Dr Bruce Neurological Exam

Front 1

The MMSE: is a highly reliable and valid mini-test for abnormalities of

Back 1

cognition, orientation, language, recall, mental concentration

Front 2

highly reliable and valid mini-test for abnormalities of cognition, orientation, language, recall, mental concentration

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The MMSE
mental status exam

Front 3

most important part of the mental process and what goes first in mental conditions particularly delerium

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persons orientation

Front 4

not lost in early dementia

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persons orientation

Front 5

mmse know how many things in room

Back 5

5

Front 6

name how many things seen today

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1

Front 7

how many points for varying degree of orientation in time and space?
where are you, what are your plans for today, what date is it, day of week? What did yesterday? Do tomorrow?

Back 7

10 points

Front 8

how many points for concentration?
spelling word backwards
count backwards from 100

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5 points

Front 9

how many points for correctly naming objects in the room?

Back 9

3 points

Front 10

how many points for correctly naming object seen today not in room

Back 10

3 points

Front 11

points for a two-things together command: “close your eyes and put your hands over your closed eyes”; “pick up this pencil and write a sentence on this piece of paper with it".?

Back 11

3 points

Front 12

points for recalling the 3 objects you asked them to name at the beginning of the test?

Back 12

3 points

Front 13

total points in mmse?

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30 points

Front 14

people who have problems with 2 sequential commands have problems with what part of the brain?

Back 14

cerebelum

Front 15

people with problems with the _______will get first command correct but not second one

Back 15

cerebelum

Front 16

tumors in the head eyes ears and throat, encephalitis, but not meningitis, brain lessions from drugs, infections, neaurological diseases, head trauman can cause

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cranial nerve abnormalities

Front 17

I nerve

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olfactory

Front 18

II nerve

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optic

Front 19

III nerve

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ocular

Front 20

NerveIII ocular is for

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pupillary constriction; elevate and depress the eye

Front 21

IV nerve

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troclear

Front 22

V – Trochlear nerve is for

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adduction (towards the midline) and intorsion of the eye

Front 23

V – Trigeminal nerve is for

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sensation of the face; motor control of the muscles of chewing

Front 24

V nerve
sensation of the face; motor control of the muscles of chewing

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trigeminal

Front 25

V – Trigeminal

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sensation of the face; motor control of the muscles of chewing

Front 26

VI – Abducens

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abduction (away from the midline) of the eye

Front 27

VI nerve
abduction (away from the midline) of the eye

Back 27

abductens

Front 28

VII – Facial

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muscles of facial expression; taste for anterior two-thirds of tongue

Front 29

VII nerve

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facial

Front 30

VIII – Auditory

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(often called the vestibulocochlear nerve): hearing and balance

Front 31

VIII nerve
(often called the vestibulocochlear nerve): hearing and balance

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auditory

Front 32

IX – Glossopharyngeal

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taste for posterior third of tongue; sensation to soft palate; gag reflex

Front 33

IX nerve
taste for posterior third of tongue; sensation to soft palate; gag reflex

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glossopharyngeal nerve

Front 34

X – Vagus

Back 34

motor to soft palate and pharynx; gag reflex; position of uvula; also parasympathetic fibers to heart, lungs, GI tract

Front 35

X nerve
motor to soft palate and pharynx; gag reflex; position of uvula; also parasympathetic fibers to heart, lungs, GI tract

Back 35

vagus nerve

Front 36

XI – Spinal accessory

Back 36

motor control of sternocleidomastoid muscle and trapezius muscle (shrug of the shoulders)

Front 37

Xi nerve
motor control of sternocleidomastoid muscle and trapezius muscle (shrug of the shoulders)

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spinal accessory

Front 38

XII – Hypoglossal

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motor control of the tongue

Front 39

motor control of the tongue

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XII – Hypoglossal

Front 40

testing for olfacrtory nerve I

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do you have a good sense of smell?
if yes... don't test

Front 41

If you detect there may be decreased sense of smell

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have two substances in ziplok baggies or small bottles such as ground coffee and cloves.
Have pt. close his eyes so he doesn’t see what you have.
Test by occluding one nostril and have the patient identify one of these substances, then switch to the other nostril and the other substance.
Do not use perfume or cologne (many pts. are sensitive to it)

Front 42

testing for optic nerve III

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test for general visual acuity (chart not necessary)
test pupillary light reflex: direct and consensual
test four quadrant visual fields with your fingers

Front 43

testing for oculomotor nerve III

Back 43

all eye muscle movements except adduction (trochleal n.) and abduction (abducens n.)
pupillary light reflex (both II and III nerves)
look for a droopy eyelid if nerve is non-functioning or weak.

Front 44

testing for troclear nerve IV

Back 44

test for adduction of both eyes (look inward)

Front 45

testing for abducens nerve VI

Back 45

abduction of eyes (lateral gaze)

Front 46

testing for facial nerve VII

Back 46

test for the muscles of facial expression: ask patient to forcibly close eyes, smile, puffing air into cheeks, and wrinkle the forehead
look for asymmetry!
partial paralysis makes the eyes look bigger on the affected side

Front 47

testing for acoustic (auditory) nerve VIII

Back 47

two divisions:
cochlear nerve; hearing acuity
vestibular nerve: balance;
Initial test: rub fingers together on one side and mock rub them on the other: ask patient to determine which side the fingers are actually rubbing.

Front 48

testing for acoustic (auditory) nerve (II) VIII

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Weber test: tuning fork struck and placed in the middle of the forehead: lateralizes to bad ear with conduction defects, good ear with nerve defects
Rinné test: vibrating fork held against the mastoid bone to check for air conduction better than bone conduction (normal)

Front 49

Weber test: auditory nerve

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tuning fork struck and placed in the middle of the forehead: lateralizes to bad ear with conduction defects, good ear with nerve defects

Front 50

testing for trigeminal nerve

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Sensation to the scalp and face: test with pin, may use cotton swab for light touch
Three sensory divisions:
V1 – anterior scalp and forehead
V2: cheek;
V3: jaw and underside of chin
Motor branch to muscles of chewing: examiner hold jaw closed and ask pt. to open jaw against this force (should be able to do it)

Front 51

tetsting for vestibular nerve (3) VIII

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VIII (Vestibular) nerve:
ask for complaints of dizziness/ vertigo
check for nystagmus with lateral eye movements

Front 52

testing for glossopharyngeal nerve IX

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sensory arm of the gag reflex (sensation to posterior pharynx):
taste for posterior third of tongue (not usually done)
can initiate gag reflex if indicated (not routinely done unless pt. has difficulty in swallowing)

Front 53

testing for vagus nerve X

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motor arm of gag reflex: ask pt. to say, “Ahh”; motor to uvula – with nerve weakness, uvula will deviate away from weak side

Front 54

testing for Spinal Accessory nerve XI

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ask pt to shrug shoulders: look for asymmetry

Front 55

testing for Hypoglossal Nerve XII

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motor to the tongue: ask pt to protrude tongue: if one nerve is weak tongue will protrude toward the weak side

Front 56

Motor is an ______ nerve that causes ___ ________?

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efferent
an effect

Front 57

Sensory is an ______ nerve that ________ ________ for processing

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afferent nerve
receives information

Front 58

when examining bulk you look for 2 things?

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atrophy
hypertrophy

Front 59

when examining muscle tone look for 4 things?

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fasciculations, tremors, flaccid tone, spasticity

Front 60

Fasciculations

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spontaneous twitching (we’re all familiar with this)

Front 61

In a strong muscle fasciculations mean?

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fatigue, tension, or too much caffeine; twitching is often around the eye, or in a shoulder

Front 62

In an abnormally weak muscle twitching means?

Back 62

denervation from injury or peripheral neuropathy, or motor neuron disease such as ALS or MS

Front 63

to test for spasticity

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Ask pt to fully relax:
While pt. is sitting, hold upper arm and hand and move arm and hand through range of motion
While pt. is lying down (supine) lift knee off the table: if normal or flaccid heel stays on the table; if spastic it rises off the table

Front 64

lower motor neuron problems (in the peripheral nerve)

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Decreased or flaccid tone

Front 65

upper motor neuron problems (in the spinal cord or the brain)

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Increased tone, spasticity

Front 66

such as Parkinson disease (resting tremor) or multiple sclerosis (intention tremor)

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Tremors extrapyramidal dysfunction

Front 67

Muscle strength grading: 0 to 5

1 is

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slight flicker

Front 68

Muscle strength grading: 0 to 5

2 is

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can move with gravity removed but not against gravity

Front 69

Muscle strength grading: 0 to 5

3 is

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can move against gravity

Front 70

Muscle strength grading: 0 to 5

4 is

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provides resistance

Front 71

Muscle strength grading: 0 to 5

5 is

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normal (or stronger than normal)

Front 72

to test Dexterity of movement:
? ? ? ?

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Open and close hands repeatedly
Pronate and supinate wrist rapidly
Lift foot and tap the toes repeatedly
If normal strength but decreased dexterity: cerebellar lesion or extrapyramidal dysfunction (Parkinson’s disease)

Front 73

Muscle stretch causes rapid firing of muscle spindles
This causes afferent impulse to spinal cord
Synapse goes directly to anterior horn cells of motor nerves
Causes contraction of muscle
Contraction is the body’s effort to prevent over stretching of muscle or hyper extension of joint

Back 73

deep tendon reflexes (DTR's)

Front 74

steps of deep tendon reflexes

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1. Muscle stretch causes rapid firing of muscle spindles
2. This causes afferent impulse to spinal cord
3. Synapse goes directly to anterior horn cells of motor nerves
4. Causes contraction of muscle
5. Contraction is the body’s effort to prevent over stretching of muscle or hyper extension of joint

Front 75

Achilles reflex

Back 75

S1,2 (Sciatic plexus)

Front 76

Patellar reflex

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L3,4 (Femoral plexus

Front 77

Biceps reflex

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C5,6 (Brachial plexus)

Front 78

Triceps reflex

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C7,8 (Brachial plexus)

Front 79

reflexes 2+ is?

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normal

Front 80

testing reflexes 4+ is

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clonus (rhythmic oscillations)

Front 81

testing reflexes 3+ is

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increased

Front 82

testing reflexes 1+ is

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reduced

Front 83

testing reflexes 0+ is

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absent

Front 84

upper motor neuron dysfunction (CNS disease) are what reflexes?

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hyperactive reflexes

Front 85

lower motor neuron dysfunction, hypothyroidism are what reflexes?

Back 85

Reduced reflexes

Front 86

hyperflexia could be 3 things?

Back 86

Could be neoplastic, inflammatory, vascular or post-traumatic changes in brain
Could be due to hyperthyroidism
Often cccurs with a positive Babinski reflex (normal reflex is plantar flexion of great toe and toes with stroking the lateral plantar fascia from heel to toe)

Front 87

cerebellum problems result in _____, _____, _____, _____, & _____?

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gait problems, speech difficulties, abnormal eye movements, tremors, excessive clumsiness

Front 88

Cerebellum integrates information from

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sensory and motor nervous systems to achieve fluid, coordinated motion, posture, and speech (not the same as sense of balance, which is labyrinthine control)

Front 89

Four manifestations of cerebellar disorders

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Ataxia: deficient ability to judge required speed, power, and distance that movement should operate within (as when inebriated)
Dysarthria: difficulty saying words correctly
Hypotonia; decreased muscle tone
Nystagmus: twitching of eye muscles with full medial or lateral or upwards or downwards gaze

Front 90

Gait examination:
Ask pt to stand up slowly with arms crossed tests for?

Back 90

a test for cerebellar function, Parkinson’s disease, lower motor neuron weakness, arthritis, back pain (put it all together!)

Front 91

Observe stride with ambulation:
short with?
slow with small steps, ape like posture?
wide-based stride with?

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stroke recovery patients
parkinsons
labyrinthine disorders

Front 92

feet right together: causes problems with patients who have?

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cerebellar or labyrinthine disease.

Front 93

There are two parts to the sensory exam?

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primary sensations and cortical sensations

Front 94

There are 5 primary sensations?

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pain, touch, temperature, vibration, joint position: these test spinal and mid brain function.

Front 95

There are two parts to the sensory exam?

Back 95

primary sensations and cortical sensations

Front 96

what 3 of the 5 primary sensations cross the spinal canal to the opposite side before going to the brain?

Back 96

Pain, touch, and temperature

Front 97

Use a safety pin for pain and touch: ask _______ or ______

Back 97

sharp or dull

Front 98

Use a _____ _____ for temperature

Back 98

tuning fork

Front 99

use a struck tuning fork for vibration on the _______ and ______, also test with ______ ______

Back 99

knuckles and toes
no viration

Front 100

two point discrimination with two safety pins; on same side, then opposite arms at same time: person needs ______ ______ (______ lobe) to pass this test

Back 100

body sense
pariental lobe

Front 101

stereognosis is?

Back 101

pt’s ability to recognize coins, keys, paper clips, small pencils in the hand with eyes closed

Front 102

graphesthesia is

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pt’s ability to recognize letters or numbers traced in the palm with eyes closed: a normal educated patient makes few errors