The Neurological Exam Flashcards
What is the role of pinhole testing and how does it work?
Corrects for refractive error - that is, inadequate focusing of light on the retina from hypermetropia or myopia. Pinholes focus a small beam of vision on the macula, allowing accurate testing of the optic nerve itself rather than the lens etc.
What muscle is responsible for eye abduction and what nerve?
Lateral rectus, abducens
What muscle and nerve controls looking down and inwards eye movement?
Superior oblique - Trochlear nerve
What sensory nerve, and roots, innervate sensation of the area below Mandibular trigeminal, above neck and just behind ear?
Greater auricular nerve C2-3
What nerves and roots innervate the sensory area at the back of the head?
Great and lesser occipital nerves, C2/3
What nerve and roots innervate the anterior neck?
Anterior cutaneous nerve of neck, C2/3
What does onion skin facial sensory loss mean?
Losing sensation in a concentric circle pattern, indicating brain stem lesion
What test is the most sensitive indicator of trigeminal nerve damage and what is the efferent part of the pathway?
Corneal reflex - afferent is ophthalmic division of trigeminal
Efferent is facial
What way does the jaw deviate in unilateral trigeminal motor nerve lesions and why?
Towards the affected side - unilateral weakness of pterygoids means the jaw is pushed towards that weak side by the strong pterygoids
Muscle responsible for forehead wrinkling?
Frontal is
Muscle responsible for eyes tightly shut?
Orbicularis oculi
Muscle responsible for purse lips and puff cheeks out?
Buccinator
Muscle responsible for showing teeth?
Orbicularis oris
What does asymmetry of palatal movements, or vocal cord palsy, suggest?
Vagus nerve damage
What are the two nerves involved in the gag reflex?
CN9 (glossopharyngeal) - afferent
CN10 (vagus) efferent palatal contraction
What does pronator drift indicate?
Pyramidal weakness
Muscle, nerve and root for shoulder abduction?
Deltoid
Axillary nerve
C5(/6)
Muscle, nerve and root for elbow flexion?
Biceps brachii
Musculocutaneous nerve
C5/6
Muscle, nerve and root for elbow extension?
Triceps
Radial nerve
C(6),7,(8)
Muscle, nerve and root for finger extension?
Extensor digitorum
Posterior interosseus nerve
C7,(8)
Muscles, nerves and root for finger flexion?
Flexor digitorum profundus 1-4
Median for 1-2, ulnar for 3-4
C(7), 8
Muscle, nerve and root for thumb abduction?
Abductor policis brevis
Median nerve
C8/T1
Muscles, nerve and root for finger abduction?
Dorsal interosseus muscles
Ulnar nerve
T1
What is the nerve and root for the supinator reflex?
Radial nerve
Root C6/7
Useful abdominal dermatomal landmarks?
T4 - nipples
T10 - umbilicus
T12 - Inguinal ligaments
What roots do the abdominal reflexes test?
T7-12
What roots does the cremasteric reflex test?
L1/2
Muscle, nerve and root for hip flexion?
Ilio-psoas
L1/2
Femoral nerve
Muscle, nerve and root for hip extension?
Gluteus maximus
L5/S1, (2)
Inferior gluteal nerve
Muscle, nerve and root for hip abduction?
Gluteus medius and minimus, tensor fasciae latae
L4/5
Superior gluteal nerve
Muscle, nerve and root for hip adduction?
Adductors (Magnus)
L2,3
Obturator nerve
Muscle, nerve and roots for knee flexion?
Hamstrings
Sciatic nerve
(L5), S1, (2)
Muscle, nerve and root for knee extension?
Quadriceps
L3/4
Femoral nerve
Muscle, nerve and root for ankle dorsiflexion?
Tibialis anterior
L4, (5)
Deep peroneal nerve
Muscle, nerve and root for ankle plantarflexion?
Gastrocnemius, soleus
S1/2
Tibial nerve
Muscle, nerve and root for big toe dorsiflexion/extension?
Extensor hallucis longus
Deep peroneal nerve
L5
Muscle, nerve and root for ankle inversion?
Tibialis posterior
L4/5
Tibial nerve
Muscle, nerve and root for ankle eversion?
Peroneus longus, brevis
L5/S1
Superficial peroneal nerve
What muscle contraction is responsible for a positive babinski response?
Extensor hallucis longus
What are the two most common aetiologies of Lhermitte phenomenon?
Demyelinating
Compressive
