Neurologic Exam

Question 1

Three important questions should govern your neurologic exam:

Answer 1

Is the mental status intact?
Are right-sided and left-sided findings symmetric?
If the findings are asymmetric or otherwise abnormal, does the causative lesion lie in the CNS or PNS?

Question 2

Assess your patient’s Orientation to these things

Answer 2

Person - “What is your name?”
Place - “Where are we right now?” (Get specific)
Time - “What is today’s day and date?”
Situation - “Why are you here right now?”

Question 3

Assess your patient’s Attention Span by doing these things

Answer 3

Serial 7’s - “Count backwards by 7 starting at 100”
“Spell the word WORLD backwards.”

Question 4

The Cranial Nerves (CNs) are a collection of ___ nerves that protrude from the CNS above the foramen magnum.

Answer 4

peripheral

Question 5

Testing CN I

Answer 5

The Olfactory Nerve-
Test sense of smell by presenting a familiar and non-irritating odor.

Question 6

Testing CN II

Answer 6

Test Visual Acuity-
Using a Snellen or Rosenbaum eye chart, assess the patient’s visual acuity.
Ask the patient to point at your fingers as they see them enter their vision.
Lesion location corresponds with the visual field defect seen.

Question 7

Testing CN II and III

Answer 7

Inspect the size and shape of the pupils,
Using a Penlight or flashlight, test the pupillary reaction to light.

Question 8

Testing CNs III, IV, and VI

Answer 8

Assess extraocular movements in the six cardinal directions of gaze and look for loss of conjugate gaze in any of the six directions.

Question 9

Testing CN V

Answer 9

The Trigeminal Nerve-
To assess the Motor portion of the nerve, have the patient clench their teeth and assess temporalis and masseter muscles by palpation.
To assess the Sensory portion of the nerve, assess sharp/dull (pain) sensation and light touch sensation in all three branches of the nerve (V1, V2, and V3).

Question 10

Testing CNs V and VII

Answer 10

The Corneal Reflex-
To assess the Corneal Reflex arch that exists between CN V and CN VII, touch the cornea of the eye with a very light wisp of cotton.
Normal response is blinking

Question 11

Testing CN VII

Answer 11

Assess facial symmetry and various facial movements.
“Facial expressions are symmetric without droop”

Question 12

Testing CN VIII

Answer 12

Assess Auditory Acuity-
While standing about 3-6 feet behind your patient, assess hearing bilaterally using the Whispered Voice test.

Question 13

Testing CNs IX and X

Answer 13

Soft Palate, Voice, and Gag-
Listen to the patient’s voice, assessing for hoarseness that can happen with unilateral vocal cord paralysis.
Have the patient say “ah” and watch the soft palate elevate
Test the gag reflex by lightly touching the back of the throat on each side in turn.

Question 14

Testing CN XI

Answer 14

• Spinal Accessory Nerve- Ask the patient to turn his/her head to each side against your hand to assess the strength and symmetry of contraction of the opposite sternocleidomastoid muscle.
• As the patient to shrug both shoulders upward and push down with your hands, paying attention to strength and symmetry.

Question 15

Testing CN XII

Answer 15

• Assess the tongue at rest and look for any atrophy or fasciculations that would indicate CN XII nerve damage
• Have the patient stick his/her tongue straight out.
  Unilateral tongue weakness may cause the tongue to deviate towards the weak, affected side.

Question 16

As you start to assess the motor system, focus on three components:

Answer 16

Involuntary Movements
Body position or posture
Muscle Bulk

Question 17

If the ____ Neuron is lost, flaccid muscle weakness will develop (lack of tone)

Answer 17

Lower Motor

Question 18

If the ____ Neuron is lost, spastic muscle weakness will develop (too much tone)

Answer 18

Upper Motor

Question 19

Cogwheel Rigidity, which can be seen with ____ and some disorders of Upper Motor Neuron.

Answer 19

Parkinson’s Disease

Question 20

Nerve roots assessed with elbow flexion vs. extension

Answer 20

Flex

Question 21

There are multiple ways to assess coordination, including:

Answer 21

Point-to- Point movements
Rapid alternating movements
Tandem walk (heel to toe)

Question 22

the path that the two main sensory tracts take and what information they carry:

Answer 22

Spinothalamic Pathway
Posterior/Dorsal Column

Question 23

The Romberg Test

Answer 23

This is mainly a test of position sense.
With feet together or shoulder width apart, ask the patient to close their eyes.
Be sure to stand ready to support the patient if they begin to fall.
In ataxia from dorsal column disease and loss of position sense, balance is lost when eyes are closed (a positive test).

Question 24

____ refers to the ability to identify an object by feeling it.

Answer 24

Stereognosis

Question 25

_____ refers to the ability to identify numbers written on the palm with imaginary ink.

Answer 25

Graphesthesia

Question 26

Two-Point discrimination should be ____ or less on the finger pads

Answer 26

5mm

Question 27

Upper motor neuron diseases can result in _____, while lower motor conditions are _____.

Answer 27

hyperreflexia, hyporeflexic

Question 28

The Plantar Response or ___ is a type of spinal reflex elicited by stroking the lateral aspect of the sole from heel to ball, curving medially across the ball.

Answer 28

Babinski Maneuver

Question 29

If the patient is hyperreflexic or has a positive Babinski sign, you should test for abnormal _____ making sure the knee is partially flexed.

Answer 29

Ankle Clonus,

Question 30

Meningeal Signs:

Answer 30

Neck mobility
Brudzinski’s sign
Kernig’s sign

Question 31

If the clinical picture suggests a possible Lumbar Herniated Disc with lumbosacral radiculopathy, perform a ____

Answer 31

Straight-Leg Raise test.