neurological examination W1 Flashcards
how do you assess conscious level?
Glasgow Coma Scale measures eye response, verbal response, motor response, pupil response
Glasgow Coma Scale: eye opening response scale?
spontaneously = 4
to speech = 3
to pain = 2
no response = 1
Glasgow Coma Scale: verbal response scale?
orientated to time, place, person = 5
confused = 4
inappropriate words = 3
incomprehensible words = 2
no response = 1
Glasgow Coma Scale: motor response scale?
obeys commands = 6
moves to localized pain = 5
flexion withdrawal from pain = 4
abnormal flexion (decorticate) = 3
abnormal extension (decerebrate) = 2
no response = 1
score classifications for Glasgow Coma Scale?
best response = 15
comatose client = 8 or less
totally unresponsive = 3
how do you assess cognitive functioning? - factors
memory
attention/orientation
verbal fluency
language
visuospatial
change in behaviour/personality
cognitive tests? (3)
MMSE
MoCA
ACE-3
3 types of lesions?
hereditary
congenital
acquired
types of acquired lesions?
traumatic
infective
neoplastic
degenerative
inflammatory or immune medicated
vascular
functional
general things to consider in a cranial nerve examination?
look at whole patient - symmetry, posture, involuntary movements
then the face - facial asymmetry
lack of facial expression?
drooling saliva?
things to consider when examining speech?
problems with expression
articulation
phonation (volume of speech)
olfactory nerve examination?
not formally assessed
ask about problems with sense of smell
ask about problems with taste at same time (cranial nerves 7/9)
optic nerve examination?
vision
Snellen chart (opticians letter chart)
reading/finger counting/perception to light
visual fields
pupillary response to light
visualisation of optic disk
oculomotor, trochlear abducens nerve examination?
eye movements
figure of H (tests eye movement extremes)
double vision?
smooth pursuit or nystagmus
what is nystagmus
rhythmical repetitive and involuntary movement of the eyes
what nerve does dilated pupils suggest an issue with
3 (oculomotor)
trigeminal nerve tests?
sensation to face
muscles of mastication - clench teeth, keep jaw open
facial nerve tests
muscles of facial expression
any asymmetry - raise eyebrows, screw up your eyes, puff out your cheeks, smile
vestibulocochlear nerve tests
hearing and balance:
whisper number in one ear while making sound in the other
Rinne’s and Weber’s tests (tuning fork tests)
glossopharyngeal and vagus nerve tests
controls pharynx, breathing, phonation
look at back of throat, say aaah
cough
accessory nerve tests
trapezius, sternocleidomastoid
shoulder shrug
turn head to each side
hypoglossal nerve tests
look at tongue muscle bulk - deviated to one side?
wiggle tongue from side to side - smooth or slow/spastic?
parts of neurological examination of the limbs
inspection
tone
power
reflexes
coordination
sensation
gait
inspection during neurological examination of the limbs?
walking aids
symmetry
muscle bulk
involuntary movements
fasciculations
what are involuntary rapid muscle twitches that are too weak to move a limb
fasciculations
tone during neurological examination of the limbs?
normal?
increased? (upper motor neuron, extrapyramidal)
decreased? (lower motor neuron)
grading scale for power during neurological examination of the limbs?
0 - no muscle contraction visible
1 - muscle contraction visible, no joint movement
2 - active joint movement possible with gravity eliminated
3 - movement can overcome gravity, no resistance from examiner
4 - muscle group can overcome gravity and examiners resistance
5 - full and normal power against resistance
root values for upper limb reflexes?
biceps - C5
supinator - C6
triceps - C7
finger jerk - C8
root values for lower limb reflexes?
knee - L3/4
Ankle - S1
Plantar responses - S1
coordination disorders?
finger-nose ataxia
dysdiadochokinesia
heel-shin ataxia
mnemonic of cerebellar disease?
DANISH:
dysdiadochokinesis
ataxia
nystagmus
intention tremor
scanning/staccato or slurred speech (dysarthria)
hypotonia
stride patterns? - gait
wide based
foot drop
shuffling
spastic
sensory examination modalities?
light touch, pinprick
vibration, joint position sense
