PD - Neuro Exam Flashcards
CN I
Smell cinnamon/vanilla; ask if smell has changed lately.
CN II
Test visual acuity; pupillary light reflex/accommodation (CN II (aff) + CN III(eff) ).
CN III
Open eye and look up; pupillary light reflex (carries parasympathetics).
CN IV
Look inward and downward (superior oblique).
CN V
Motor (chewing; clench teeth), Sensory (test dermatomal distributions of V1-3)
Corneal reflex: CN V (aff) + CN VII (eff)
CN VI
Look laterally (lateral rectus).
CN VII
Motor (Bare teeth, puff cheeks, close eyes tight)
Sensory (Taste anterior ⅔ tongue)
CN VIII
Hearing: auditory and bone and air conduction tests (Weber and Rinne)
Vestibular: test for Romberg’s Sign; (close eyes on one foot).
CN IX
Motor (stylopharyngeus + parotid gland; say “ahh” and watch for symmetric palate elevation)
Sensory (Taste posterior ⅓ of tongue; pharynx sensation tested with gag reflex [CN IX (aff) + CN X (eff)])
CN X
listen to pt speak
have pt swallow
CN XI
elevate shoulders against resistance (SCM + trapezius)
CN XII
Test by sticking tongue out (lesion to CN XII = tongue deviates toward lesioned side).
General order of neuro exam
- mental status examination
- CN examination
- motor function
- sensory function
- reflex testing
- coordination testing
steps to examine motor function during neuro exam
- Inspect for atrophy, fasiculations, clonus, etc.
- Palpate for muscle tone (decreased, normal, elevated).
- Test major muscle groups and grade 0-5.
- Assess gait: Walk normally, on tiptoes/heels and feet aligned (heel-to-toe).
In the neuro exam, when is gait testing usually performed?
last, after coordination testing
In a patient without any signs or symptoms of neurologic disease, you can quickly screen for sensation how?
using the proximal and distal portion of the upper and lower extremities.
normal examination findings using light touch and pain is probably sufficient to document intact sensation.
Light touch
With patient’s eyes closed, touch various dermatomes and ask them to note feeling it.
Pain
Touch with safety pin (sharp/blunt ends) with eyes closed; ask to tell which side is used.
Vibration
Strike tuning fork and place it on any bony prominence and ask when the vibration ceases.
(then immediately put it on your own extremity to verify vibe ceased)