Basic Neuro Exam

Question 1

5 components of basic neuro exam

Answer 1

1. General assessment (mental status)
2. Cranial nerves (II-XII)
3. Motor systems
4. Sensory systems
5. Reflexes

Question 2

4 things you are testing in your general assessment during basic neuro exam

Answer 2

1. Level of alertness
2. Appropriateness of responses
3. Orientation to person, place, and time
4. Congruency of mood

Question 3

Location of cranial nerves

Answer 3

Telencephalon = 1

Diencephalon = 2

Midbrain = 3-4

Pons = 5

Pontomedullary junction = 6-8

Medulla = 9-12

Question 4

Olfactory n. testing

Answer 4

Use familiar/non-irritating odors, have pt occlude one nostril and identify odor on each side

Question 5

Conditions that cause loss of sense of smell

Answer 5

Sinus conditions
Head trauma
Smoking
Aging
Cocaine use
Parkinson’s disease

Question 6

Optic n. testing

Answer 6

Visual acuity w/ snellen chart

Visual fields by confrontation (wiggling fingers at edge of VF)

Light reaction (check for direct and consensual reaction)

Question 7

Visual acuity result indicating pt is legally blind

Answer 7

20/200

Question 8

Light reaction actually checks what 2 CNs?

Answer 8

CN II sensory

CN III constriction

Question 9

CN III, IV, and VI testing

Answer 9

Cardinal signs of gaze

Near reaction (accommodation)

Also checking for nystagmus and/or ptosis

Question 10

Trigeminal n. testing

Answer 10

Sensory: test forehead, cheeks, and jaw bilaterally with pinprick and cotton wisp. If pain sensation not intact, check temperature using hot/cold test tube

Motor: test temporalis+masseter with teeth clenching, lateral pterygoid with jaw movement side to side

Question 11

Unilateral weakness of jaw musculature indicates what type of lesion

Answer 11

CNS pontine lesion

Question 12

Bilateral weakness of jaw musculature indicates what type of lesion?

Answer 12

Cerebral hemispheric disease d/t bilateral cortical innervation

Question 13

CNS patterns of stroke

Answer 13

Facial and body sensory loss on same side but from contralateral cortical or thalamic lesion

Ipsilateral face but contralateral body sensory loss in brainstem

Question 14

Isolated facial sensory loss may indicate what condition

Answer 14

Trigeminal neuralgia

Question 15

Facial n. testing

Answer 15

Motor: mm. of facial expression: raise eyebrows, frown, close both eyes tight, show upper and lower teeth, smile, puff out both cheeks

Sensory: taste for salty, sweet, sour, and bitter substances on anterior 2/3 tongue

Parasympathetic: secretion of saliva and tears

Question 16

During facial n. testing, a widened ____ ____ and _____ ____ are indicative of weakness

Answer 16

Palpebral fissure; nasolabial fold

Question 17

What condition affects both upper and lower face, loss of taste, hyperacusis, and increased/decreased tearing as a result of facial n. damage?

Answer 17

Bell’s palsy

Question 18

A central lesion affecting the facial n. typically affects which part of the face?

Answer 18

Lower face

Question 19

Vestibulocochlear n. testing

Answer 19

Whisper test

Weber/Rinne test

Balance testing (typically done with cerebellar testing)

Question 20

Glossopharyngeal n. testing

Answer 20

Motor: voluntary m. for swallowing+phonation

Sensory: sensation of nasopharynx, gag reflex and taste for posterior 1/3 tongue

Parasympathetic: secretion of salivary glands and carotid reflex

Question 21

Vagus n. testing

Answer 21

Inspect palate+uvula for symmetry
Observe for difficulties swallowing (water test)
Test for gag reflex
Check for hoarseness of voice

Question 22

Spinal accessory n. testing

Answer 22

Shoulder shrug

Head turn against resistance

Question 23

General observations for motor system

Answer 23

Body position and gait
Involuntary movement - tremors, tics, or fasciculations
Muscle bulk - wasting, atrophy
Muscle tone - muscle resistance to passive stretch

Question 24

Testing major muscle groups of upper extremity

Answer 24

Shoulder shrug - CN XI
Elbow flexion (C5,6) and extension (C6-8)
Wrist flexion and extension (C6,7)
Hand grip (C7,8, T1)
Finger abduction (C8, T1)
Thumb opposition (C8, T1)

Question 25

Testing major muscle groups of lower extremity

Answer 25

``` Hip flexion (L2-4) and extension (S1) Hip adduction (L2-4) and abduction (L4-S1) Knee flexion (L4-S2) and extension (L2-4) Ankle plantarflexion (S1) and dorsiflexion (L4-5) ```

Question 26

Gait observation

Answer 26

Casual -observe posture, balance, arm swinging, leg movement, look for ataxia Tandem - heel-to-toe in straight line Toe walk/heel walk - may reveal distal weakness in legs

Question 27

Inability to heel-walk is a sensitive test for damage to what tract?

Answer 27

CST damage

Question 28

Cerebellar tests and what abnormal test is

Answer 28

Rapid alternating movements (abnormal=dysdiadokinesia) Finger-to-nose (abnormal=tremor) Heel-to-shin (tests position sense)

Question 29

Sensory testing utilizes dermatomes and what 3 methods of testing for spinothalamic tract, posterior columns, and both pathways at once?

Answer 29

Spinothalamic testing = pain and temp of dermatomes Posterior columns = proprioception and vibration Both pathways = light touch

Question 30

What is the romberg test

Answer 30

Test of position sense/proprioception (posterior columns) Pt stands with feet together and eyes open, pt closes eyes for 30-60 seconds without support, doc notes pt ability to maintain upright posture without excessive swaying

Question 31

Cutaneous reflexes

Answer 31

Abdominal reflexes (T10-12) - contraction of abdominal muscles w/ deviation toward stimulus Cremasteric reflex (afferent L1, efferent L2) - scrotum raises on ipsilateral side Plantar response (babinski) Anal reflex (S2-4) - note contraction of anal muscles (cauda equina)

Question 32

Babinski sign

Answer 32

Use object to stroke lateral aspect of sole from heel to ball of foot. Normal response should be plantarflexion. Dorsiflexion of big toe and fanning of toes is + and suggests UMN dysfunction

Question 33

Clonus

Answer 33

Abnormal pattern of neuromuscular activity, characterized by rapidly alternating involuntary contraction+relaxation of skeletal m.

Question 34

Meningeal signs

Answer 34

Nuchal rigidity (stretching of spinal nn) Brudzinskis sign (stretching of femoral n) Kernigs sign (stretching of sciatic n)