Neurology Exam

Question 1

1) cranial nerves- I,II,III,IV,VI

Answer 1

• State in OSCE I am testing I, II, III, IV, VI
  • Ask them to sniff through one nostril
  • Any change in smell (CN I)
  • Ask them to read a piece of paper
  • Any issues with vision longstanding (glasses/contacts)
  • Test pupil reaction- direct and consensual (CN II+III)
  • Test visual fields- Hand over one eye (CN II+III)
  • Test for nystagmus
  • Test accomidation- ask them to look at something close then move it away see if the pupil accomidates
  • Test Convergence

Question 2

2) cranial nerve V

Answer 2

• Test mastication
• Feel jaw muscles
• Test sensation- forehead, under eyes, chin

Question 3

3) Test cranial nerve VII

Answer 3

• Raise eye brows
• Frown
• Shut eyes and try and open them
• Smile
• Blow out

Question 4

4) Test cranial nerve VIII

Answer 4

• whisper test
• ask patient if they have had any issues with hearing
• cover 1 ear and say 99
• cover other ear 99

Question 5

5) test cranial nerve IX, X, XII

Answer 5

• Any difficulty swallowing
• Stick there tounge out
• Say AH- straigh uvula
  Close mouth with tounge out and wiggle - no deviation

Question 6

6) Test cranial Nerve XI

Answer 6

• Push down on shoulders
• Test Neck power

Question 7

7) peripheral nerves Upper limbs- Tone

Answer 7

• Ask if any pain
• Tone UL- ask them to go floppy.
• Assess tone in shoulder elbow and wrist

Question 8

8) Peripheral nerves upper limbs- Power

Answer 8

• Shoulder abduction (C5) + Aduction (chicken wing) (C6/7)
• Elbow flexion (C5/6) + Extension (C7)
• Wrist Extension (C6) + Flexion (C6/7)
• Finger- test power index finger and pinky
• Thumb

Question 9

9) Peripheral nerves Upper limbs- Sensation

Answer 9

• Deltoid C5
• Thumb C6
• Middle Finger C7
• Pinky C8
• Elbow T1

Question 10

10) Peripheral nerves Lower limbs- Tone

Answer 10

• Role each leg to assess tone of hip
• Lift each knee off the bed (heel should remain in contact with the bed) the heel will often lift off the bed in increased tone

Question 11

11) Peripheral nerves Lower limbs- Power

Answer 11

• Hip flexion (L1/2)- lift leg and push down on thigh
• Hip Extension- (L5/S1/S2)- Put hand under hamstring ask them to push down
• Knee Flexion (S1)- ask them to put resist me pull knee
• Knee Extension (L3/4)- Ask patient to try and straighten leg
• Ankle Dorsiflexion (L4/5)- Don’t let me push your foot down
• Ankle Plantarflexion (S1/2)- Push toe’s into the floor

Question 12

12) Peripheral nerves- Lower limbs- Sensation

Answer 12

• Upper thigh (L2)
• Knee (L3)
• Medial lower leg (inside calf)- L4
• Outer aspect of lower leg (L5)
• Lateral border of foot- outside of foot (S1)

Question 13

13) Co-ordination upper and lower

Answer 13

-DANISH
-Dyskinesia- Flip hand over ask quick as posisble
- Ataxia- check gait
- Nystagmus
- I = past pointing
- Speech
- Heel-to-toe-

Question 14

14) Standing Tests

Answer 14

• Romberg test- feet together, eyes closed, put hands either side of patient, assess sway
• Protinator drift- put hands in supernated position, see if there is drift down or pronation of hand