Neurological examination Flashcards
What is the structure of a neurological examination
Romberg test Walking Cranial Nerves Motor system Sensory system
What position is needed for the Romberg test
Feet next to each other
Eyes closed
Arms stretched out
Hands supinated
Which centres are responsible for balance
Cerebellum, proprioception, vestibulum, eyes
What does balance being worse on eye closure suggest
Proprioceptive problem
What needs to be determined with power problems
Central or peripheral
What does pronatory drift suggest
A pyramidal lesion
What should you look out for when assesseing water
Posture
Balance
Stride length
Arm swing
Acute history reasons
Vascular, toxins, drugs, trauma
Subacute history reasons
Infections, inflammation, tumours
Chronic history reasons
Neurodegenerative conditions
Name four walking patterns
Hemiplegic, scissoring, steppage, parkinsonian gait
What is the test for meningism
Take head of patient in both hands, move forwards and backwards
Causes of meningism
Meningism, subarachnoid haemorrhage
Who shows scissoring gate
Cerebral palsy
Who shows hemiplegic gate
Hemplegics
How to test CN2
Shine light into one eye.
Bring light from side
Both pupils will constrict
(Direct and indirect light reflexes)
Do people keep their glasses on for visual activity tests
Yes. If they dont have glasses with them, can use the pinhole test
Testing visual fields
Eyes at same level as patient
Both the patients fields should be the same
Fundoscopy
Use your right eye to look into the patients right eye, looking for papilloedema
Which reflex are you looking for with fundoscopy
Red reflex
How do you test eye movements
Tell patient to keep head still and follow the finger with their eyes. T
What are you testing with the eye movements examination
3,4,6 CNs and cortical eye fields
How does right 6th nerve palsy show
Cant move the eye to the right
How does 3rd nerve palsy show
Ptosis and mydriasis
Eyes out and down
What are you looking for
Sclera completely going, and if the sides are different
Which shapes are you doing with the object for the patient to follow
H and I
Which nerve is tested by the corneal reflex
Efferent trigeminal
Motor function of the trigeminal
Jaw closure and mastication
Which nerve is responsible for jaw jerk
Efferent V3
What is sparing of the forehead a sign of
Upper CNVII (eg after stroke) lesion
What is all facial muscles on the affected side being weak a sign of
Lower CNVII (Bells palsy) lesion
What is all facial muscles on the affected side being weak a sign of
Lower CNVII (Bells palsy) lesion
How to test trigeminal sensory
Use cotton wool then a pin, testing each division on both sides. Ask them if it feels the same on both sides. Start by testing on chest
How to test trigeminal motoro
Ask them to clench teeth
Get them open mouth and then test the power in different directions
How to test jaw jerk
As them to open their mouth and then test reflex
How to test facial motor
Raise eyebrows Stop doctor opening eyes Smile Pout Puff out cheeks
What is bells sign
Ask them to smile and the eye moves up
How to test 9th and 10th
Say aaargh
Movements of palate
Swallow reflex
Right vagal nerve palsy would cause uvula and palate to move in what direction
Towards the left
Swallow reflex tests which nerves
9th afferent
10th efferent
Which two muscles are innervated by the accessory nerve
Sternocleidomastoid and trapezius
How do you test sternocleidomastoid
Turn head to opposite side, and make them resist force
How do you test trapezius
Shoulder strug and make them resist force
Right 12th nerve palsy would cause the tongue to move to which side
To the right
Does a 10th nerve palsy cause move towards or away?
Does a 12th nerve palsy cause move towards or away?
Vagal away
12th towards
What position should the tongue be in for examination
Relaxed
If projected, fasciculation cant be seen
What position should the tongue be in for examination
Relaxed
If projected, fasciculation cant be seen
Why use a tuning fork
To compare air and bone conduction. It should be louder in the air. Louder on the mastoid process would suggest a problem with the outer ear such as wax
Why use a tuning fork
To compare air and bone conduction. It should be louder in the air. Louder on the mastoid process would suggest a problem with the outer ear such as wax
What five things do you look at for the motor system
Inspection Tone Power Reflexes Coordination
What is tone
Resistance of the muscle to heightened movement
When is tone high
UMN
When is tone low
LMN
Describe UMN changes
Increased spastic tone
Pyramidal pattern of weakness
increased tendon relexes
Describe LMN changes
Descreased muscle mass -atrophy and fasciculations Decreased tone Peripheral weakness Decreased tendon weakensses
What is spasticity
Velocity dependent
First increase, then decrease
Selectivity
Typical of UMN
What is rigidity
Increased tone over entire radius of joint movement
Seen in parkinsons
What do you look for in Power
Symmetry/asymmetry
Pattern of weakness
Grade the power
What do you look for in Power
Symmetry/asymmetry
Pattern of weakness
Grade the power
Define fasciculation
Involuntary small muscle movement
What does proximal weakness suggest
A problem with the muscle
What does distal weakness suggest
Nerve
When is a reflex pathologically brisk
- brisker than the other side
- widening of reflex zone
- spread of reflex response
Which directions do you test the hip in
Abduction, adduction, flexion, extension
Which directions do you test the knee in
Flexion and extension
Which directions do you test the ankle in
Dorsiflexion and plantar flexion
What does impaired coordination suggest
Cerebellar damage
What are the tests for coordination
Heel to shin
(finger nose)
Rapid alternating movements
How to test plantar responses
Scratch lateral border of foot then towards big toe. Normal response is big toe goes up. In adults its an UMN sign
What is a <2yr olds response to babinski
Big toe goes down
What are the four main qualities of sensation
Light touch and pin prick
Joint position sense and vibration
How can you reinforce reflexes
Clench teeth or across chest
Upper limb reflexes
Biceps
Triceps
Suppinator
Lower limb reflexes
Knee
Ankle
How do you test finger nose coordination
Get the patient to alternate touching their nose and your finger
Why do peripheral nerves show a glove and stocking distribution
As only the cell body has mitochondria to make ATP so the distal parts are low on ATP first
What is an eye which can acommodate but not the light a sign of
Syphilis
What is fatigueability a sign of
Myasthenia gravis
Which nerve controls the corneal reflex
Trigeminal
The motor division of the 1st branch of the facial nerve is responsible for
Stapedius, tightening the tympanic membrane
Where is the lesion if there is forehead sparing
Upper motor neurone
