neuro exam Flashcards
usual sequence of neuro exam
mental status exam
CN exam
motor system exam
coordination/cerebellar dysfunction
reflexes
sensory system
gait
how to test for mental status
level of consciousness - glasgow comma scale or if pt cant speak (awake, alert, drowsy, comatose)
orientation - time, place, person
memory
language and speech - if coordinated or garbled
insight and judgement
abstract thinking
calculation
minimum requirement for CN exam
pupillary size and rect - CN III
fundi - CN II
visual fields - CN II
ocular motility - CN III, IV, VI
facial movement/symmetry - CN V and VII
how to test for CN I and usual findings
ask pt to smell mild scents
inf frontal lobe disease - compress olfactory bulb or tract
foster-kennedy - anosmia and papilledema; tumors or ICP
covid-19 - (B) anosmia
how to test for CN II and usual findings
visual acuity - snellen’s eye chart
visual filed - close one eye, follow finger
fundoscopy - ophtalmoscope for optic never and disk
visual confrontation - peripheral vision
pupillary responses
how to test for CN III, IV, VI and usual findings
pupil reactivity and accommodation; size and shape
EOM - observe paresis and nystagmus
how to test for CN V and usual findings
light touch, temp or pain on ophthalmic, maxillary and mandibular
motor testing - jaw clench
corneal reflex
how to test for CN VII and usual findings
facial symmetry:
- eyebrow elevation
- forehead wrinkling
- eye closure
- smiling
- cheek puff
how to test for CN VIII and usual findings
rinne test - air conduction vs bone
weber test - laterality of lesion
audiometry
how to test for CN IX and X and usual findings
pos and symm of palate and uvula at rest and phonation
gag reflex - post pharyngeal wall for both sides
how to test for CN XI and usual findings
shoulder shrug - traps
head rot against resistance - SCM; turn R to test R SCM
how to test for CN XII and usual findings
tongue atrophy or fasciculation
tongue protrusion - dev towards weak side
poke tongue to inner cheek and resist
how to test for motor system
check for atrophy, tone and fasciculations
MMT
usual findings for tone
spasticity
rigidity
flaccidity
abnormal findings during motor system exam
bradykinesia c tremors - PD
athetosis - caudate; nag ppiano
chorea - semi purposeful, chaotic unpredictable movements
hemibalissmus - STN nuc; wild flinging of one side
dystonia - contraction of agon and antag;
myoclonus - jerks; seizures, dialysis. and cardiac arrest
