Neurological Exam Flashcards
What questions should be asked during the History Portion of the Neurological Exam?
- What is the problem? If the only symptom is pain:
Can you describe the pain? (sharp, dull, throbbing)
Is the pain localized, or hard to pinpoint? - Have you made a dive recently?
- What was your dive profile? (Depth, bottom time, what rig, what type of work, anything unusual occur?)
- How many dives have you made in the last 24 hours?
- When did you first notice this? (if after the dive, how long after? If during the dive during descent, on bottom or during ascent?)
- Has it gotten better or worse since you noticed it?
- Have you developed any additional symptoms?
- Have you ever felt like this before?
- Have you ever been bent or had an AGE?
- Do you have any medical condition that might explain this?
What are the SIX parts of a Neurological Exam?
- Mental Status.
- Coordination.
- Motor Skills.
- Cranial Nerves.
- Sensory.
- Deep Tendon Reflexes.
What does the “Mental Status” Portion of the neuro consist of?
- Do you know where you are?
- Do you know what time it is?
- Do you understand what is happening?
- Who is the current president?
- Who was the first president?
- I want you to remember three things. Hammer, Barrel, Trigger. What does that make you think of?
- If I have two dimes and a nickel. How much money do I have? What if I take away one of the dimes?
- What were those things I Asked you to remember?
What does the “Coordination” Portion of the neuro consist of?
- Heal-to-toe test.
- Romberg test (eyes closed, palms forward and up).
- Finger-to-nose (eyes closed, head back, arms outstretched to the side.)
- Heel-Shin Slide.
- Rapid Alternating Movement.
What were those things I Asked you to remember?
How is the symptom?
What does the “Cranial Nerves” Portion of the neuro consist of?
- Optic - Do you have any blurry vision, loss of vision or spots? Hand patient something to read. ask them to cover one eye and read a line.
- Oculomotor, Trochlear, Abducens - Have the patient follow your finger in all four quadrents then towards the tip of his nose.
- Acoustic- Close your eyes, tell me what side you hear this one. lightly rub fingers next to ear.
- Facial- Smile, show your teeth, Whistle, wrinkle your forehead, close your eyes tightly.
- Trigeminal - Lightly stroke the forehead, face, and jaw on each side of the face.
- Vaqus- Say “Ahhhhh” look for the palate to rise.
- Spinal Accessory- Shrug and turn head against resistance.
What were those things I Asked you to remember?
How is the symptom?
What does the “Motor” Portion of the neuro consist of?
- Deltoids- Raise your arms to your side. resist me. (push down on wrists)
- Lats- Raise your arms to your side. push down on my hands (place hands under wrists)
- Biceps- bend arm at the elbow. resist me. (pull arm toward you).
- Triceps- Bend arm at the elbow. resist me. (push arm toward patient)
- Forearm- make a fist. resist me. (try and bend wrist up and down)
- Hand muscles- spread your fingers. resist me (push two fingers together)
Sit Down——————–
- Hip flexion- place a hand on patients thigh. Raise your leg.
- Hip extension- place hand under thigh. push down.
- Hip abduction. push knees together. resist me.
- Hip Adduction. pull knees apart. resist me.
- Knee extension. place hand on shin. kick out.
- Knee flexion. Place hand above heel. Pull back.
- Ankle Dorsiflexion- hand on top of foot. resist me.
- Ankle plantarflexion- hand on bottom of foot. Push down.
- Toes- flex your toes, resist me.
What were those things I Asked you to remember?
How is the symptom?
What does the “Sensory” Portion of the neuro consist of?
- testing the trunk- Run the object from just behind the ear to below the buttocks. Feel all that.
- Testing the arms- look away, circular pattern just below the shoulder, below the elbow, on the wrist.
- Test the legs- look away, circular pattern, upper thigh, just below the knee, and the ankle.
- Hands- look away, run a sharp object across the back of the hand, the palm and each finger tip.
What does the “Deep Tendon Relfex” Portion of the neuro consist of?
- Biceps- hold the patients elbow and have them relax and look away. place your thumb on the bicep tendon in the bend of the elbow. tap your thumb with the hammer. feel for muscle contraction.
- Triceps- support the arm at the bicep, tap the back of the arm just above the elbow.
- Knee- patient sits on a table with feet off the deck- tap the patients knee just below the knee cap.
- Ankle- patient sits on a table with feet off the deck- push slightly on the patients toes to stretch the Achilles tendon. feel for the toes to contract at the tendon is contracted.
How is the Muscle Strength Graded?
0- Paralysis. No motion possible.
1- Profound Weakness. Flicker or trace of muscle contraction.
2- Severe Weakness. Able to contract the muscle but cannot move joint against gravity.
3- Moderate Weakness. Able to overcome the force of gravity but not the resistance of the examiner.
4- Mile Weakness. Able to resist slight force of examiner.
5- Normal. Equal strength bilaterally. Able to resist the examiner.
