The Neurological Exam

Question 1

What is the role of pinhole testing and how does it work?

Answer 1

Corrects for refractive error - that is, inadequate focusing of light on the retina from hypermetropia or myopia. Pinholes focus a small beam of vision on the macula, allowing accurate testing of the optic nerve itself rather than the lens etc.

Question 2

What muscle is responsible for eye abduction and what nerve?

Answer 2

Lateral rectus, abducens

Question 3

What muscle and nerve controls looking down and inwards eye movement?

Answer 3

Superior oblique - Trochlear nerve

Question 4

What sensory nerve, and roots, innervate sensation of the area below Mandibular trigeminal, above neck and just behind ear?

Answer 4

Greater auricular nerve C2-3

Question 5

What nerves and roots innervate the sensory area at the back of the head?

Answer 5

Great and lesser occipital nerves, C2/3

Question 6

What nerve and roots innervate the anterior neck?

Answer 6

Anterior cutaneous nerve of neck, C2/3

Question 7

What does onion skin facial sensory loss mean?

Answer 7

Losing sensation in a concentric circle pattern, indicating brain stem lesion

Question 8

What test is the most sensitive indicator of trigeminal nerve damage and what is the efferent part of the pathway?

Answer 8

Corneal reflex - afferent is ophthalmic division of trigeminal
Efferent is facial

Question 9

What way does the jaw deviate in unilateral trigeminal motor nerve lesions and why?

Answer 9

Towards the affected side - unilateral weakness of pterygoids means the jaw is pushed towards that weak side by the strong pterygoids

Question 10

Muscle responsible for forehead wrinkling?

Answer 10

Frontal is

Question 11

Muscle responsible for eyes tightly shut?

Answer 11

Orbicularis oculi

Question 12

Muscle responsible for purse lips and puff cheeks out?

Answer 12

Buccinator

Question 13

Muscle responsible for showing teeth?

Answer 13

Orbicularis oris

Question 14

What does asymmetry of palatal movements, or vocal cord palsy, suggest?

Answer 14

Vagus nerve damage

Question 15

What are the two nerves involved in the gag reflex?

Answer 15

CN9 (glossopharyngeal) - afferent

CN10 (vagus) efferent palatal contraction

Question 16

What does pronator drift indicate?

Answer 16

Pyramidal weakness

Question 17

Muscle, nerve and root for shoulder abduction?

Answer 17

Deltoid
Axillary nerve
C5(/6)

Question 18

Muscle, nerve and root for elbow flexion?

Answer 18

Biceps brachii
Musculocutaneous nerve
C5/6

Question 19

Muscle, nerve and root for elbow extension?

Answer 19

Triceps
Radial nerve
C(6),7,(8)

Question 20

Muscle, nerve and root for finger extension?

Answer 20

Extensor digitorum
Posterior interosseus nerve
C7,(8)

Question 21

Muscles, nerves and root for finger flexion?

Answer 21

Flexor digitorum profundus 1-4
Median for 1-2, ulnar for 3-4
C(7), 8

Question 22

Muscle, nerve and root for thumb abduction?

Answer 22

Abductor policis brevis
Median nerve
C8/T1

Question 23

Muscles, nerve and root for finger abduction?

Answer 23

Dorsal interosseus muscles
Ulnar nerve
T1

Question 24

What is the nerve and root for the supinator reflex?

Answer 24

Radial nerve

Root C6/7

Question 25

Useful abdominal dermatomal landmarks?

Answer 25

T4 - nipples T10 - umbilicus T12 - Inguinal ligaments

Question 26

What roots do the abdominal reflexes test?

Answer 26

T7-12

Question 27

What roots does the cremasteric reflex test?

Answer 27

L1/2

Question 28

Muscle, nerve and root for hip flexion?

Answer 28

Ilio-psoas L1/2 Femoral nerve

Question 29

Muscle, nerve and root for hip extension?

Answer 29

Gluteus maximus L5/S1, (2) Inferior gluteal nerve

Question 30

Muscle, nerve and root for hip abduction?

Answer 30

Gluteus medius and minimus, tensor fasciae latae L4/5 Superior gluteal nerve

Question 31

Muscle, nerve and root for hip adduction?

Answer 31

Adductors (Magnus) L2,3 Obturator nerve

Question 32

Muscle, nerve and roots for knee flexion?

Answer 32

Hamstrings Sciatic nerve (L5), S1, (2)

Question 33

Muscle, nerve and root for knee extension?

Answer 33

Quadriceps L3/4 Femoral nerve

Question 34

Muscle, nerve and root for ankle dorsiflexion?

Answer 34

Tibialis anterior L4, (5) Deep peroneal nerve

Question 35

Muscle, nerve and root for ankle plantarflexion?

Answer 35

Gastrocnemius, soleus S1/2 Tibial nerve

Question 36

Muscle, nerve and root for big toe dorsiflexion/extension?

Answer 36

Extensor hallucis longus Deep peroneal nerve L5

Question 37

Muscle, nerve and root for ankle inversion?

Answer 37

Tibialis posterior L4/5 Tibial nerve

Question 38

Muscle, nerve and root for ankle eversion?

Answer 38

Peroneus longus, brevis L5/S1 Superficial peroneal nerve

Question 39

What muscle contraction is responsible for a positive babinski response?

Answer 39

Extensor hallucis longus

Question 40

What are the two most common aetiologies of Lhermitte phenomenon?

Answer 40

Demyelinating | Compressive