neurological examination W1

Question 1

how do you assess conscious level?

Answer 1

Glasgow Coma Scale measures eye response, verbal response, motor response, pupil response

Question 2

Glasgow Coma Scale: eye opening response scale?

Answer 2

spontaneously = 4
to speech = 3
to pain = 2
no response = 1

Question 3

Glasgow Coma Scale: verbal response scale?

Answer 3

orientated to time, place, person = 5
confused = 4
inappropriate words = 3
incomprehensible words = 2
no response = 1

Question 4

Glasgow Coma Scale: motor response scale?

Answer 4

obeys commands = 6
moves to localized pain = 5
flexion withdrawal from pain = 4
abnormal flexion (decorticate) = 3
abnormal extension (decerebrate) = 2
no response = 1

Question 5

score classifications for Glasgow Coma Scale?

Answer 5

best response = 15
comatose client = 8 or less
totally unresponsive = 3

Question 6

how do you assess cognitive functioning? - factors

Answer 6

memory
attention/orientation
verbal fluency
language
visuospatial
change in behaviour/personality

Question 7

cognitive tests? (3)

Answer 7

MMSE
MoCA
ACE-3

Question 8

3 types of lesions?

Answer 8

hereditary
congenital
acquired

Question 9

types of acquired lesions?

Answer 9

traumatic
infective
neoplastic
degenerative
inflammatory or immune medicated
vascular
functional

Question 10

general things to consider in a cranial nerve examination?

Answer 10

look at whole patient - symmetry, posture, involuntary movements
then the face - facial asymmetry
lack of facial expression?
drooling saliva?

Question 11

things to consider when examining speech?

Answer 11

problems with expression
articulation
phonation (volume of speech)

Question 12

olfactory nerve examination?

Answer 12

not formally assessed
ask about problems with sense of smell
ask about problems with taste at same time (cranial nerves 7/9)

Question 13

optic nerve examination?

Answer 13

vision
Snellen chart (opticians letter chart)
reading/finger counting/perception to light
visual fields
pupillary response to light
visualisation of optic disk

Question 14

oculomotor, trochlear abducens nerve examination?

Answer 14

eye movements
figure of H (tests eye movement extremes)
double vision?
smooth pursuit or nystagmus

Question 15

what is nystagmus

Answer 15

rhythmical repetitive and involuntary movement of the eyes

Question 16

what nerve does dilated pupils suggest an issue with

Answer 16

3 (oculomotor)

Question 17

trigeminal nerve tests?

Answer 17

sensation to face
muscles of mastication - clench teeth, keep jaw open

Question 18

facial nerve tests

Answer 18

muscles of facial expression
any asymmetry - raise eyebrows, screw up your eyes, puff out your cheeks, smile

Question 19

vestibulocochlear nerve tests

Answer 19

hearing and balance:
whisper number in one ear while making sound in the other
Rinne’s and Weber’s tests (tuning fork tests)

Question 20

glossopharyngeal and vagus nerve tests

Answer 20

controls pharynx, breathing, phonation
look at back of throat, say aaah
cough

Question 21

accessory nerve tests

Answer 21

trapezius, sternocleidomastoid
shoulder shrug
turn head to each side

Question 22

hypoglossal nerve tests

Answer 22

look at tongue muscle bulk - deviated to one side?
wiggle tongue from side to side - smooth or slow/spastic?

Question 23

parts of neurological examination of the limbs

Answer 23

inspection
tone
power
reflexes
coordination
sensation
gait

Question 24

inspection during neurological examination of the limbs?

Answer 24

walking aids
symmetry
muscle bulk
involuntary movements
fasciculations

Question 25

what are involuntary rapid muscle twitches that are too weak to move a limb

Answer 25

fasciculations

Question 26

tone during neurological examination of the limbs?

Answer 26

normal?
increased? (upper motor neuron, extrapyramidal)
decreased? (lower motor neuron)

Question 27

grading scale for power during neurological examination of the limbs?

Answer 27

0 - no muscle contraction visible
1 - muscle contraction visible, no joint movement
2 - active joint movement possible with gravity eliminated
3 - movement can overcome gravity, no resistance from examiner
4 - muscle group can overcome gravity and examiners resistance
5 - full and normal power against resistance

Question 28

root values for upper limb reflexes?

Answer 28

biceps - C5
supinator - C6
triceps - C7
finger jerk - C8

Question 29

root values for lower limb reflexes?

Answer 29

knee - L3/4
Ankle - S1
Plantar responses - S1

Question 30

coordination disorders?

Answer 30

finger-nose ataxia
dysdiadochokinesia
heel-shin ataxia

Question 31

mnemonic of cerebellar disease?

Answer 31

DANISH:
dysdiadochokinesis
ataxia
nystagmus
intention tremor
scanning/staccato or slurred speech (dysarthria)
hypotonia

Question 32

stride patterns? - gait

Answer 32

wide based
foot drop
shuffling
spastic

Question 33

sensory examination modalities?

Answer 33

light touch, pinprick
vibration, joint position sense