Neurological Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Proper exposure and position
  • General inspection of the patient + surroundings

 

  • Cognition:
    • Orientation:
      • Time
      • Place
      • Person
    • Memory:
      • Tell the pt 3 random things, and tell them to remember them bc you’ll ask about them later
      • Continue your exam, 5 mins later ask the pt to repeat the 3 things
    • Attention: any of the following ways:
      • Serial seven; subtract 7 out of 100, subtract 7 out of that answer, continue…
      • Tell the pt a 3-digit number, and ask them to repeat it backwards
      • Ask to pt to say the week days backwards
  • Language:
    • Comprehension: 1-step command -> 2-step command -> 3-step command
    • Fluency: “can you describe the weather for me? Can you describe how did you get here?”
    • Repetition: “no ifs ands or buts”
    • Naming
    • Reading
    • Writing
  • CN examination:
    • CN 1 (olfactory): skip
    • CN 2 (optic): visual acuity, color vision, visual field, pupillary reflexes, fundoscopy
    • CN 3, 4, 6 (oculomotor, trochlear, abducent): extraocular movement
    • CN 5 (trigeminal):
      • Sensory: with a cotton wool, touch over the distribution of the 3 branches (+ compare sides):
        • Ophthalmic -> forehead
        • Maxillary -> check
        • Mandibular -> jawline
      • Motor:
        • Clench your teeth -> feel the bulk of the masseter + temporalis
        • Open your mouth against resistance
      • Reflex: jaw jerk
    • CN 7 (facial):
      • Raise your eyebrows
      • Close your eyes forcefully and resist me opening them
      • Show me your teeth
      • Puff your cheeks and resist me
      • Reflex: corneal
    • CN 8 (vestibulocochlear): Rinne and Weber tests (512 tuning fork)
    • CN 9, 10, 12 (glossopharyngeal, vagus, hypoglossal):
      • Any change in taste recently?
      • Open your mouth and say aah -> observe uvula
      • Stick your tongue out -> observe for deviation or fasciculations
      • Say: papapa (CN7), lalala (CN9), kakaka (CN12)
    • CN 11 (accessory): test against resistance
      • SCM -> turn your head
      • Trapezius -> shrug your shoulders
  • Motor:
    • Inspection:
      • Asymmetry
      • Muscle wasting
      • Fasciculations
    • Tone:
      • “normal tone; no spasticity or rigidity”
    • Power:

neuro 1

  • Reflexes:

neuro 2

  • Sensory:
    • Light touch
    • Pin prick
    • Vibration (128 tuning fork)
    • Proprioception 
  • Cerebellum:
    • General inspection: the usual + truncal ataxia
    • Gait “normal walk, posture, stance, balance, turn, hand swing”
    • Romberg’s test
    • Nystagmus: do the “H” formation
    • Dysarthria: can you describe the weather? How did get to the hospital?
    • Upper limbs:
      • Finger-to-nose test
      • Postural tremor
      • Pronator drift
      • Rebound phenomenon
      • Rapid alternating movement (dysdiadochokinesis)
      • Reflexes
    • Lower limbs:
      • Heel-to-shin test
      • Rapid alternating movement (dysdiadochokinesis)
      • Reflexes

 


Download the PDF version: here

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