Neurological Examination Flashcards
What parts are assessed in a neurological exam?
Mental Status Cranial Nerves Motor Function Reflexes Sensation
How is mental status assessed?
Level of alertness - GCS or AVPU Language function Memory Calculation Thought processing Visuospatial awareness
What parts of language function are assessed?
Fluency
Comprehension
Repetition
Naming
What are the 12 cranial nerves?
I - Olfactory II - Optic III - Oculomotor IV - Trochlear V - Trigeminal VI - Abducens VII - Facial VIII - Vestibulocochlear IX - Glosspharyngeal X - Vagus XI - Accessory XII - Hypoglossal
How is cranial nerve I tested?
Smelling salts
How is the optic nerve tested?
Fundoscopy
Visual Acuity - Snellens chart, Ishihara Plates
How are CN III, IV, VI tested?
Eye movements
Which muscles do CN III, IV and VI innervate?
LR6 - lateral rectus - abducens
SO4 - superior oblique - trochlear
R3 - rest of eye muscles - oculomotor
How is the trigeminal nerve tested?
Facial sensation
Muscles of mastication
How is the facial nerve tested?
Muscles of facial espression
close eyes tight
blow out cheeks
show teeth
wrinkle forehead
How is the auditory nerve tested?
Rinne’s and Webers
How is the glossopharyngeal nerve tested?
pharyngeal sensation
How is the vagus nerve tested?
Swallow Observe uvula (say aah)
How is the accessory muscle tested?
Shrug shoulders
Test face turning - sternocleidomastoid
How is the hypoglossal nerve tested?
Move tongue - tongue to roof
Put tongue out - look for any deviation
How is motor function assessed?
Gait Muscle bulk and wasting Fasciculations Involuntary movements Tone - resistance to passive movement Power - muscle strength Co-ordination
How is co-ordination tested?
Dysdiadochokinesia
Balance
Rombergs
What reflexes are tested in a neurological exam?
Deep tendon reflexes
Plantar response - babinski
Jaw jerk
Gag reflex
What deep tendon reflexes are tested?
Biceps Triceps Brachioradialis Knee jerk Ankle jerk
What does a positive babinski reflex suggest?
Upper motor neurone problem
In what ways is sensation tested?
Light touch Pain Temperature Proprioception Vibration
In patients with no neurological symptoms, what screening assessment should be done?
Observe gait
Mental status
Limb function
Deep tendon reflexes
How can you examine a patient with altered consciousness?
Work out level of consciousness - GCS/AVPU
Pupillary responses
Fundoscopy
Reflex responses - corneal vestibule-ocular reflex
Gag reflex
Deep tendon reflexes
Plantar response
What is a corneal vestibule-ocular reflex?
If the vestibule is activated, you see compensatory eye movements
Patient rapidly moved/rotated
