Neurological Examination Flashcards
What is the order for an Upper Limb Neuro Examination?
Inspection, Tone, Power, Reflexes, Coordination, Sensation
What are you looking for on inspection?
Scars, Wasting, Involuntary Movements, Fasciculations, Tremor
Upper Limb Inspection Extra Test?
Pronator Drift
Which Upper Limb Movements should Power be assessed for?
Shoulder Abduction (C5)
Shoulder Adduction (C6/7)
Elbow Flexion (C5/6)
Elbow Extension (C7)
Wrist Extension (C6)
Wrist Flexion (C6/7)
Finger Extension (C7)
Finger Abduction (T1)
Thumb Abduction (C8/T1)
Which upper limb reflexes should be assessed?
Biceps (C5/6)
Triceps (C6/7)
Supinator (C5/6)
Where should sensation be assessed in the upper limb (Dermatome)?
Lateral Upper Limb (C5)
Lateral Forearm + Dorsal Aspect of the Thumb (C6)
Palmar Middle Finger (C7)
Palmar Little Finger (C8)
Medial Forearm + Upper Limb (T1)
What elements are involved in sensation testing?
Soft Touch (Cotton Wool)
Vibration (128 Hz Tuning Fork DIP)
Proprioception (Thumb Movement)
Pain (Neurotip) OFFER ONLY
Temperature OFFER ONLY
Also, tests the ability to write, and identify a coin by touch and two-point discrimination.
Neurological Examination Concluding Offers
Other Neuro Exams e.g Lower Limb and CN
What should be included in the beginning of an Lower Limb Neuro Exam?
Rombergs (Stood Up, Eyes Closed, Arms Supinated).
Gait Assessment
How to assess tone in Lower Limbs?
Leg Roll, Leg Lift, Ankle Clonus
Assessment of Power in Lower Limb?
Hip Flexion (L1/2)
Hip Extension (L5/S1)
Adduction (L2/3)
Abduction (L4/5)
Knee Flexion (S1)
Knee Extension (L3/4)
Dorsiflexion (L4)
Plantar Flexion (S1/2)
Ankle Inversion (L4)
Ankle Eversion (L5/S1)
Great Toe Plantarflexion (L5)
Great Toe Dorsiflexion
Lower Limb Reflexes
Knee Jerk (L3/4)
Ankle Jerk (L5/S1)
Where to assess lower limb sensation (Dermatomes)?
Upper Thigh (L2)
Above Patella (L3)
Below Patella (L4)
Medial Foot (L5)
Lateral Foot (S1)
Upper Limb Coordination
Finger to Nose - Move Your finger
Fine Finger Movements - Thumb to Fingertips
Dysdiadochokinesia
Lower Limb Coordination
Heel-Shin Test
CN I Examination
Olfactory - Have you noticed any changes in your sense of smell?
CN II Examination
Optic - ARIFA
- Acuity - Snellen Chart 2m (Ask Patient to Cover one eye)
- Reflexes (Light)
- Inattention
- Fields (Red Pin)
- Accommodation (Focus on Wall then finger)
CN III, IV, VI Examination
Oculomotor, Trochlear, Abducens
H Pattern Follow Finger - Ask about diplopia.
- CN IV - Downward
- CN VI - Abduction
CN V Examination
Trigeminal -
Sensation - Forehead, Cheeks, Chin (Both sides)
Assess Muscle Bulk of Masseter and Temporalis
Assess Jaw opening power
Jaw-Jerk Reflex
CN VII
Facial - Test Facial Expressions
- Close eyes - don’t let you open them.
- Puff out cheeks
- Raise eyebrows
- Show teeth
CN VIII
Vestibulocochlear
- Cover one ear and whisper a number for them to repeat.
If an abnormality is suspected perform Rinne’s and Webers Tests
Rinne’s & Webers Tests
Rinne’s - 512 Hz Tuning Fork is held on the mastoid until the sound is no longer heard then it is brought outside the ear. And should be heard again unless there is conductive hearing loss.
Webers - 512Hz is held on the forehead in the midline - the sound is heard louder in the conductive hearing loss ear.
CN IX, X Examination
Glossopharyngeal and Vagus
- Note Uvula deviation
- Ask about swallowing difficulty -test.
- Ask the patient to cough.
CN XI Examination
Accessory
Ask the patient to shrug and turn their head against resistance.
