Neurological Exam

Question 1

Cerebrum

Answer 1

Outer layer with right and left hemispheres. Tests basic cognition.

Question 2

Cerebellum

Answer 2

Posterior base of brain. Tests coordination of movement, posture, balance.

Question 3

Frontal lobe

Answer 3

Anterior/superior cortex. Tests thinking, decision making, personality, Broca’s area.

Question 4

Parietal lobe

Answer 4

Superior/posterior cortext. Tests taste, temperature, touch.

Question 5

Occipital lobe

Answer 5

Posterior. Tests vision.

Question 6

Temporal lobe

Answer 6

Lateral. Test hearing, comprehending speech, Wernicke’s area.

Question 7

Limbic system

Answer 7

Midbrain. Tests memory, emotional responses.

Question 8

Brainstem

Answer 8

Midbrain/pons/medulla. Regulates life-sustaining functions (breathing, HR, temp, etc).

Question 9

Cranial nerves I-XII

Answer 9

CN I (Olfactory) : Sensory (distinguish smells).
(Optic) CN II: Sensory (visual acuity, fundoscopy, confrontation)
CN III (Oculomotor): Motor (Cardinal Eye Movement, AO3)
CN IV (Trochlear): Motor (Cardinal Eye Movement, SO4)
CN V (Trigeminal): Motor (clench teeth, move jaw side to side), Sensory (sharp, dull, light touch – Ophthalmic, Maxillary, Mandibular)
CN VI (Abducens): Motor (Cardinal Eye Movement, LR6)
CN VII (Facial): Motor (elevate eyebrows, close eyes tightly, puff out cheeks, smile & show teeth)
CN VIII (Acoustic): Sensory (gross hearing, Weber, Rinne)
CN IX (Glossopharyngeal): Motor (Gag Reflex, Say “Ah”, Swallow)
CN X (Vagus): Motor (Gag Reflex, Say “Ah”, Swallow)
CN XI (Spinal Accessory): Motor: Trapezius (shoulder shrug, against resistance); Sternocleidomastoid (turn head against resistance
CN XII (Hypoglossal): Motor: Extend tongue, test lateral strength of tongue (press through cheek), listen for dysarthria

Question 10

Basal ganglia

Answer 10

Midbrain. Coordinates fine motions (with cerebellum).

Question 11

Spinal cord

Answer 11

White and gray matter. Form spinal nerves.

Question 12

Ascending spinal tracts

Answer 12

White matter. Mediate sensations.
Spinocerebellar - proprioception.
Spinothalamic - light/crude touch, pressure, temp, pain.
Dorsal columns - Fine touch, 2 point discrimination, proprioception.

Question 13

Descending spinal tracts

Answer 13

Grey matter. Mediate motor funciton.
Corticospinal - convey impulses to muscle groups. Role in muscle tone, posture, precise motor movements.
Corticobulbar - Innervates motor function of cranial nerves.

Question 14

Spinal nerves

Answer 14

Innervate throughout body for sensory and motor function in dermatomal pattern.

Question 15

Difference between upper and lower motor lesion

Answer 15

Both perform different signs and symptoms.
UMN: from spinal cord connections up to brain.
LMN: involve neurons from spinal cord connections to periphery.

Question 16

Difference between voluntary and autonomic nervous system

Answer 16

Autonomic NS: Visceral motor control of cardiac/smooth muscles/glands.
Voluntary (Somatic) NS: Somatic motor control. CNS conducts impulses to skeletal muscles.

Question 17

GCS and it’s usefulness

Answer 17

Used to quantify consciousness; assesses function of cerebral cortex. Best for emergencies. 15/15 normal.

Question 18

Equipment needed for neuro exam

Answer 18

Penlight
Tongue blade
Tuning forks
Familiar objecs (paper clips, coins)
Cotton wisp
Monofilament
Reflex hammer
Vials of aromatic substances
Eye chart

Question 19

DTR scores/meanings

Answer 19

0: No response
1+: Sluggish or diminished
2+: Active or expected
3+: More brisk than expected, slightly hyperactive
4+: Brisk, hyperactive, with intermittent or transient clonus