Neurology

Question 1

What are the stages of a neurological exam?

Remember: top of head downwards

Answer 1

Introduction, name and DOB
Explain purpose and offer chaperone
Expose patient adequately

1. Eyes
   - Fundoscopy: macula fovea, retina, blood vessels (using my opposite eye)
   - Pupil reaction: direct, consensual, swinging light
   - Visual field: (“tell me when you see my fingers”)
   - Eye movements: H test, saccadic movements - palm on left, fist on right (“don’t move your head, tell me if you get any double vision”)
2. Face
   - Eyebrows
   - Tight eyes
   - Show teeth
   - Tight lips
   - Blow our cheeks
3. Palatal movement
   - Say “Ahhh”
4. Tongue
   - Up, down, left and right
   - Test power
5. Upper limbs
   - Pronator drift
   - Tone (floppy arms) Check all movements
   - Power: elbows out, boxer pose, cock wrists, open palm, squeeze my fingers, splay fingers, point thumbs
   - Reflexes: triceps, biceps, brachioradialis
   - Coordination: touch nose/finger
   - Sensation: (demonstrate on sternum) vibration, pin prick
6. Lower limbs
   - Tone: legs floppy, roll leg, raise knee, knee jerk, ankle jerk
   - Power: (hold leg straight), lift leg, push leg down, heel to bottom, straighten leg, feet toward head, feet toward ground, toes back as far as possible,
   - Reflexes: (take weight of leg) patellar, Achilles, plantar
   - Coordination: heel scrape on shins
   - Sensation: (demonstrate on sternum) vibration, pin prick
   - Gait: walk normally, walk heel to toe
   - Propriception: Romberg test