Neurological Exam Flashcards
First 2 Qs in neurological diagnosis
Where is the lesion
What is the lesion
Examination elements?
Higher mental fuNation
Gait
Cranial nerves
Motor and sensory exam of limbs
Assess level of consciousness how
Glasgow scale 3-15
15= alert
Observation of gait includes
Speed Stride length Arm swing Base Steady? Initiation, turning, freezing Abnormal movements or postures
Olfactory test
Not usually examined often but smelling salts should be used
Trigeminal test
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
What should be present on jaw jerk test
Not a very big jerk
Trigeminal test - muscles of mastication assessed how?
Palpate and look for unilateral weakness when opening mouth back up
Facial nerve test
Muscles of facial expression s
Taste 2/3 front of tongue
Check for muscles working eg. Raise eyebrows, screw up eyes tight
VIII- vestibulocochlear test?
Screen hearing using voice and tuning forks (Tuning form if deaf)
Vestibular part is done mainly during gait and nystagmus tests earlier
IX glossopharyngeal + Vegus
XI - taste back 1/3 of tongue , pharyngeal sensation , gag reflex
X- gag reflex, vocal chords
Listen to speech, gag, swallow, cough
XI accessory
Test trapezius and sternosternocleidomastiod
Shrug shoulders and keep them up
Turn head and palpate sternocleidomastoid muscle
XII Hypoglossal exam
Observe tongue for wasting/fasciculation(flickering)
Tongue profusion look for deviation (will deviate to side of the lesion)
Power and speed of movement
Observation for limbs?
Look for wasting
Fasciculation
Abnormal movements
How to assess tone
In arms and legs
Arms- fled and extend wrist
Pronate and supinate forearm
Flex and extend elbow
Legs-
Roll leg
Lift leg quickly
Passive movement
Difference between spasticity and rigidity
Spasticity is velocity dependant
Rigidity is not velocity dependant
Test of power
Shoulder abduction
Elbow flexion and extension
Wrist extension
Finger flexion
How to grade power?
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
MRC patterns of weakness
Proximal
Distal
Pyramidal
Focal
Proximal- usually muscular
Distal -usually nerve problem
Pyramidal -upper + flexed arm and extended leg
Plantar response ?
Looking for what ?
Flexor= normal
Extensor= abnormal (UMN)
Coordination test/cerebellar
Look for?
Test example?
Look for nystagmus , slurred speeech
Finger nose test
- dysmetria (past pointing)
- intention tremor
- rapid alternating movements
Examining limbs (sensory)
Observe Ask about symptoms Light touch Pinprick Temperature Vibration
Sensory test observe for
Scars , burns , ulcers
Skin changes
Sensory touch test ?
Cotton woo
Does it feel normal
Pinprick test used for same thing
Temperature measurement using cold tuning fork
Sensory vibration test ?
Vibration on tuning fork on toes
