Neurology Exam Flashcards
How do you examine CN I?
What are possible causes of problems?
1st- make sure each nostril is open. With patients eyes CLOSED occlude one nostril and hold a familiar and mildly aromatic substance (vanilla, cinnamon, coffee, clove, etc.). If patient detects–> ask to identify.
PROBLEMS: Parkinson’s, head trauma, smoking, aging, cocaine
Which cranial nerves arise from the brain?
Where do the other cranial nerves arise from?
CN I and II
CN III-XII arise from the diencephalon and brainstem
How do you test CN II?
Visual acuity test, visual fields, AND fundoscopy.
What do you look for in fundoscopy? (5)
1) size ratio of arteries to veins (should be 1:3)
2) Changes in arteries (ex. narrowing)
3) papilledema
4) cup enlargement (glaucoma)
5) palor from optic atrophy
How do you test CN III, IV, VI?
What can be cause of problems?
1) 6 cardinal directions of gaze.
2) Look for conjugate movements–> diplopia
3) nystagmus
4) convergence of eyes
5) PROBLEMS: Ptosis (CN III palsy and Myestenia gravis), abnormal pupillary constriction (CN III Palsy)
What can ptosis signify?
Intracranial aneurysm, Myestenia gravis, CN III palsy
How do you test CN V?
Motor (muscles of mastication):
Clench teeth (temporal and masseter muscles).
Lateral jaw movt (lateral pterygoids)
Sensory:
Test dull and light touch AND pain. Also test Corneal Reflex with cotton wisp (ask pt to remove contacts!)
Identify Sensory and Motor limbs of Corneal Reflex
Sensory: CN V
Motor: CN VII
How to test CN VII?
1) Asymmetry/ involuntary movt
2) ask to show teeth
3) close eyes tightly, cannot open
4) wrinkle forehead
5) puff out cheeks
6) tense neck muscles
How to test CN VIII?
1) whisper test
2) Weber Test (medial)
3) Rinne test (lateral)
How to test CN IX and CN X?
1) observe soft palate and pharynx as patient says “Ah”–>
2) Gag reflex
3) Ask patient “any difficulty swallowing?” (pharyngeal, palate)
4) listen to pt’s voice (vocal cords-coarse voice, palate-nasal voice)
How to test CN XI?
What muscles are you testing? (2)
1) Ask pt to shrug shoulders upward against your hands
2) Ask pt to turn head to each side against your hand and observe contraction of opposite sternomastoid muscle
- —> Testing Sternomastoid muscle and Trapezius Muscle
How do you test CN XII?
1) Listen to articulation of pt’s words
2) observe tongue for atrophy or fasciculations
3) Ask pt to stick out tongue–> look for assymetry
4) Ask pt to stick out tongue and move side to side
What is the difference between Lethargy and Obtundation?
Lethargy: severe drowsiness, pt can be aroused by moderate stimuli and then drift back to sleep
Obtundation: Slowed response to stimuli, sleeps more than normal with drowsiness
List some symptoms of DEPRESSION
1) hopeless, slumped posture and slowed movt
2) deteriorating grooming/ personal hygeine
3) slowed speech
