Neurological examination Flashcards

1
Q

what are the types of lesions

A

hereditary or congenital
acquired - traumatic, infective, neoplastic, degenerative, inflammatory, immune-mediated, vascular or functional

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2
Q

what does the Glasgow coma scale test

A

test eye opening response, motor response, verbal response, pupil response
score out of 15

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3
Q

what is the definition of a coma using the GCS

A

score of 8, lowest possible score is 3 which is no response for everything

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4
Q

how is cognitive function assessed

and what is tested

A

cognitive function test (MMSE, MoCA, ACE-3)
these test memory, attention, orientation, verbal fluency, language, visuospatial, change in behaviour or personality

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5
Q

overview of cranial nerve exam

A

inspection
look for symmetry, posture, involuntary movements
facial asymmetry
lack of facial expression
drooling saliva
speech - any problems with expression, articulation or phonation

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6
Q

olfactory nerve assessment

A

tests CN1
not formally assessed
ask about problems with sense of smell
asl about taste at same time which test CN7/9

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7
Q

optic nerve assessment

A

CN2
test vision
use Snellen chart (letter chart in opticians)
reading, finger counting, perception to light, visual fields, pupillary response to light, visualisation of optic disc

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8
Q

oculomotor, trochlear and abducens nerve assesments

A

CN3,4 and 6
eye movements (figure of H to test eye movement extremes)
double vision (issue with abducens, failure of one eye to abduct)
smooth pursuit or nystagmus
dilated pupil suggests issue with CN3

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9
Q

trigeminal nerve assessment

A

CN5
sensation to face (ophthalmic, maxillary and mandibular branches)
muscles of mastication (clench teeth, keep jaw open)

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10
Q

facial nerve assessment

A

CN7
muscles of facial expression
look for any asymmetry ( raise eyebrows, screw up eyes, puff out cheeks, smile)

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11
Q

vestibulocochlear nerve assessment

A

CN8
hearing and balance
whisper number in each ear whilst masking sound in other
Rinne’s and Weber’s test

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12
Q

glossopharyngeal and vagus nerve assessment

A

CN9 and 10
controls pharynx, breathing and phonation
look at back of throat
get them to cough

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13
Q

accessory nerve assessment

A

CN11
trapezius, sternocleidomastoid
shoulder shrug and turn head to each side

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14
Q

hypoglossal nerve assessment

A

CN12
look at tongue muscle bulk, is it deviated to one side
wiggle tongue from side to side
smooth movement or slow/spastic

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15
Q

neurological limb exams

A

inspection
tone
power
reflexes
coordination
sensation
gait

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16
Q

what does increased tone suggest

A

upper motor neuron lesions

17
Q

what does decreased tone suggest

A

lower motor neuron lesion

18
Q

what nerves do the reflexes test

A

biceps - C5
supinator - C6
triceps - C7
finger jerk - C8
knee - L3/4
ankle - S1
plantar responses - S1

19
Q

what are the coordination tests

A

finger-nose
heel-shin
dysdiadochokinesia (inability to perform rapidly alternating muscle movements)