 30 by 3s
CRANIAL NERVES
CRANIAL NERVES
CN II - optic nerves - visual acuity
pt. holds eye card 14 inches from face, test each eye alone, test each eye with and without corrections (glasses)
CN II - optic nerve - visual fields
confrontation, stand behind pt and randomly place fingers in 6 (3 on each side) different parts of the visual field - if fields affects do each eye alone as well
CN II / III - optic and oculomotor nerves - pupillary reflexes
far and near - converge eyes and then look to distance; light in each pupil twice for direct and consensual constriction reflex
CN III / IV / VI - oculomotor / trochlear / abducens nerves - extraocular muscles
H follow my finger with convergence at the end - also look for nystagmus laterally (CN VIII) named for direction of fast twitch
CN V - trigeminal nerve - ophthalmic branch - sensory
sensation on forehead, light touch to forehead
CN V - trigeminal nerve - maxillary branch - sensory
sensation on tip of nose / lower eyelid / upper lip, light touch to upper lip / tip of nose
CN V - trigeminal nerve - mandibular branch - sensory and motor
motor to muscles of mastication and sensory to lower lip, light touch to lower lip, close and open jaw (bite down)
CN VII - facial nerve - motor
muscles of facial expression, close eyes tight, wrinkle forehead, bear teeth, smile, puff out cheeks
CN VIII - vestibulocochlear nerve - hearing acuity
hearing acuity, stand in front of pt, rub fingers together randomly on either or both sides
CN VIII - vestibulocochlear nerve - rinne test
hold vibrating tuning fork to mastoid and then in front of ear, which is louder (should be air conduction) also have pt state when it goes away
CN VIII - vestibulocochlear nerve - weber test
hold vibrating tuning for in middle top of pt skull, have pt state which side is louder and when it goes away
CN VIII - vestibulocochlear nerve - nystagmus
nystagmus, have pt look at finger laterally on H test and state no seen nystagmus
CN IX - glossopharyngeal nerve
motor to one pharyngeal muscle, taste to post 1/3 tongue and pharynx, note elevation of uvula, note lack of hoarseness aloud
CN X - vagus nerve
motor to pharyngeal and laryngeal muscles, sensory to larynx, note elevation of uvula, note lack of hoarseness aloud
CN XI - accessory nerve
motor to trapezius and sternocleidomastoid, shoulder shrug against resistance, turn head against resistance
CN XII - hypoglossal nerve
motor to tongue, tongue protrusion and side to side movement
CN XII - hypoglossal nerve
motor to tongue, lingual speech, say - sally sells seashells by the seashore
MOTOR FUNCTION, bicep strength
arm flexion against resistance
tricep strength
arm extension against resistance
deltoid strength
arm abduction against resistance
grip strength
squeeze fingers against resistance
wrist extension strength
wrist extension against resistance, don’t forget to isolate the wrist
thumb opposition
thumb to forefinger against resistance
intrinsic hand muscles
thread fingers and squeeze against resistance
hip flexion strength
lift leg against resistance
hip extension strength
leg backwards against resistance
hip adduction strength
leg inward against resistance
hip abduction strength
leg outward against resistance
knee flexion strength
lower leg backwards against resistance
knee extension strength
lower leg forward against resistance
foot dorsiflexion strength
foot toward calf against resistance
plantar flexion strength
foot toward ground against resistance
deep tendon reflexes - biceps
reflex hammer to inside bend of elbow
deep tendon reflexes - triceps
reflex hammer to back / outside bend of elbow
deep tendon reflexes - brachioradialis
reflex hammer to lower arm above thumb
deep tendon reflexes - patellar
reflex hammer to tendon below knee cap
deep tendon reflexes - achilles
reflex hammer to tendon behind ankle - shoes off
babinski sign (extension of big toe, flaring of toes)
run reflex hammer handle along lateral sole, medially across ball of foot - state result -> negative means none, positive means present - shoes off
pain and temperature sensory - one location on each extremity
sharp prick of pointed tip versus dull end of Qtip - OR - coolness of tuning fork vs. normal temp of tongue depressor
vibration and position sensory - one location on each extremity
vibration of tuning fork on bony prominence (tell when it stops) - OR - close eyes position pts finger and pt tells you what you have done
general coordination
finger nose finger - AND - heel to shin
fine coordination
rapid alternating movement, flip hands and slap top of thighs while doing it
gait - normal
look for foot placement, posture, arm movement, state normal
gait - tandem
walk heel to toe on a straight line
gait - walk on heels
walk on heels, coordination and strength
gait - walk on toes
walk on toes, coordination and strength
Romberg
stand with feet together, eyes open for 20 sec, eyes closed for 20 sec without waivering, positive means it happens
pronator drift
hold arms outstretched with hands upward with eye closed, if arm drifts down = cerebrospinal tract damage, if arm drifts up = proprioception damage, positive means it happens
STOP!!! ask 3 words again
chair, wall, clock
