OSCE: Neurologic Exam Flashcards
1
Q
How would you test for CN I (Olfactory Nerve)?
A
- Use familiar and non-irritating odors
- Have patient compress one nostril and sniff through the other
- A person normally perceives odor on each side and can often identify them
2
Q
When can loss of smell happen?
A
- Sinus conditions
- Head trauma
- Smoking
- Aging
- Use of cocaine
- Parkinson’s disease
3
Q
How would you test for CN II (Optic Nerve)?
A
- Visual acuity: Snellen eye chart
- Visual fields by confrontation: Wiggling fingers at edge of field asking patient if they see it
- Light Reaction: Shining light into eye checking for direct reaction and consensual reaction in other eye
4
Q
How would you test for CN III, IV, and IV (Oculomotor, Trochlear, and Abducens Nerves)?
A
-
Near Reaction: Patient shift gaze from far object to near one, pupils constrict.
- Tests CN III and acommodation
- Cardinal Signs of Gaze: Make the H about 12-18 inches in front of patient’s face
- 6 eye movement testing CN III, IV, VI
- Check for nystagmus (direction of the quick component)
5
Q
How would you test for CN V (Trigeminal Nerve)?
A
Motor
- Palpate the temporal and masseter muscles and ask patient to clench their teeth.
- Ask patient to move jaw side to side testing lateral pterygoids.
Sensory
- Test forehead, cheeks, jaw on each side for pain sensation. Patient eyes should be closed.
- Use a broken long-tipped cotton swab occasionally substituting blunt end for point as stimulus.
- Ask patient if it is sharp or dull & be sure to compare sides.
- If abnormality found, confirm by temperature sensation. Touch skin w/ either hot or cold stimuli and ask patient to report which they feel.
Corneal Reflex
- Use a clean cotton swab to touch the cornea lateral to the iris, blinking of both eyes is the normal reaction to the stimulus.
6
Q
What can corneal reflex tell about cranial nerves?
A
- CN V lesion: blinking absent in both eyes
- CN VII lesion: blinking is abesent on side of weakness
7
Q
How would you test for CN VII (Facial Nerve)?
A
Motor
- Raise both eyebrows, frown, close both eyes tight so that you cannot open them
- Test muscular strength by trying to open them, show both upper & lower teeth, smile, puff out both cheeks
Taste
- Anterior ⅔ tongue
8
Q
What is the difference between Bell’s palsy and a central lesion?
A
- Bell’s Palsy: affects both upper & lower face, loss of taste, and hyperacusis
- Central Lesion: affects mainly lower face
9
Q
How would you test for CN VIII (Vestibulocochlear Nerve)?
A
-
Whisper Test: Check for hearing loss
- Stand 2 feet behind patient.
- Instruct patient to occlude ear not being tested.
- Exhale a full breath before whispering to ensure a quiet voice.
- Whisper a combination of three numbers and letters, such as 3-U-1.
- Use a different combination for the other ear.
- Abnormal Test: 4/6 numbers or letters are incorrect
- Weber and Rinne Test
10
Q
How would you test for CN IX (Glossopharyngeal Nerve)?
A
- Test gag reflex and motor function with CN X
- Test tasting with CN VII
11
Q
How would you test for CN X (Vagus Nerve)?
A
- Inspect soft palate & uvula for symmetry
- Fails to rise (bilateral lesion)
- Deviate to normal side (unliateral lesion)
- Observe for difficulties w/ swallowing
- Test for gag reflex
- If absenct, lesion in CN IX or X (rarely done in office setting)
- Evaluate for presence of nasal tone & hoarseness of voice (may be presenting sx)
12
Q
How would you test for CN XI (Spinal Accessory Nerve)?
A
- Look from behind for fasiculations & compare side to side.
- Check for trapezius muscle strength by shrugging shoulders against resistance
- In paralysis, the shoulder droops, & scapula is displaced downward & laterally
- Check SCM muscle strength by turning head to each side against resistance
- Contraction of L SCM turns head to R
13
Q
How would you test for CN XII (Hypoglossal Nerve)?
A
- Inspect tongue for symmetry, tremors, & atrophy
- Check tongue movement towards nose & chin
- Check tongue strength when pressed against cheek
- Evaluate quality of lingual sounds
- CN XII lesion results in tongue deviation to the weak side
14
Q
How would you test cerebellar function?
A
- Rapid Alternating Movements
- Finger-to-nose, finger-finger
- Heel-shin
15
Q
Rapid Alternating Movements
A
- Arms: Strike one hand on thigh, raise hand, turn it over and then strike the back of hand down on same place.
- Urge patient to repeat these movement rapidly. Observe speed, rhythm, smoothness. Repeat w/ other hand. Non-dominate hand often slower.
- Tap the distal joint of thumb w/ tip of index finger as rapidly as possible. Observe same things & non dominate less well again.
- Legs: Tap doc hand as quick as possible w/ ball of each foot in turn. Note any slowness or awkwardness. Feet normally perform less well than hands.
