Neurological Exam Information

Question 1

Comments of the neurological screening sequence

Answer 1

1) mental status, speech, language
2) cranial nerve testing
3) motor system
4) coordination
5) sensory system
6) reflexes

Question 2

Cranial nerve 1 sense and testing

Answer 2

Sense of smell

To test: use cinnamon, peppermint, coffee beans and cloves to test with eyes closed

DONT use alcohol or noxious stimuli (doesn’t stimulate the nerve, stimulates inhibitory structures)

Question 3

cranial nerves 2/3/4/6 sense and testing

Answer 3

Vision and motor with the eyes

Testing:

• eye exams (CN 2)
• pupillary reactions (CN 2/3)
• extra-ocular movement tests (CN 3/4/6)

Question 4

Cranial nerve 5 testing and sense

Answer 4

Facial stimuli And jaw movement

Testing:

• jaw clench and moving side-side
• facial sensation
• corneal reflex
• measure symmetries on the face

Question 5

Cranial nerve 7 sense and testing

Answer 5

Facial muscle movements

Testing:

• facial expression mimics
• eyes closing and opening
• raising eyebrows test
• can test taste of anterior 2/3 of tongue and ear sensation also, but is rarely done in practice*

Question 6

Cranial nerve 8 sense and testing

Answer 6

Hearing

Testing:

• rub fingers together right outside ear to test silent sounds
• balance and eye movement tests

Question 7

CN 9 and 10 sense and testing

Answer 7

Motor of the tongue and pharynx/vocal cords as well as speech

Testing:

• have patient talk
• “ah” test
• swallowing tests

Question 8

Cranial nerve 11 sense and testing

Answer 8

Shoulder and neck movements

Testing: 
Shrug test (against pressure and not)
Turning head (against pressure and not)

Question 9

CN 12 sense and testing

Answer 9

Tongue movements and static positioning

Testing:

• static symmetry of the tongue
• positions and movement of tongue

Question 10

Muscle strength scale

Answer 10

O/5 = no muscular contraction

1/5 = barely detectable contractions

2/5 = active movement of body when gravity is eliminated

3/5 = active movement against gravity, but no resistance

4/5 = active movement against gravity and some resistance

5/5 = active movement against full resistance (normal muscle strength)

Question 11

What areas of the nervous system is required to function properly for coordination

Answer 11

Motor

Cerebellar function

Vestibular function

Sensation function

requires all 4 to function properly

Question 12

Dysdiadochokinesis

Answer 12

Clumsy non-coordinated movements

Question 13

Dysmetria

Answer 13

Cerebellar dysfunction which displaces accuracy of placement

Ex: touch nose with pointer finger and miss completely

Question 14

Ataxic gait

Answer 14

Cerebellar dysfunction that causes walking/balance dysfunction

Ex: walking heel-to-toe “tandem walking” is not possible

Question 15

Romberg test

Answer 15

Tests position sense in space

Patient eyes close with hands at side and feet together

If patient starts drifting then it shows neurological issues (usually CN 8 or corticospinal tract lesions)

Question 16

What are the most important things to note for sensory loss

Answer 16

1) is the lesion central or peripheral
2) is the sensory loss bilateral or unilateral
3) is the pattern distribution dermatomal, polyneuropathy or a spinal cord syndrome

Question 17

Sensory evaluation techniques

Answer 17

Focus on areas of abnormalities

Start dismally and move proximally ( loss-o-sensation is more common dismally)

Question 18

Spinothalamic tract lesions vs posterior columns lesions vs sensory cortex lesions

Answer 18

Spinothalamic tract lesions

• pain/temperature loss
• light touch

Posterior columns

• positioning and vibration loss
• light touch

Sensory cortex
- discriminative sensations

Question 19

Muscle stretch reflexes and the spinal segments associated review

Answer 19

Biceps
- C5/6

Triceps
- C7/8

Brachioradialis
- C5/6

Quads
- L3/4

Achilles
- S1/2

Question 20

Reflex scale

Answer 20

0/4 = absent

1/4 = somewhat diminished

2/4 = average (normal reflex)

3/4 = brisker than average (not necessarily pathological)

4/4 = clonus (usually pathological)

Question 21

Babinski sign

Answer 21

A positive (abnormal) plantar reflex (L5-S1)

Question 22

Kernig and brudzinski signs

Answer 22

Test for meningitis

Brudzinski= have patient laying down supine and lift only their head up passively
- if patient lifts knees up/bends them = (+)

Kernig = lay patient supine, Flex the hip to 90 degrees and then try to extend the knee. If sharp pain = (+)

Question 23

Asterixis

Answer 23

Extend arms out and push the fingers slightly out (hyperextension). If they “flap” hands back = (+)

Tests for liver disease/cirrhosis and or uremic diseases