Neuro Physical Exam Flashcards
what are the things you are checking on inspection
- level of consciousness
- breathing pattern
- body position
- involuntary movements
- muscle bulk
- gait
Describe what you are checking regarding level of consciousness
- Alert: responding appropriately/timely to normal voice volume
- Lethargic: drowsy, needed to raise voice
- Obtunded: requires shaking
- Stupor: requires painful stim
- Comatose: no response
Describe what you are looking for on breathing inpection
abnormal breathing patterns
- cheyne-stokes: deep breaths followed by apnea (diencephalon)
- ataxic: irregular unpredictable breaths (medulla)
What are you looking for on body position inspection
- Hemiplegia/flaccid/spastic body position: CVA, CP
- Decorticate/decerebrate rigidity: impending cerebral herniation
Describe the involuntary movements you are looking for
- resting tremor: Parkinsonism, Wilson’s
- postural tremor: Essential Tremor
- fasciculations: LMN ALS
- tics: Tourette’s
- chorea/athetosis: Huntington’s, dyskinetic CP
- facial dyskinesias: TD
Describe what you’re looking for when inspecting muscle bulk
atrophy/asymmetry indicative of chronic radiculopathy, peripheral neuropathy, ALS, CRPS, charcot marie tooth
Describe what you are looking for in gait inspection
- hemiplegic: spastic CP
- trendelenburg
- shuffling: parkinsonism
- high stepping: L5 radiculopathy
- ataxic: MS, CP
Describe the CN I test
Olfactory
- ensure nares are patent
- sniff 2 distinct familiar smells
Describe the CN II test
Optic
- Visual acuity: snellen chart (blindness, blurriness)
- Optic disc: fundoscope (papilledema, atrophy)
- Visual field: biconfrontation (hemianopsia)
Describe the test for CN III, IV, and VI
oculomotor, trochlear, abducens
- H pattern: nystagmus (MS, cerebellar stroke), strabismus (CN paralysis)
Describe the CN V test
Trigeminal (ophthalmic, maxillary, mandibular)
- sharp v dull
- light touch
- clench teeth/wiggle jaw to test temporalis & masseter muscles
- corneal reflex with light touch (may be desensitized w contact lenses)
Describe the CN VII test
Facial
- raise eyebrows
- frown
- close eyes tightly
- show teeth
- smile
- puff out cheeks
(Bell’s palsy, CVA)
Describe the CN VIII test
Vestibulocochlear
- Weber (lateralization to bad ear if conductive, to good ear if sensorineural loss)
- Rinne (AC>BC if sensorineural, BC>AC if conductive loss)
Describe the test for CN IX and X
Glossopharyngeal and Vagus
- swallow
- observe soft palate rise (partial paralysis = CVA)
- voice: hoars, nasal
- gag reflex (absent = lesion)
Describe the test for CN XI
Accessory
- inspect for atrophy
- resisted shrug (trap)
- resisted head turn (SCM)
Describe the test for CN XII
Hypoglossal
- assess articulation (dysarthria)
- inspect tongue at rest (atrophy, fasciculations)
- stick tongue out and side to side (deviation to weak side)
(damage to CN X or XII)
Describe the reflex tests
- Tricep: C7
- Brachioradialis: C6
- Patellar: L4
- Achilles: S1
- Clonus: hyper-reflexic (UMN lesion, corticospinal tract, spinal cord injury, cervical myelopathy)
- Hoffman’s: hyper-reflexic (UMN lesion, corticospinal tract, spinal cord injury, cervical myelopathy)
- cutaneous stimulation of abdomen: upper T8, 9, 10; lower T10, 11, 12 (absent = UMN/LMN lesion)
- plantar: Babinski (corticospinal tract lesion)
- anal reflex: S2, 3, 4 lesion (cauda equina)
Describe the areas tested in sensation (pain, light touch)
- shoulders (C5)
- inner & outer forearms
- thumb (C6)
- middle finger (C7)
- pinky (C8)
- thighs (L4)
- medial malleolus
- dorsum of foot (L5)
- pinky toe (S1)
- medial buttocks (S3)
(widespread loss with stroke, spinal nerve root compression, periopheral mononeuropathy, or widespread diabetic/alcoholic peripheral neuropathy)
Describe the muscle strength tests
- shoulder abduction (C5)
- supination (C6)
- elbow flexion bicep (C6)
- elbow flexion tricep (C7)
- wrist extension (C6)
- wrist flexion (C7)
- finger extension (radial)
- finger abduction (ulnar)
- resisted APB (median)
- Hip flexion (L3)
- Hip extension (S1)
- knee extension (L4)
- knee flexion
- dorsiflexion (L5)
- plantar flexion (S1)
(proximal: radiculopathy, PMR, muscular dystrophy. distal: guillain barre)
Describe the vibration test
- distal then proximal prominence
(MS, Vit B12 deficiency, alc thiamine deficiency)
Describe the proprioception test
hold digit by its sides, move it up and down (finger and big toe)
(body position in space: MS, B12 deficiency, peripheral neuropathy)
Describe the number discriminative sensation test
examiner draws a number on pts hand to test associative cerebral cortical function (lesion to posterior column or sensory cortex)
Describe the tests for cerebellar function, coordination, balance, position in space
- rapid alternating movements: hand and toe tap
- point to point movements: finger to nose and heel to shin
- walk heel to toe
- romberg
- pronator drift
Describe the meningeal sign tests
- Brudzinskis: pt supine and head flexed forward (positive if knees scrunch up)
- Kernigs: pt supine with knee flexed then extended (positive if neck flexes forward)
(Meningitis)
Describe what the passive straight leg raise is testing for
- muscle weakness, herniated disc, radiculopathy
- positive if painful along a specific motor sensory radicular pattern (L3, 4, 5, S1)
