Neurological Exam

Question 1

Assess freestyle gait for rhythm, symmetry of movement of arms and legs

Answer 1

Assess spring of gait and swing of arms. Start in exam room and move to the hall if abnormal

Question 2

Assess Toe Walking

Answer 2

Have patient walk AWAY from you on their toes while observing elevation of heels

Question 3

Assess Heel Walking

Answer 3

Have patient walk TOWARDS you on their heels while observing elevation of toes

Question 4

Assess Tandem Gait

Answer 4

Heel-to-toe. Demonstrate then have patient perform. Stand close to steady if necessary

Question 5

What are the tests of gait assessment?

Answer 5

Normal Walking, Heel Walking (away), Toe Walking (Towards), Tandem Gait (Heel-Toe)

Question 6

Perform the Romberg Test

Answer 6

Ask Pt to stand with feet together and arms at side, have patient close eyes to assess balance. Stand near to patient to prevent a fall.

Question 7

Assess upper extremity drift

Answer 7

Have Pt sit and extend arms w/ palms up and eyes closed.

Question 8

Test CN1

Answer 8

Have patient close eyes, identify fragrance in each nostril.

Question 9

Test CNII Visual Acuity

Answer 9

Have Pt. hold vision card, read the smallest line possible. ONE EYE COVERED then the other

Question 10

Test CNII Visual Field

Answer 10

Stand 3 ft from patient. COVER ONE EYE, present varied number of fingers in each of the four quadrants and have patient add them together,

Question 11

Test CNII Pupillary Reaction

Answer 11

Dim lights, test direct and consensual pupillary responses

Question 12

Test CNII Movement

Answer 12

Perform swinging light test

Question 13

Test CNII

Answer 13

Visual Acuity (card), Visual Field (How many fingers?), Pupillary Reaction (Direct & Consensual), Movement (Swinging light test)

Question 14

Test CNIII, IV, VI

Answer 14

Have patient follow your finger with the ‘H’. OBSERVE EYELIDS!

Question 15

Test CNV Pain

Answer 15

Use sharp object, agree ‘does this feel sharp?’, poke Pt face in all three divisions: forehead, cheek and chin. Ask Pt to compare sensation in both sides.

Question 16

Test CNV Light Sensation

Answer 16

Use cotton wisp, agree “does this feel soft?”, Stroke Pt in all three divisions of CNV: Forehead, cheek and chin. Ask Pt. to compare sensation on both sides.

Question 17

Test CNV Motor

Answer 17

Test contraction of MASSETER. Clench jaw, Move jaw side to side.

Question 18

Test CNVII

Answer 18

Observe motor function and tone in face. Have patient raise eyebrows, clench eyes, grimace, show teeth. PUFF CHEEKS OUT AND PUSH IN (ONE FINGER) ON EACH SIDE

Question 19

Test CNVIII Whisper/Friction

Answer 19

Stand behind Pt. Make friction and test on both sides

Question 20

Test CNV

Answer 20

Test Pain, Light Touch, Masseter Contraction (clench jaw, move from side to side). Don’t forget to have Pt. compare sensation on both sides.

Question 21

Test CNVIII Weber Test

Answer 21

Percuss tuning fork, place at midline and ask Pt if they hear it equally on both sides

Question 22

Test CNVIII Rhinne Test

Answer 22

Percuss tuning fork, place at mastoid process. Ask Pt to identify when they stop hearing it and then move to air test and ask when they stop hearing it.

Question 23

Test CNVIII

Answer 23

Friction Test, Rhinne Test (fork to mastoid process), Weber Test (fork to midline skull). Don’t forking forget to ask Pt. to compare hearing in both ears.

Question 24

Test CNIX, X

Answer 24

Have Pt. open mouth, say “ahhhh”. Observe gag reflex both sides.

Question 25

Test CN XI

Answer 25

Have Pt. rotate head against resistance and shrug shoulders against resistance.

Question 26

Test CNXII

Answer 26

Have Pt. open mouth, observe tongue at rest for fasiculation or atrophy. Test strength by having Pt. push tongue against cheek and push against w/ finger from outside.

Question 27

Assess upper extremity muscle group for atrophy, bulk or fasiculations

Answer 27

Observe and compare on both sides: Deltoids, Biceps and Pecs

Question 28

Assess lower extremity muscle group for atrophy, bulk or fasiculations

Answer 28

Observe and compare on both sides calves and quadriceps

Question 29

Assess muscle tone

Answer 29

Have Pt. relax completely, passively move arms and legs on both sides.

Question 30

Grade muscle strength in hands

Answer 30

Have Pt squeeze 2 fingers and prevent you from pulling them out, have Pt. spread fingers and resist them being pushed together. BOTH SIDES

Question 31

Grade muscle strength in arms

Answer 31

Have patient do the wingy elbow thing and resist you pushing down on them (proximal), test elbow flexion and extension. BOTH SIDES

Question 32

Grade muscle strength in feet

Answer 32

Ask Pt. to dorsiflex and plantar flex foot against resistance. BOTH SIDES

Question 33

Assess pain sensation on lower extremities

Answer 33

Use sharp object, agree "does this feel sharp?" Touch foot each side and shin each side, ask Pt. to compare. Poke distal (foot) to proximal (ask for change in sensation) BOTH SIDES

Question 34

Assess pain sensation upper extremities

Answer 34

Use sharp object, agree "does this feel sharp?" Touch hand each side and arm each side, ask Pt. to compare. Poke distal (hand) to proximal (ask for change in sensation) BOTH SIDES

Question 35

Assess light sensation lower extremities

Answer 35

Use soft object. agree "does this feel soft?" Touch foot each side and shin each side, ask Pt. to compare. stroke distal (foot) to proximal (ask for change in sensation) BOTH SIDES

Question 36

Assess light sensation on upper extremities

Answer 36

Use soft object, agree "does this feel soft?" Touch hand each side and arm each side, ask Pt. to compare. stroke distal (hand) to proximal (ask for change in sensation) BOTH SIDES

Question 37

Assess sensation on upper and lower extremities

Answer 37

pain then light touch, feet & shins and hands & arms. Remember to alternate and ask Pt. to compare. Then do distal to proximal, one limb and then the other, and ask Pt. to compare sides for changes in sensation.

Question 38

Assess position sense in feet

Answer 38

HAVE PT. CLOSE EYES. Grasp toe by sides, move up and down and ask Pt to identify its position. Do for both feet.

Question 39

Assess position sense in hands

Answer 39

HAVE PT. CLOSE EYES. Grasp index finger by sides, move up and down and ask Pt. to identify its position. Do for both hands

Question 40

Assess vibration sense in toes and hands

Answer 40

Percuss tuning fork, hold against distal big toe joint or index finger joint, ask Pt. to tell when vibration stops. Compare to your own sensation. DO BOTH SIDES!

Question 41

Assess Reflexes

Answer 41

Brachioradialis, Biceps, Triceps (hands on hips), Patellar, Achillese (gently DORSIFLEX foot). BABINSKI!

Question 42

Test rapid movements in arms and legs

Answer 42

Have Pt pronate/supinate hands with arms fully extended, have Pt rapidly tap on floor with feet. TEST EACH LIMB INDIVIDUALLY

Question 43

Test fine finger movements

Answer 43

Have Pt touch fingers to thumbs, BOTH SIDES

Question 44

Test finger to nose

Answer 44

Touch finger to nose and back again repeatedly

Question 45

Test heel to shin

Answer 45

Have Pt. lying down, perform maneuver BILATERALLY!