Week 1 - Intro to Neurologic Examination Flashcards
What are the 8 parts of assessing mental status?
- Level of consciousness
- Orientation
- Attention/Concentration
- Calculation
- Language
- Speech
- Memory
- Fund of Knowledge
What are the 8 basic components of a neurologic exam?
- Mental status
- Cranial nerves
- Motor
- Strength
- Sensory
- Reflexes
- Coordination
- Gait & Station
What are some ways to describe a patient’s Level of Consciousness?
Awake, Drowsy, Somnolent, Lethargic, Coma
How do you test a patient’s orientation?
Ask patient their name. Do they know where they are? What day/time is it?
How do you assess a patient’s Attention/Concentration?
Ask pt to spell “world” backwards.
Ask pt to say months of the year backwards.
How do you assess a patient’s Calculation abilities?
Serial 7’s
Calculate change after hypothetical purchase
How do you assess a patient’s Language?
Listen to them!
Naming, fluency, vocabulary
How do you assess a patient’s memory?
Ability to comprehend
Recall 5 words after distraction
How do you assess Fund of Knowledge?
Current president, recent events
What abnormalities does a physician look for in fundoscopic exam?
- blurring of disk margins
- loss of venous pulsations
- color of optic nerve head
How do you test CN I?
Olfactory - smell
- Pass odors under nose with patient’s eyes closed
- More important to perceive stimulus than to identify correct odor
How do you test CN II?
Optic - visual acuity, visual fields, pupils
Pocket card/wall chart
Confrontation or threat (wiggle fingers in periphery)
How do you test CN III?
Oculomotor - pupils, eye movements
- Direct, consensual, accomodation
- Swinging flash light
How do you test CN IV?
Trochlear - superior oblique eye muscle
-“H” movement, follow finger
How do you test CN V?
Trigeminal - facial sensation, corneal response, muscles of mastication
- Cotton, pin, tuning fork to compare side by side
- Bite down, open jaw, feel TMJ
How do you test CN VI?
Abducens - lateral rectus eye muscle
“H” movement
How do you test CN VII?
Facial - facial muscle movements
- At rest observe palpebral fissures and nasolabial folds
- Squeeze eye shut
- Smile, puff out cheeks
How can you tell Peripheral vs. Central facial weakness?
Forehead is spared in a central lesion (i.e. stroke)
How do you test CN VIII?
Vestibulocochlear - inner/middle ear
- Test for dizziness/vertigo, abnormal nystagmus, or coma
- Fine finger rubbing or watch ticking
- Weber and Rinne tests
How do you test CN X?
Vagus - pharynx, oropharynx, & larynx
- Palate elevation, gag, swallow
- Listen for hoarseness
How do you test CN XI?
Accessory - sternocleidomastoid & trapezius muscle
-Turn head against resistance at chin
How do you test CN XII?
Hypoglossal - tongue muscles
- Listen to articulation, slurring
- Observe at rest for fasciculations
- Observe for protrustion and movement for deviation to one side/slowness
How do you assess patient’s Motor control?
- Observe for atrophy
- Disuse
How do you assess a patient’s Tone?
- Passive motion about a joint
- Decreased tone = flaccid
- Increased tone = spastic, rigid “lead pipe”, or paratonia (can’t relax)
What does an arm drift or pronator drift test?
Strength:
- Upper motor neuron weakness
- Drifts downward on contralateral side to stroke occurrence
What CNS component is a physician testing when assessing Sensory response to Vibration and Proprioception?
- Dorsal columns
- Large fibers
In what conditions are reflexes Hyporeflexive?
Radiculopathy & Neuropathy
In what conditions are reflexes Hyperreflexive?
Brain lesion & Spinal Cord Lesion
What gait is typical with cerebellar damage?
Wide base, ataxic
What gait is typical with Neuropathy?
Wide base, slapping feet
What gait is typical in basal ganglia damage/parkinson’s?
Shuffling, stooped, multistep turns, fenestrating
What gait is typical in upper motor neuron damage?
Spastic movements
What gait is typical in myopathy/proximal weakness?
Circumducting
What gait is typical with distal weakness?
Steppage gait
What gait is typical with pain?
Antalgic
What is astasia-abasia?
Inability to either stand or walk in a normal matter. BIZARRE!
