Neurology Exam

Question 1

Structure? Cranial Nerves

Answer 1

General Inspection
5Qs: sight, smell, hearing, swallow, speech/ dry eyes/ mouth
4 eyes: visual fields, pupils (direct, consensual, swinging), fundoscopy, eye movements
3 face: raise eye brows, squeeze eyes shut, show teeth - against resistance
2 mouth: uvula, tongue

Question 2

Structure? Limbs

Answer 2

Inspection - wasting, fasciculation, tremor, myoclonic jerks, deformity/ posture, pronator drift 
Tone, clonus 
Power 
Reflexes 
Coordination 
Sensation- pin prick, vibration
Gait
Romberg's

Question 3

Power Upper Limb Nerve Roots

Answer 3

Shoulder abduction C5
Elbow flexion C5/6 and elbow extension C7
Wrist flexion C7 and wrist extension C7
Finger extension C7, flexion C8 and abduction T1
Thumb abduction T1

Question 4

Power Lower Limb Nerve Roots

Answer 4

Hip flexion L1/2/3 and extension L5/ S1
Knee flexion L5/S1 and extension L3/4
Ankle dorsiflexion L4/L5 and plantarflexion S1/S2

Question 5

Reflexes Upper Limb Nerve Roots

Answer 5

Biceps C5
Supinator C5/6
Triceps C7

Question 6

Reflexes Lower Limb Nerve Roots

Answer 6

Knee L3/4
Ankle S1/2
Plantar - UMN lesion

Question 7

Sensation Upper Limb Nerve Roots

Answer 7

Shoulder C5
Thenar eminence C6
Middle finger C7 
Little finger C8
Medial arm T1

Question 8

Sensation Lower Limb Nerve Roots

Answer 8

ASIS L1 
Lateral upper thigh L2
Knee upper L3
Medial shin L4 
Lateral shin L5 
Little toe S1
Back of leg S2

Question 9

Eye signs

Answer 9

Ptosis
Miosis 
Mydriasis 
Kayser Fleischer Rings 
Argyll Robertson pupil 
Holme- Adie pupil 
RAPD
External ophthalmoplegia 
CN III, IV, VI nerves
Papilloedema

Question 10

Ptosis

Answer 10

Unilateral: 
- CNIII palsy 
- Horner's syndrome 
Bilateral 
- Myasthenia gravis 
- Muscular Dystrophies 
- Mitochondrial Disorders

Question 11

Miosis

Answer 11

Small pupil

• Opioids
• Horner’s

Question 12

Kayser Fleischer Rings

Answer 12

Copper deposition

- Wilson’s disease

Question 13

Argyll- Robertson Pupil

Answer 13

Small, irregular pupils
No response to light, response to accommodation
- Diabetes
- Syphilis

Question 14

Holme- Adie Pupil

Answer 14

Dilated pupil
Benign
Once constricted remains small for a long time

Question 15

Relative Afferent Pupillary Defect

Answer 15

'Marcus Gunn Pupil' 
Swinging light test 
Lesion anterior to optic chiasm 
Affected eye dilates when light shone on it 
- Retinal detachment 
- Optic nerve e.g. optic neuritis

Question 16

Mydriasis

Answer 16

• CNIII palsy
• Holmes Adie
• Traumatic iridoplegia
• Pheochromocytoma
• Congenital
• Drugs e.g. sympathomimetic, topical mydriatics (tropicamide), anticholinergics

Question 17

External Ophthalmoplegia

Answer 17

• Mitochondrial disease
• Myasthenia Gravis
• LEMS
• ## Miller Fisher Syndrome

Question 18

CN III palsy

Answer 18

Eye down and out

Associated with mydriasis, ptosis

Question 19

CN IV palsy

Answer 19

Nasal upshoot 
Superior oblique (eye down and rotated in)

Question 20

CN VI palsy

Answer 20

Can't abduct 
Lateral rectus (abduction)

Question 21

Papilloedema

Answer 21

Raised intracranial pressure

• Increased CSF: hydrocephalus
• Haematoma
• Aneurysm
• Tumour
• Infection: meningitis, encephalitis
• CVST
• Idiopathic

Question 22

CN VII Palsy

Answer 22

Paralysis of facial muscles

LMN - Bell’s Palsy, no sparing of the forehead

Question 23

Mouth

Answer 23

Uvula
- deviates away from lesion 
- vagus nerve
Tongue 
- deviates towards lesion 
- hypoglossal nerve
- fasciculations

Question 24

Pronator Drift

Answer 24

Down and pronates
- Muscular weakness due to UMN lesion
Up and pronates
- Cerebellar disease

Question 25

Cerebellar Ataxia

Answer 25

Intention tremor 
Dysmetria- past pointing
Dysdiadochokinesia  
Ataxia
Slurred/ scanning speech

Question 26

Sensory Ataxia

Answer 26

Loss of proprioception = sensory ataxia

Question 27

Parkinsonism

Answer 27

Bradykinesia
Rigidity
Tremor
(Postural instability)

Question 28

Bradykinesia

Answer 28

Pincers

Foot tapping

Question 29

Tremor Parkinsonism

Answer 29

Unilateral
Pill rolling
Resting
Count down from 10 - distraction

Question 30

Rigidity

Answer 30

Cogwheel rigidity

Question 31

Parkinson’s Gait

Answer 31

Reduced arm swing
Shuffling
Freezing
Stooped

Question 32

Essential Tremor

Answer 32

Action tremor
Family history
Bilateral

Question 33

Chorea

Answer 33

Dance like involuntary movements- hyperkinetic  
Athetosis and ballismus 
Causes
- Genetic: Huntington's 
- Drug induced: Phenothiazines, L dopa 
- Immune mediated: SLE, post infectious 
- Infectious: HIV, syphillis 
- Structural: stroke, brain tumours 
- Metabolic/ toxic: hyperglucaemia, CO poisoning

Question 34

Dystonia

Answer 34

Involuntary co-contraction of agonist and antagonist muscles
Abnormal posturing

Question 35

Parkinson’s Assessment

Answer 35

EOB: walking aids, hypomimia, tremor

Tremor: resting, worse on distraction (count back from 10), postural (hands outstretched), action (perform an action e.g. take pen out of hand), finger to nose,

Bradykinesia: rapid pincers - reduction in speed, cadence and amplitude

Rigidity: increase tone, cogwheel (if not increased, ask patient to perform task with other limb

(Power, tone reflexes all normal)

Gait: stooped posture, difficulty initiating movement, short, shuffling steps, reduced/ absent arm swing, festination, difficulty turning, freezing phenomenon

Eye movements: vertical gaze palsy (progressive supranuclear palsy) and nystagmus (cerebellar pathology)

Speech: Dysarthria or staccato (cerebellar), baby hippopotamus, hypophonia

Other: postural BP, micrographia, cognition

Question 36

Power MRC 0-5`

Answer 36

0 No contraction 
1 Twitch 
2 No gravity 
3 Against gravity 
4 Reduced power against resistance 
5 Normal Power