Neurological Exam

Question 1

First 2 Qs in neurological diagnosis

Answer 1

Where is the lesion

What is the lesion

Question 2

Examination elements?

Answer 2

Higher mental fuNation
Gait

Cranial nerves

Motor and sensory exam of limbs

Question 3

Assess level of consciousness how

Answer 3

Glasgow scale 3-15

15= alert

Question 4

Observation of gait includes

Answer 4

Speed
Stride length
Arm swing
Base
Steady?
Initiation, turning, freezing 
Abnormal movements or postures

Question 5

Olfactory test

Answer 5

Not usually examined often but smelling salts should be used

Question 6

Trigeminal test

Answer 6

Sensation of face

Test muscles of mastication (clench jaw and palpate, also looking for uni lateral weakness on sides when opening mouth back up)

Look for corneal reflex

Jaw jerk

Question 7

What should be present on jaw jerk test

Answer 7

Not a very big jerk

Question 8

Trigeminal test - muscles of mastication assessed how?

Answer 8

Palpate and look for unilateral weakness when opening mouth back up

Question 9

Facial nerve test

Answer 9

Muscles of facial expression s
Taste 2/3 front of tongue

Check for muscles working eg. Raise eyebrows, screw up eyes tight

Question 10

VIII- vestibulocochlear test?

Answer 10

Screen hearing using voice and tuning forks (Tuning form if deaf)

Vestibular part is done mainly during gait and nystagmus tests earlier

Question 11

IX glossopharyngeal + Vegus

Answer 11

XI - taste back 1/3 of tongue , pharyngeal sensation , gag reflex

X- gag reflex, vocal chords

Listen to speech, gag, swallow, cough

Question 12

XI accessory

Answer 12

Test trapezius and sternosternocleidomastiod
Shrug shoulders and keep them up

Turn head and palpate sternocleidomastoid muscle

Question 13

XII Hypoglossal exam

Answer 13

Observe tongue for wasting/fasciculation(flickering)

Tongue profusion look for deviation (will deviate to side of the lesion)

Power and speed of movement

Question 14

Observation for limbs?

Answer 14

Look for wasting
Fasciculation

Abnormal movements

Question 15

How to assess tone

In arms and legs

Answer 15

Arms- fled and extend wrist
Pronate and supinate forearm
Flex and extend elbow

Legs-
Roll leg
Lift leg quickly
Passive movement

Question 16

Difference between spasticity and rigidity

Answer 16

Spasticity is velocity dependant

Rigidity is not velocity dependant

Question 17

Test of power

Answer 17

Shoulder abduction

Elbow flexion and extension

Wrist extension
Finger flexion

Question 18

How to grade power?

Answer 18

MRC grading of power

0-5

0 is paralysis

1- flicker

2-movement with gravity eliminated

3- movement against gravity but not resistance

4- some resistance but not full power

5- normal

Question 19

MRC patterns of weakness

Proximal

Distal

Pyramidal

Focal

Answer 19

Proximal- usually muscular

Distal -usually nerve problem

Pyramidal -upper + flexed arm and extended leg

Question 20

Plantar response ?

Looking for what ?

Answer 20

Flexor= normal

Extensor= abnormal (UMN)

Question 21

Coordination test/cerebellar

Look for?

Test example?

Answer 21

Look for nystagmus , slurred speeech

Finger nose test

• dysmetria (past pointing)
• intention tremor
• rapid alternating movements

Question 22

Examining limbs (sensory)

Answer 22

Observe 
Ask about symptoms 
Light touch
Pinprick 
Temperature
Vibration

Question 23

Sensory test observe for

Answer 23

Scars , burns , ulcers

Skin changes

Question 24

Sensory touch test ?

Answer 24

Cotton woo

Does it feel normal

Pinprick test used for same thing

Temperature measurement using cold tuning fork

Question 25

Sensory vibration test ?

Answer 25

Vibration on tuning fork on toes