Master Neuro exam for adult

Scharfy's Master Neuro Exam for Adults

General Medical


HEENT - otoscope


CV


Resp


Abd


Extremities

Mental Status
 Alert & Oriented to person, place, and time. 


Language


spont. speech


comprehension


naming


repetition


reading


writing


Memory


immediate (telephone number said backwards)


short (3 object recall)


long (presidents)


Calculations


Construction (clock@4:10)
 Abstraction (similarities/differences/aphorism)

Cranial Nerves

CNI


CNII- pupil reaction, acuity, confrontation, funduscope

abnormal - anisocoria is an efferent defect

swing test for afferent pupil defect (marcus gunn)

CNIII, IV, VI - EOMi, look for nystagmus here,

brainstem lesion - "nuclear" gaze palsy no doll's eyes

cortical lesion - "supranuclear" only voluntary is affected, still have doll's eyes

INO - intranuclear ophthalmoplegia

CNV - touch, pin, muscles of mastication

CN VII - close eyes tight, wrinkle forehead

lesion? peripheral vs. central

CN VIII - finger rub

hearing loss -

one ear - has to be peripheral

both ears affected equally - central lesion

CN IX/X - palatal elevation "open up and say ah"

CN IX,X,XI - dysarthria - kuh lah mah

pseudobulbar palsy - bilateral central lesions induce bulbar lesion (dramatic speech/swallow problems) -strained strangled character

bulbar palsy - lower motor neuron lesion (breathy hoarse, hypernasal)

CN XI - scm/shoulder shrug

Trapezius - input from contralateral hemisphere

SCM - input from bilateral hemispheres (mostly ipsi though) Left SCM rotates head to right

CN XII - stick out tongue




Motor System - 0-5

Bulk - note for atrophy/fasciculations

Tone (residual tension) -

spasticity

rigidity

paratonia - tone decreases when patient distracted

Shoulder abduction C5, INT/EXT rotation

Elbow ext C6,7/flex C5,6

Wrist ext C6,7/flex C7,8

Finger flex C8/ext C8 ABD/ADD - T1

Hip flex L2,3/ext L4,5

Knee flex L5S1 /ext L3,4

Ankle dorsi L4,5/plantarflexion S1,2

-paresis - weakness

-plegia -paralyis

-hemi - one side

-para - both lower extremities

-quad - all four extremities

Remember

Central lesion (UMN pattern of weakness)

Upper extremities - flexors stronger than extensors (accounts for pronator drift)

Lower extremities - extensors stronger than flexors

Reflexes (0-4)

brachioradialis

biceps

triceps

patellar

achilles

ankle jerk clonus

plantar response

having troubles?

upper extremity - patient clench teeth

lower extremity - patient hook flexed fingers (Jendrassik)

Sensation

Light touch

L/R/simultaneous (check for extinguishing)

Pain/Temp

only have to choose one

Position (thumbs, big toes)

Vibration

Other

Stereognosis

Graphesthesia

2 point discrimination

Coordination

Finger/toe tapping

Rapid alternating

FNF

Orbiting

Heel to shin

Pronator Drift - drift suggests UMN lesion affecting that arm

Gait

walk, heels, tiptoes, tandem

festination - steps get progressively smaller and gait accelerates

Romberg

Look out for the whole time:

Tremor

Myoclonus

Chorea

Athetosis

Ballismus

Tics

Dystonia