Intro to Neurological Exam

Question 1

If the differential is formed during the history, what is the purpose of the physical exam?

Answer 1

It determines location & refines differential

Question 2

What is the Romberg test? What does a positive test indicate?

Answer 2

Standing with legs together, holding out arms and closing eyes.
A positive test/falling indicates old sprain - torn nerves - lost proprioception
-Detects sensory abnormality

Question 3

How to test CN I?

Answer 3

Olfactory

• Pass odors with eyes closed
• More imp. to perceive stimulus than to identify correct odor

Question 4

How to test CN II?

Answer 4

Optic

• Visual acuity, fields, pupils
• Pocket card or wall chart
• Confrontation or threat
• Do each eye individually

Question 5

How to test CN III?

Answer 5

Oculomotor

• Pupils, eye movements
• Direct, consensual, accommodation
• Swinging flash light
• All muscles except 2; MR, SR, IR, IO

Question 6

How to rest CN IV?

Answer 6

Trochlear

• SO4
• Superior oblique

Question 7

How to test CN VI?

Answer 7

Abducens

• Lateral rectus
• Look for doll eyes if coma/unresponsive
• Look for conjugate gaze (by shining flashlight on both corneas) & nystagmus

Question 8

How to test CN V?

Answer 8

Trigeminal

• Facial sensation, corneal response, muscles of mastication
• Cotton, pin, tuning fork
• Wipe cotton on eye of coma patient to look for response of this nerve
• Bite down, open the jaw

Question 9

How to test CN VII?

Answer 9

Facial

• Facial muscle movments
• At rest observe palpebral fissure and nasolabial folds
• Sqeeze eyelashes shut, are eyelashes buried?
• Smile, puff out cheeks
• Peripheral vs. Central facial weakness –> forehead spared in central

Question 10

What is central facial weakness?

Answer 10

Stroke - can still raise eyebrows

Question 11

What is peripheral facial weakness?

Answer 11

Bells palsy - cannot raise eyebrows

-Whole side of face is lateral/weak

Question 12

How to test CN VIII?

Answer 12

Vestibulocochlear

• Vestibulo: test for dizziness, abnormal nystagmus, or coma
• Cochlear: fine finger rubbing or watch ticking
• Weber & Rinne tests

Question 13

What is the Weber test?

Answer 13

• Checking for hearing impairment on one side

- Placing tuning fork on top of head and asking which side is louder

Question 14

What is the Rinne test?

Answer 14

Using tuning fork and putting it on the mastoid bone and then holding it next to the ear once patient can’t feel it on bone - should still be able to hear it

Question 15

How to test CN X?

Answer 15

Vagus

• Palate elevation (not uvula)
• Gag, usually only in coma
• Swallow
• Listen for hoarseness or “breathiness”

Question 16

How to test CN XI?

Answer 16

Spinal Accessory

• Sternoclidomastoid, trapezius muscles
• Turn head against resistance at chin (tests sternocleidomastoid)
• Head to right tests the left SCM/CN XI

Question 17

How to test CN XII?

Answer 17

Hypoglossal

• Listen - slurring w/lingual sounds (la-la-la)
• Observe at rest for fasciculations (muscle twitch)
• Observe w/protrusion & movement deviation to one side and slowness (will deviate to weak side)

Question 18

Why have patient lift arms with eyes closed?

Answer 18

If they had a stroke, eventually you’ll see the fingers flex and the arm will pronate and slowly move downward

Question 19

What are the nerve roots for reflexes?

Answer 19

• Biceps = C5-6
• Brachioradialis C6-7
• Triceps = C7-8
• Knees = L3-4
• Ankles = S1-2

Question 20

What do rapid, alternating movements test?

Answer 20

Frontal lobes

Question 21

What does fine finger and toe tapping test?

Answer 21

Basal ganglia

Question 22

What are you looking for in an abnormal fundoscopic exam?

Answer 22

• Blurring of disk margins
• Loss of venous pulsations
• Color of optic nerve head