Neurological Exam Flashcards
What is the first thing you should do before starting the Neuro physical exam?
Sanitize Hands
What is the first step of the neuro physical exam?
Evaluate orientation
How is the patient’s orientation evaluated?
Ask patient the following:
- Where are they at the current moment
- What date and time is it
- What is the current situation they are in
- What is their name
What is the second step of the neuro physical exam?
Perform Cranial Nerve Exam for CN 2 - CN 12
How do you test CN 2?
Wiggle Finger test
- test visual fields
How do you test CN 3?
Perform H Test
- Have patient follow finger in H pattern followed by accomodation test
How do you test CN 4?
Perform H Test
- Have patient follow finger in H pattern followed by accomodation test
How do you test CN 5?
Motor:
- Have patient clench teeth while you palpate temporal and masseter Ms.
Sensory:
- Test sensation of forehead, cheeks, and jaw bilaterally
How do you test CN 6?
Perform H Test
- Have patient follow finger in H pattern followed by accomodation test
How do you test CN 7?
Have patient perform the following actions:
- Raise eyebrows
- Frown
- Close both eyes tight (then try and open them to test strength)
- Smile
- Puff out both cheeks
How do you test CN 8?
Have Pt close their eyes and tell them to let you know if they hear any sound, and specify which ear they hear it
Then rub your finger pads together near their ear
How do you test CN 9?
Ask patient to voluntarily swallow
How do you test CN 10?
Ask patient to swallow voluntarily
Inspect soft palate and uvula for symmetry
How do you test CN 11?
Test muscle strength of patient’s ability to shrug their shoulders
How do you test CN 12?
Ask patient to stick their tongue out and move it around
Ask patient to stick tongue into their cheek and push against cheek to test for strength
What is the third step of the neuro physical exam?
Evaluate sensation of upper and lower extremities bilaterally (including pain/vibratory sensation)
How do you test sensation?
- Have pt close their eyes
- Have pt tell you if they feel touch or pain and where they feel it
- Touch one thumb (C6)
- Poke other thumb with sharp tool (C6)
- Touch one big toe (L5)
- Poke other big toe with sharp tool (L5)
- Poke one thumb with sharp tool (C6)
- Touch other thumb (C6)
- Poke on big toe (L5)
- Touch other big toe with sharp tool (L5)
What is the fourth step of the neuro physical exam?
Evaluate Deep Tendon Reflexes (one upper and one lower)
How do you test the deep tendon reflexes?
Scaled out of 4
- Normal is +2/4
- 0 is no reflex
- +1/4 is weak reflex
- +3/4 is a brisk reflex
- +4/4 is an abnormal clonus (repetitive reflex)
Lower Extremity:
- Calcaneal Reflex (S1 nerve root)
- Patellar Reflex (L4 nerve root)
Upper Extremity:
- Biceps reflex (C5 nerve root)
- Brachioradialis (C6 nerve root)
- Triceps (C7 nerve root)
How do you perform the Cerebellar Exam?
Finger to nose, heel to shin, or rapid alternating movement (pronation/supination tapping on lap)
What is the sixth step of the neuro physical exam?
Evaluate plantar response
How do you evaluate plantar response?
AKA Babinski
Take handle end of reflex hammer and rub the foot from heal to toes in one stroke.
Toes should curl
What is the seventh step of the neuro physical exam?
Perform one specialty test
How do you perform a romberg test?
Have patient stand with feet together eyes open.
- If pt loses balance with eyes open, sign of cerebellar ataxia
Have pt close eyes for 30-60 seconds with feet together
- Normal = minimal swaying
- (+) Romberg sign = pt loses balance when eyes are closed
