Neurological Exam & Common Complaints

Question 1

What is the meaning of Consensual pupil reaction?

Answer 1

The change in pupil size in the eye opposite to the eye to which the light is directed (e.g., if the light is shone in the right eye, the left pupil also constricts consensually)

Question 2

What is the name of the condition in which the person sees only one side (right or left) of the visual world of each eye?

Answer 2

Homonymous hemianopsia (right or left)

Question 3

What is the cranial nerve (CN) responsible for the following:
1. voice
2. Swallowing
3. Movement of soft palate & pharynx
4. Gag reflex
5. Uvula movement

Answer 3

CN IX & X (9 & 10). The Glossopharyngeal & Vagus CN

Question 4

What is the CN responsible for deviated uvula (shift of the uvula towards the opposite side of the lesion)?

Answer 4

CN X - vagus (10)
???
Cranial Nerve IX – Glossopharyngeal
Ask the patient to open their mouth and say “Ah” and note symmetry of the upper palate. The uvula and tongue should be in a midline position and the uvula should rise symmetrically when the patient says “Ah.

Question 5

What cranial nerve control the movement of the neck and shoulders?

Answer 5

Cranial nerve XI - Accessory nerve (11)
It provides motor function to some muscles in the neck. It controls the sternocleidomastoid and trapezius muscles that allow a person to rotate, extend, and flex the neck and shoulders.

Question 6

Which cranial nerve are you assessing when you inspect the patient’s face at rest & during the conversation, ask the patient to smile, show teeth, close both eyes, puff cheeks, frown, and raise eyebrows & Look for symmetry and strength of facial muscles?

Answer 6

CN VII - Facial nerve (7)

Question 7

What CN you are assessing when you use a cotton swab or tongue blade to touch the patient’s posterior pharynx & observe for a gag reflex followed by a swallow?

Answer 7

CN X – Vagus (10)
The glossopharyngeal (IX) and vagus (x) nerves work together for integration of gag and swallowing.

Question 8

Parkinson’s disease is

Answer 8

A brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination. Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. Tremors present even with rest.

Question 9

What are the alarming symptoms for confusion?

Answer 9

1. Obvious neurological deficits (like slurred speech, not walking well … etc.)
2. Fever or hypothermia
3. Seizure
4. Headache
5. Dyspnea (Difficult, painful breathing or SOB)
6. Diaphoresis

Question 10

Which cranial nerve tests corneal reflex?

Answer 10

CN V - trigeminal nerve (5)
Pt should blink when you touch the cornea with a fine wisp or cotton

Question 11

What systems should always be reviewed in the ROS for any neurological complaint?

Answer 11

1. Constitutional
2. HEENT
3. Cardiovascular
4. Musculoskeletal
5. Nuro
6. Mental health

Question 12

What is the meaning of Fasciculation?

Answer 12

(involuntary muscle twitches); involuntary rapid muscle twitches that are too weak to move a limb but are easily felt by patients and seen or palpated by clinicians. Most healthy people experience fasciculations at some time, especially in the eyelid muscles

Question 13

Name the tests for coordination.

Answer 13

1. Rapid alternating movements
   -Finger to finger; Palm of hand/back of hand (Pt touches each finger of one hand to the thumb of the same hand in an alternating pattern (5th, 4th, 3rd, & then 2nd finger). Next, the patient performs the same test on the opposite hand)
2. Point-to-point movements
   
   • Arms: fingers-to-nose test (FNT). Ask Pt are to touch their own nose alternately
   • Legs: heel-to-shin test (Pt in a sitting position, instruct Pt to place the heel of one foot onto the knee of the other leg & then slide the heel down the shin from the knee to the ankle and back up to the knee)
3. Gaint & others’ related body movements
   
   • Heel-toe walk (Walking in a straight line with the front foot placed such that its heel touches the toe of the standing foot)
4. Standing in a specific way
   
   • The Reomberg test (measures a person’s sense of balance)
   • Test for Pronator drift (ask the patient to close their eyes and then hold both arms straight out with palms facing up. Observe the arms for 20 to 30 seconds. The patient should be able to maintain the position of both arms equally if their motor pathway is intact)

Question 14

Type of Gait Abnormalities?

Answer 14

https://www.massagetherapyreference.com/11-abnormal-gaits-problems-with-walking/#1–antalgic-gait

1. Steppage
2. Parkinsonian
3. Spastics Hemiparesis
4. Scissors
5. Cerebellar Ataxia
6. Sensory Ataxia

Question 15

Explain the scale for grading reflexes.

Answer 15

4+ Very brisk, hyperactive, with clonus (rhythmic oscillations between flexion & extension)

3+ Brisker than average; possibly but not necessarily indicative of disease

2+ Average; Normal

1+ Somewhat diminished; low normal

0 No response

Question 16

What alarming symptoms indicate or may indicate a serious cause of headache?

Answer 16

Always indicate a serious cause for headache:
1. Vision loss
2. Confusion or altered mental status
3. Headache with seizure

May indicate serious cause of headache:
1. Fever
2. Unintentional Wt loss
3. HIV infection or immunosuppressed
4. Hx of neurosurgery
5. New headaches in Pt over age 50
6. Sever eye pain
7. Double vision
8. Hemiparesis
9. ‘‘Worst headache of my life’’

Question 17

Headeache types?

Answer 17

1. Migraine: Unilateral headache, Nausea, photophobia, phonophobia, throbbing, visual disturbances, disabling, or numbness/tingling. Lasts 4-72 hr. Occurs on evenings & weekends, once or twice a month.
2. Cluster: Around eyes, piercing, sharp shocks, pain, nasal congestion, always on the same side. Lasts 15 min to 3 hr (comes on rapidly 5-10 mint). Occurs in the middle of the night every 1-4 days.
3. Tension: Pressure, tight, forehead, temples, bandlike headache. Comes on slow & gradually worsens. Lasts 30 min to 1 wk. Occurs in the afternoon, especially while working. Occurs once or twice a wk.