Neurological examination

Question 1

what are the types of lesions

Answer 1

hereditary or congenital
acquired - traumatic, infective, neoplastic, degenerative, inflammatory, immune-mediated, vascular or functional

Question 2

what does the Glasgow coma scale test

Answer 2

test eye opening response, motor response, verbal response, pupil response
score out of 15

Question 3

what is the definition of a coma using the GCS

Answer 3

score of 8, lowest possible score is 3 which is no response for everything

Question 4

how is cognitive function assessed

and what is tested

Answer 4

cognitive function test (MMSE, MoCA, ACE-3)
these test memory, attention, orientation, verbal fluency, language, visuospatial, change in behaviour or personality

Question 5

overview of cranial nerve exam

Answer 5

inspection
look for symmetry, posture, involuntary movements
facial asymmetry
lack of facial expression
drooling saliva
speech - any problems with expression, articulation or phonation

Question 6

olfactory nerve assessment

Answer 6

tests CN1
not formally assessed
ask about problems with sense of smell
asl about taste at same time which test CN7/9

Question 7

optic nerve assessment

Answer 7

CN2
test vision
use Snellen chart (letter chart in opticians)
reading, finger counting, perception to light, visual fields, pupillary response to light, visualisation of optic disc

Question 8

oculomotor, trochlear and abducens nerve assesments

Answer 8

CN3,4 and 6
eye movements (figure of H to test eye movement extremes)
double vision (issue with abducens, failure of one eye to abduct)
smooth pursuit or nystagmus
dilated pupil suggests issue with CN3

Question 9

trigeminal nerve assessment

Answer 9

CN5
sensation to face (ophthalmic, maxillary and mandibular branches)
muscles of mastication (clench teeth, keep jaw open)

Question 10

facial nerve assessment

Answer 10

CN7
muscles of facial expression
look for any asymmetry ( raise eyebrows, screw up eyes, puff out cheeks, smile)

Question 11

vestibulocochlear nerve assessment

Answer 11

CN8
hearing and balance
whisper number in each ear whilst masking sound in other
Rinne’s and Weber’s test

Question 12

glossopharyngeal and vagus nerve assessment

Answer 12

CN9 and 10
controls pharynx, breathing and phonation
look at back of throat
get them to cough

Question 13

accessory nerve assessment

Answer 13

CN11
trapezius, sternocleidomastoid
shoulder shrug and turn head to each side

Question 14

hypoglossal nerve assessment

Answer 14

CN12
look at tongue muscle bulk, is it deviated to one side
wiggle tongue from side to side
smooth movement or slow/spastic

Question 15

neurological limb exams

Answer 15

inspection
tone
power
reflexes
coordination
sensation
gait

Question 16

what does increased tone suggest

Answer 16

upper motor neuron lesions

Question 17

what does decreased tone suggest

Answer 17

lower motor neuron lesion

Question 18

what nerves do the reflexes test

Answer 18

biceps - C5
supinator - C6
triceps - C7
finger jerk - C8
knee - L3/4
ankle - S1
plantar responses - S1

Question 19

what are the coordination tests

Answer 19

finger-nose
heel-shin
dysdiadochokinesia (inability to perform rapidly alternating muscle movements)