Neurological Examination

Question 1

What parts are assessed in a neurological exam?

Answer 1

Mental Status
Cranial Nerves
Motor Function
Reflexes
Sensation

Question 2

How is mental status assessed?

Answer 2

Level of alertness - GCS or AVPU
Language function
Memory
Calculation
Thought processing
Visuospatial awareness

Question 3

What parts of language function are assessed?

Answer 3

Fluency
Comprehension
Repetition
Naming

Question 4

What are the 12 cranial nerves?

Answer 4

I - Olfactory
II - Optic
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Abducens
VII - Facial
VIII - Vestibulocochlear
IX - Glosspharyngeal
X - Vagus
XI - Accessory
XII - Hypoglossal

Question 5

How is cranial nerve I tested?

Answer 5

Smelling salts

Question 6

How is the optic nerve tested?

Answer 6

Fundoscopy

Visual Acuity - Snellens chart, Ishihara Plates

Question 7

How are CN III, IV, VI tested?

Answer 7

Eye movements

Question 8

Which muscles do CN III, IV and VI innervate?

Answer 8

LR6 - lateral rectus - abducens
SO4 - superior oblique - trochlear
R3 - rest of eye muscles - oculomotor

Question 9

How is the trigeminal nerve tested?

Answer 9

Facial sensation

Muscles of mastication

Question 10

How is the facial nerve tested?

Answer 10

Muscles of facial espression

close eyes tight
blow out cheeks
show teeth
wrinkle forehead

Question 11

How is the auditory nerve tested?

Answer 11

Rinne’s and Webers

Question 12

How is the glossopharyngeal nerve tested?

Answer 12

pharyngeal sensation

Question 13

How is the vagus nerve tested?

Answer 13

Swallow
Observe uvula (say aah)

Question 14

How is the accessory muscle tested?

Answer 14

Shrug shoulders

Test face turning - sternocleidomastoid

Question 15

How is the hypoglossal nerve tested?

Answer 15

Move tongue - tongue to roof

Put tongue out - look for any deviation

Question 16

How is motor function assessed?

Answer 16

Gait
Muscle bulk and wasting
Fasciculations
Involuntary movements
Tone - resistance to passive movement
Power - muscle strength
Co-ordination

Question 17

How is co-ordination tested?

Answer 17

Dysdiadochokinesia
Balance
Rombergs

Question 18

What reflexes are tested in a neurological exam?

Answer 18

Deep tendon reflexes
Plantar response - babinski
Jaw jerk
Gag reflex

Question 19

What deep tendon reflexes are tested?

Answer 19

Biceps
Triceps
Brachioradialis
Knee jerk
Ankle jerk

Question 20

What does a positive babinski reflex suggest?

Answer 20

Upper motor neurone problem

Question 21

In what ways is sensation tested?

Answer 21

Light touch
Pain
Temperature
Proprioception
Vibration

Question 22

In patients with no neurological symptoms, what screening assessment should be done?

Answer 22

Observe gait
Mental status
Limb function
Deep tendon reflexes

Question 23

How can you examine a patient with altered consciousness?

Answer 23

Work out level of consciousness - GCS/AVPU

Pupillary responses

Fundoscopy

Reflex responses - corneal vestibule-ocular reflex

Gag reflex

Deep tendon reflexes

Plantar response

Question 24

What is a corneal vestibule-ocular reflex?

Answer 24

If the vestibule is activated, you see compensatory eye movements

Patient rapidly moved/rotated