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Physical Exam Skills > Neurological Exam > Flashcards

Neurological Exam Flashcards

To demonstrate clinical knowledge of the standard neurological examination.

1
Q

Assess freestyle gait for rhythm, symmetry of movement of arms and legs

A

Assess spring of gait and swing of arms. Start in exam room and move to the hall if abnormal

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2
Q

Assess Toe Walking

A

Have patient walk AWAY from you on their toes while observing elevation of heels

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3
Q

Assess Heel Walking

A

Have patient walk TOWARDS you on their heels while observing elevation of toes

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4
Q

Assess Tandem Gait

A

Heel-to-toe. Demonstrate then have patient perform. Stand close to steady if necessary

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5
Q

What are the tests of gait assessment?

A

Normal Walking, Heel Walking (away), Toe Walking (Towards), Tandem Gait (Heel-Toe)

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6
Q

Perform the Romberg Test

A

Ask Pt to stand with feet together and arms at side, have patient close eyes to assess balance. Stand near to patient to prevent a fall.

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7
Q

Assess upper extremity drift

A

Have Pt sit and extend arms w/ palms up and eyes closed.

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8
Q

Test CN1

A

Have patient close eyes, identify fragrance in each nostril.

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9
Q

Test CNII Visual Acuity

A

Have Pt. hold vision card, read the smallest line possible. ONE EYE COVERED then the other

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10
Q

Test CNII Visual Field

A

Stand 3 ft from patient. COVER ONE EYE, present varied number of fingers in each of the four quadrants and have patient add them together,

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11
Q

Test CNII Pupillary Reaction

A

Dim lights, test direct and consensual pupillary responses

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12
Q

Test CNII Movement

A

Perform swinging light test

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13
Q

Test CNII

A

Visual Acuity (card), Visual Field (How many fingers?), Pupillary Reaction (Direct & Consensual), Movement (Swinging light test)

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14
Q

Test CNIII, IV, VI

A

Have patient follow your finger with the ‘H’. OBSERVE EYELIDS!

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15
Q

Test CNV Pain

A

Use sharp object, agree ‘does this feel sharp?’, poke Pt face in all three divisions: forehead, cheek and chin. Ask Pt to compare sensation in both sides.

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16
Q

Test CNV Light Sensation

A

Use cotton wisp, agree “does this feel soft?”, Stroke Pt in all three divisions of CNV: Forehead, cheek and chin. Ask Pt. to compare sensation on both sides.

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17
Q

Test CNV Motor

A

Test contraction of MASSETER. Clench jaw, Move jaw side to side.

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18
Q

Test CNVII

A

Observe motor function and tone in face. Have patient raise eyebrows, clench eyes, grimace, show teeth. PUFF CHEEKS OUT AND PUSH IN (ONE FINGER) ON EACH SIDE

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19
Q

Test CNVIII Whisper/Friction

A

Stand behind Pt. Make friction and test on both sides

20
Q

Test CNV

A

Test Pain, Light Touch, Masseter Contraction (clench jaw, move from side to side). Don’t forget to have Pt. compare sensation on both sides.

21
Q

Test CNVIII Weber Test

A

Percuss tuning fork, place at midline and ask Pt if they hear it equally on both sides

22
Q

Test CNVIII Rhinne Test

A

Percuss tuning fork, place at mastoid process. Ask Pt to identify when they stop hearing it and then move to air test and ask when they stop hearing it.

23
Q

Test CNVIII

A

Friction Test, Rhinne Test (fork to mastoid process), Weber Test (fork to midline skull). Don’t forking forget to ask Pt. to compare hearing in both ears.

24
Q

Test CNIX, X

A

Have Pt. open mouth, say “ahhhh”. Observe gag reflex both sides.

25
Q

Test CN XI

A

Have Pt. rotate head against resistance and shrug shoulders against resistance.

26
Q

Test CNXII

A

Have Pt. open mouth, observe tongue at rest for fasiculation or atrophy. Test strength by having Pt. push tongue against cheek and push against w/ finger from outside.

27
Q

Assess upper extremity muscle group for atrophy, bulk or fasiculations

A

Observe and compare on both sides: Deltoids, Biceps and Pecs

28
Q

Assess lower extremity muscle group for atrophy, bulk or fasiculations

A

Observe and compare on both sides calves and quadriceps

29
Q

Assess muscle tone

A

Have Pt. relax completely, passively move arms and legs on both sides.

30
Q

Grade muscle strength in hands

A

Have Pt squeeze 2 fingers and prevent you from pulling them out, have Pt. spread fingers and resist them being pushed together. BOTH SIDES

31
Q

Grade muscle strength in arms

A

Have patient do the wingy elbow thing and resist you pushing down on them (proximal), test elbow flexion and extension. BOTH SIDES

32
Q

Grade muscle strength in feet

A

Ask Pt. to dorsiflex and plantar flex foot against resistance. BOTH SIDES

33
Q

Assess pain sensation on lower extremities

A

Use sharp object, agree “does this feel sharp?” Touch foot each side and shin each side, ask Pt. to compare. Poke distal (foot) to proximal (ask for change in sensation) BOTH SIDES

34
Q

Assess pain sensation upper extremities

A

Use sharp object, agree “does this feel sharp?” Touch hand each side and arm each side, ask Pt. to compare. Poke distal (hand) to proximal (ask for change in sensation) BOTH SIDES

35
Q

Assess light sensation lower extremities

A

Use soft object. agree “does this feel soft?” Touch foot each side and shin each side, ask Pt. to compare. stroke distal (foot) to proximal (ask for change in sensation) BOTH SIDES

36
Q

Assess light sensation on upper extremities

A

Use soft object, agree “does this feel soft?” Touch hand each side and arm each side, ask Pt. to compare. stroke distal (hand) to proximal (ask for change in sensation) BOTH SIDES

37
Q

Assess sensation on upper and lower extremities

A

pain then light touch, feet & shins and hands & arms. Remember to alternate and ask Pt. to compare. Then do distal to proximal, one limb and then the other, and ask Pt. to compare sides for changes in sensation.

38
Q

Assess position sense in feet

A

HAVE PT. CLOSE EYES. Grasp toe by sides, move up and down and ask Pt to identify its position. Do for both feet.

39
Q

Assess position sense in hands

A

HAVE PT. CLOSE EYES. Grasp index finger by sides, move up and down and ask Pt. to identify its position. Do for both hands

40
Q

Assess vibration sense in toes and hands

A

Percuss tuning fork, hold against distal big toe joint or index finger joint, ask Pt. to tell when vibration stops. Compare to your own sensation. DO BOTH SIDES!

41
Q

Assess Reflexes

A

Brachioradialis, Biceps, Triceps (hands on hips), Patellar, Achillese (gently DORSIFLEX foot). BABINSKI!

42
Q

Test rapid movements in arms and legs

A

Have Pt pronate/supinate hands with arms fully extended, have Pt rapidly tap on floor with feet. TEST EACH LIMB INDIVIDUALLY

43
Q

Test fine finger movements

A

Have Pt touch fingers to thumbs, BOTH SIDES

44
Q

Test finger to nose

A

Touch finger to nose and back again repeatedly

45
Q

Test heel to shin

A

Have Pt. lying down, perform maneuver BILATERALLY!

Physical Exam Skills (3 decks)

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