Neuro Exam

Question 1

Cranial Nerve I

Answer 1

Olfactory: test q nostril – establish that nasal airway is patent, use pleasant odor

Question 2

Cranial Nerve II

Answer 2

Optic: test for acuity first, VF by confrontation, funduscopic exam, examine Pupils for size, shape, symmetry, reaction to light & accommodation – PERRLA

Question 3

Cranial Nerve III, IV, VI

Answer 3

(Oculomotor, Trochlear, Abducens)

Test extra-ocular movements (muscles) EOM’s – make wide sweep of “H” to test for subtle extra-ocular muscle weakness.

Question 4

Cranial Nerve V

Answer 4

Trigeminal: facial sensation has 3 divisions (V1, V2 and V3 – also known as ophthalmic, maxillary and mandibular divisions) – test all 3 divisions for pin and light touch; also responsible for sensory portion of corneal reflex.
Motor: test jaw jerk with reflex hammer (should be absent)
Check masseter and temporalis muscle by having pt chew

Question 5

Cranial Nerve VII

Answer 5

Facial: check first for asymmetry of the face by looking for subtle flattening of the nasolabial fold bilaterally. Have pt show teeth, squeeze eyes shut, wrinkle forehead. Bells phenomena – ask pt to close eyes and the eye on the ipsilateral side as the facial weakness will not close but the eyeball rolls superiorly

Question 6

Stroke produces?

Answer 6

central facial paralysis (interruption of message from brain stem to cortex

Question 7

Bell’s Palsy results in?

Answer 7

results in a peripheral facial paralysis because the peripheral facial nerve is injured.

Question 8

How do you differentiate between Stroke and Bell’s palsy

Answer 8

have the patient wrinkle their forehead–> bells palsy is a paralysis so they will not be able to

Question 9

Cranial Nerve VIII

Answer 9

Auditory Nerve: hearing, Weber and Rinne (lateralization, A>B)

Question 10

Cranial Nerve IX and X

Answer 10

Glossopharyngeal, Vagus (tested together): say AHHH watch uvula for deviation, deviates to unimpaired (or strong) side, test gag reflex

Question 11

Cranial Nerve XI

Answer 11

Spinal Accessory: trapezius muscle, test for shoulder shrug bilat, SCM – test turning head against resistance.

Question 12

Cranial Nerve XII

Answer 12

Hypoglossal: have pt stick out tongue – look for symmetry – tongue will deviate toward the weak side or the side of the lesion (weakness is on the side the tongue moves towards)

Question 13

the Folstein MMSE comprised of? (5)

Answer 13

Orientation
Registration
Attention/calculation
Recall 
Language