Neurological Exam

Question 1

The left motor cortex controls the motion of. . .

Answer 1

. . .the right side of the body

Question 2

Motor Pathway from Brain to Periphery

Answer 2

Question 3

Sensory Pathway from Brain to Periphery

Answer 3

Question 4

Cranial nerves

Answer 4

Question 5

Ways that the nervous system may be disrupted

Answer 5

• Ischemia
• Hemorrhage
• Abcess/infection
• Neoplasm
• Trauma
• Inflammation
• Degeneration

Question 6

Patterns of nerve damage

Answer 6

Question 7

Dysarthria

Answer 7

slurring of speech due to malfunction of the tongue

Question 8

The basic neurological exam components

Answer 8

Assessment of mental status

Examination of the cranial nerves

The motor exam

Deep tendon reflexes

The sensory exam

Assessment of coordination and gait

Question 9

Mental status examination

Answer 9

• Loss of consciousness
• attention
• language fluency
• Orientation x3 (person, time, place)
• Memory

Question 10

Testing the Cranial Nerves

Answer 10

I - Olfactory: rarely tested unless the patient has a specific complaint

II - Optic: assess visual acuity, test visual fields and assess pupillary responses

III - Oculomotor, IV - Trochlear, and VI - Abducens: Together control extraocular movements

V - Trigeminal: Three divisions; V1 ophthalmic, V2 maxillary, V3 mandibular. Test each with a light touch.

VII - Facial: Wrinkling of forehead, movement of eyebrows, smile, puffing of cheeks, closing eyes tightly shut

VIII - Acoustic: Hearing

IX - Glossopharyngeal: Palate elevation

X - Vagus

XI - Accessory: Raise shoulders and turn head against resistance

XII - Hypoglossal: Tongue protrusion

Question 11

Testing motor function

Answer 11

Note muscle bulk and tone.

Have patient close eyes and stand still. Have patient hold out arms for ~15 seconds with eyes closed. (May observe pronator drift)

Question 12

Strength tests

Answer 12

Extension of wrist (C 7,8 radial N)

Flexion (C 5,6) and extension (C 6,7,8) of elbow

Grip strength (C 7,8 and T1)

Hip flexion (L2,3,4)

Knee flexion (L5-S1) and extension (L3,4)

Ankle dorsiflexion (L4,5) and plantar flexion (L5-S1)

Question 13

Grading of Strength Scale

Answer 13

0 = no movement

1 = flicker of movement

2 = active movement without gravity

3 = can move against gravity

4 = reduced strength

5 = normal strength against full resistance

Question 14

Assessing deep tendon reflexes

Answer 14

biceps tendon (C5,6)

brachioradialis (C 5,6)

knee (L 3,4,5)

Achilles (L5-S1)

Question 15

Grading of spinal reflexes

Answer 15

0 = no response

1 = decreased

2 = normal

3 = brisk

4 = brisk with clonus

Question 16

Sensory Exam (touch and proprioception)

Answer 16

Vibration and Light touch tests at upper and lower extremities

Rombert test (Stand still/straight with eyes closed)

Question 17

Cerebellum exam

Answer 17

Finger-to-nose test

Heel-to-shin test

Observation of gait

Question 18

Recording a normal neuro exam

Answer 18

Question 19

Cranial Nerve I

Answer 19

I - Olfactory: rarely tested unless the patient has a specific complaint

Question 20

Cranial Nerve II

Answer 20

II - Optic: assess visual acuity, test visual fields and assess pupillary responses

Question 21

Cranial Nerve III, IV, and VI

Answer 21

III - Oculomotor, IV - Trochlear, and VI - Abducens: Together control extraocular movements

Question 22

Cranial Nerve V

Answer 22

V - Trigeminal: Three divisions; V1 ophthalmic, V2 maxillary, V3 mandibular. Test each with a light touch.

Question 23

Cranial Nerve VII

Answer 23

VII - Facial: Wrinkling of forehead, movement of eyebrows, smile, puffing of cheeks, closing eyes tightly shut

Question 24

Cranial Nerve VIII

Answer 24

VIII - Acoustic: Hearing

Question 25

Cranial Nerve IX

Answer 25

IX - Glossopharyngeal: Palate elevation

Question 26

Cranial Nerve X

Answer 26

X - Vagus

Question 27

Cranial Nerve XI

Answer 27

XI - Accessory: Raise shoulders and turn head against resistance

Question 28

Cranial Nerve XII

Answer 28

XII - Hypoglossal: Tongue protrusion