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Z Year3 Clinical Examinations > Neurological Exam (Cranium) > Flashcards

Neurological Exam (Cranium) Flashcards

1
Q

When taking a neurological history what are the 6 key changes to look for?

A
  1. Fits, faints or funny turns
  2. Sensory changes
  3. Speech and swallowing changes
  4. Cognition and Mood
  5. Bladder and bowel changes
  6. Headaches
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2
Q

What is included in fits faints and funny turns?

A
  1. seizures

2. loss of consciousness

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3
Q

If there is a fit, faint or funny turn what questions should be asked?

A
  1. Any evidence of pre-warning / preceding symptoms
  2. any witnesses to the event
  3. what the recovery period was like after regaining consciousness
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4
Q

Why is it important to know the occupation of the patient?

A

occupation / hobby where a sudden syncopal episode would be especially dangerous e.g. diving / swimming / driving

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5
Q

What can sensory changes include?

A
  1. hearing
  2. taste
  3. smell
  4. numbness
  5. tingling
  6. vision (including diplopia)
  7. weakness
  8. balance
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6
Q

What are the red flags of headaches?

A
  1. abrupt severe onset (“thunderclap”)
  2. age of onset > 50
  3. progressive severity / worsening frequency
  4. significant change in pattern of headache
  5. worsening of symptoms with posture or straining / coughing, neurological symptoms or focal neurological signs, confusion
  6. reduced consciousness
  7. meningism
  8. previous or family history of malignancy
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7
Q

What are some risk factors that are important for inquire about for developing neurological symptoms?

A
  1. Immunocompromise
  2. head injury / recent trauma
  3. drug and alcohol use
  4. anticoagulation
  5. pregnancy
  6. previous history of cancer
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8
Q

What is the position of a patient in the neurological exam?

A

patient should be sitting up

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9
Q

What is the exposure of a patient in the neurological exam?

A

examine the neck upwards

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10
Q

What must you always ask at the start of an exam?

A

Check is patient is in any pain

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11
Q

What features are you looking for in a general inspection

A
  1. Squint
  2. Ptosis
  3. Facial droop
  4. Asymmetric / abnormal eye position
  5. Proptosis
  6. Pupils
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12
Q

How do you test for the olfactory nerve (I)?

A
  1. Ask the patient if they have noticed any change in smell

2. If Yes: test olfaction using scented bottles to test each nostril separately

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13
Q

What are the 4 components for testing for the optic nerve (II)?

A
  1. Visual acuity (Snellen chart)
  2. Visual fields and inattention
  3. Reflexes (accommodation reaction, pupillary light reaction including swinging light reflex).
  4. Fundoscopy
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14
Q

What cranial nerves do the reflexes test?

A

optic nerve and occuolomotor nerve

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15
Q

What are the possible field defects when testing for the optic nerve?

A
  1. Unilateral blindness
  2. Bitemporal hemianopia
  3. Homonymous hemianopia
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16
Q

What can be used to test the blindspot and to assess colour vision?

A
  • CV: Ishihara plates

- B:hatpin

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17
Q

What is used in fundoscopy?

A
  1. Red reflex

2. Fundus - Disc (Contour, Colour, Central Cup), Vessels, Periphery, Macula/Fovea)

18
Q

What should you ask for when testing Oculomotor (III), Trochlear (IV), Abducens (VI) nerves ?

A
  1. keep the patient’s head still 2. ask them if they have any double vision
  2. Also test for nystagmus
19
Q

What would 3 nerve palsy show?

A
  1. complete ptosis
  2. dilated pupil
  3. eye turned down and out
20
Q

What would 4th nerve palsy show?

A

downwards diplopia

21
Q

What would 6th nerve palsy show?

A

failure to abduct eye

22
Q

What function does the trigeminal nerve have (V)?

A

mixed sensory and motor

23
Q

How do you test trigeminal nerve?

A
  1. ask the patient to clench their teeth while you feel over the masseter and temporalis muscles
  2. ask the patient to open their jaw against resistance
24
Q

What reflexes can also be tested with the trigeminal nerve?

A
  • jaw jerk

- corneal

25
Q

What function foes the facial nerve have (VII)?

A

mixed sensory and motor

26
Q

What is the sensory function of the facial nerve?

A

taste sensation to anterior 2/3 of tongue

27
Q

How do you test the motor function of the facial nerve?

A
  1. raising eyebrows
  2. closing eyes
  3. puff out cheeks
  4. show teeth/smile
28
Q

If there is facial muscle weakness how do you tell if it is UMN or LMN defect?

A

-UMN: relative sparing of the upper 1/3rd of the face due to the bilateral representation of muscles that move the upper 1/3rd of the face in the cerebral cortex

29
Q

How do you test the vestibulocochlear nerve (VIII)?

A

ask about hearing and balance

30
Q

What is the gross assessment to test for the vestibulocochlear nerve (VIII)?

A

rubbing your fingers next to each ear in turn and asking if there is a difference

31
Q

What is the sensitive assessment to test for the vestibulocochlear nerve (VIII)?

A

Rinne’s and Weber’s tests

32
Q

How do you test for the glossopharyngeal nerve (IX)?

A

look for deviation of the uvula

33
Q

How do you test for vagus nerve (X)?

A

swallow💦💦💦💦💦

34
Q

How does the gag reflex test both of vagus and glossopharyngeal nerve?

A

sensory limb of this reflex comes from the glossopharyngeal nerve and the motor limb is the vagus nerve

35
Q

What muscles do you test the motor function of to test the accessory nerve (XI)?

A

sternocloidmastoid and trapezius muscle

36
Q

How do you test the motor function of the trapezius muscle?

A

ask the patient to raise their shoulders against resistance

37
Q

How do you test the motor function of the sternocloidmastoid muscle?

A

ask the patient to turn their head against resistance

38
Q

How do you test for the hypoglossal nerve (XII)?

A
  1. Inspect the tongue for wasting, fasciculation and deviation
  2. assess the patient’s tongue movement and speech.
39
Q

What do you say to the patient after the exam?

A
  1. thank the patient
  2. assist in covering them up
  3. wash your hands
40
Q

What would you say to examiner after exam?

A
  1. Take a full history

2. Conduct a neurological examination of the upper and lower limbs

Z Year3 Clinical Examinations (33 decks)

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