Neuro Diagnosis Lab

Front 1

Mental Status:
Orientation

Back 1

Ask:
1. patient's name
2. present location
3. today's date

Front 2

Mental Status:
Level of alertness, attention, and cooperation

Back 2

Ask the patient to:
1. spell a word forward and backward
2. repeat a string of integers forward and backward
3. name the months forward and backward

Front 3

Mental Status:
Memory

Back 3

1. Recent - recall three random words after a 5 minute delay
2. Remote - recall certain historical facts within patient's lifetime; "Where did you go to high school?"

Front 4

Mental Status:
Language

Back 4

1. Name the shapes and colors of the objects on the index card
2. Repeat a sentence after me
3. Read a sentence off back of index card

Front 5

Mental Status:
Calculations

Back 5

Ask them to do a simple addition or subtraction problem with at least 2 steps

Front 6

Mental Status:
Apraxia

Back 6

Ask them to do a complex motor command, like pretending to comb your hair or brush your teeth

Front 7

Mental Status:
Sequencing tasks

Back 7

Show how and ask patient to perform a sequencing task like rock, paper, scissors on table

Front 8

Mental Status:
Abstraction

Back 8

Ask patient to interpret a proverb or colloquialism like "The early bird gets the worm"

Front 9

Motor System:
Inspection

Back 9

1. Check limbs and trunk for fasciculations (involuntary movements or abnormal positions)
2. Look for atrophy/hypertrophy
3. Observe posture and gait

Front 10

Motor System Examination:
Testing Muscle Strength

Back 10

1. Passively move limbs through ROM noting resistance and rigidity
2. Ask patient ot hold arms straight out, front palms up, for 20-30 secs with eyes closed. Look for drift to one side or pronator drift.
3. Test muscle strength at multiple joints and record.

Front 11

Coordination and Gait:
Diadochokinesia

Back 11

1. Patting test - Rapid, rhythmic alternating movements. (Drumroll with both hands on leg)
2. Supination/Pronation Test - pronate and supinate hands as quickly as possible

Front 12

Coordination and Gait:
Dysmetria

Back 12

1. Index Finger test - Have patient touch your index finger and then their nose, move your finger to several locations
2. Heel-Shin - Have patient run their heel from the knee to the foot, front and back

Front 13

Coordination and Gait:
Gait

Back 13

1. Observe patient walking toward and away from you
2. Tandem gait - patient walks heel to toe in straight line (DUI)
3. Forced gait testing - patient walks on heels and toes

Front 14

Sensory Exam:
Topognosis; aka...

Back 14

Point Localization
Touch patient with dull side of neurotip and the have them point to where you touched them with their opposite hand

Front 15

Sensory Exam:
Pain

Back 15

Pinprick
Touch patient with sharp end of neurotip and have them tell you when they feel it

Front 16

Sensory:
Vibration; aka...

Back 16

Pallesthesia
Place the handle of the 128 Hz tuning fork on the following locations: 3 DIPs, base of the 5th, and lateral bumps (styloids and malleoli) of BOTH THE HANDS AND FEET

Ask: Can you feel the vibration? When does it stop?

Front 17

Sensory:
Light Touch

Back 17

Stroke the skin of hand/arm with a wisp of cotton or camel hair brush in 5 different places going distal to proximal

Front 18

Sensory:
Joint Position Sense

Back 18

Using 2 fingers on each hand, stabilize laterally, bend patients joint, instruct which way is up and which is down. 2 fingers/toes on each side then move on. Testing DIPs, PIPs, MCPs

Front 19

Sensory:
Romberg's Test

Back 19

Patient stands with eyes open, then closed for 20-30 seconds each; note any swaying

Front 20

Sensory:
Sharp vs Dull Discrimination

Back 20

Instruct them what sharp and dull feels like, have them close their eyes and tell you whether they feel sharp or dull; 5 locations distal to proximal, hands and feet

Front 21

Sensory:
Stereognosis

Back 21

Ask them to close their eyes, give them a familiar object in each hand, and ask them to identify it through touch

Front 22

Sensory:
Graphesthesia

Back 22

With their eyes closed, trace a number or letter on the palm of their hand and ask them to identify it

Front 23

Sensory:
Barognosis

Back 23

With their eyes closed, place an object of different weight into their hands and have them identify the heavier one

Front 24

Sensory:
Two Point Discrimination

Back 24

With their eyes closed, take a paperclip and apply both ends on three locations of their hand using 3 different diameters going wide to narrow

Front 25

Sensory:
Double Simultaneous Tactile Stimulation

Positives/indicators

Back 25

Touch patient at the same point bilaterally: one side, the other side, then together

1. Extinction: one side is felt
2. Displacement: one side felt normally, the other displaced toward midline
3. Synesthesia - one side felt normally, the other a vague burning

Front 26

Olfactory Nerve Examination

Back 26

1. Do you hav any change in your ability to smell?
2. Using a penlight, make sure nostrils are not blocked.
3. With eyes closed and one nostril occluded at a time, have them sniff two odors one at a time:
Do you smell anything?
Can you identify the substance?

Front 27

Optic Nerve Examination

Back 27

1. Inspect external structures of eye
2. "I would inspect the optic fundi with an ophthalmoscope"
3. Visual Acuity - read sentence, identify shapes and colors
4. Confrontation test - directly in front, come in from 8 directions one eye at a time (sometimes wiggle finger)
5. Direct light reflex - with hand between eyes, shine light in one eye and ipsilateral pupil should constrict
6. Indirect light reflex - shine light in one eye and opposite pupil should constrict
7. Accomodation reflex - have patient follow your finger as you bring it close, eyes should converge, pupil should constrict

Front 28

Oculomotor, trochlear, and abducens nerves examination

Back 28

1. Direct light reflex: Ipsilateral pupillary constriction when light is shined in eye
2. Indirect light reflex: Contralateral pupillary constriction when light is shined in eye
3. Accomodation: Convergence of the eyes and pupillary constriction as patient focuses on object moving toward center of eyes
4. Extraocular movements: Patient follows finger as you make a wide H in the air

Front 29

Trigeminal nerve examination

Back 29

1. Have patient clench teeth while you palpate masseter and temporalis muscles
2. Pain discrimination: Touch 3 points per division and ask patient to tell you whether they feel sharp or dull. Bilateral
3. Light touch: Touch 3 points per division with wisp of cotton. Patient closes eyes and tells you when they feel it
4. Corneal reflex: Touch the iris with a wisp of cotton and observe for blinking and tearing
5. Light touch to anterior 2/3 of tongue, inside cheeks, and hard palate with a toothpick. View inside of mouth with a penlight
6. Oculocardiac Reflex: Establish pulse, apply pressure over patient's closed eye, pulse rate should decrease 2-3 beats per 15 secs

Front 30

Facial nerve examination

Back 30

1. Have you had a change in your ability to taste sweet, salty, and sour on the anterior 2/3 of your tongue?
2. Observing for asymmetry, ask patient to: raise eyebrows, close eyes tightly, puff out cheeks, smile, show teeth, frown

Front 31

Vestibulocochlear nerve examination

Back 31

1. Finger Rub Test
2. Whisper Test: patient closes eyes and covers the ear not being tested. Increase distance as your whisper questions
3. Weber's Test: tuning fork on midline of skull
4. Rinne's Test: tuning fork on mastoid processes
5. Barany's Whirling Chair Test
6. Mittlemeyer's Test aka Fukuda Step Test
7. Vestibulo-ocular Reflex
8. Hallpike Dix Test

Front 32

Weber's Test

Back 32

Place the handle of the vibrating 512 Hz tuning fork on midline of skull and ask patient if the sound is more intense in one ear

If the intensity of the sound is equal in both ears, it's normal
If the intensity of the sound is greater in the bad ear, it indicates conductive deafness
If the intensity of the sound is greater in the good ear, it indicates sensorineural deafness

Front 33

Rinne's Test

Back 33

Place the handle of the vibrating 512 Hz tuning fork against the mastoid process. Can you hear this? Tell me when you can't hear it anymore. When the sound ceases hold the fork near the ear and have patient tell you when he can't hear it

If air conduction persists twice as long as bone conduction, it's normal
If air conduction is equal to or less than bone conduction, it indicates conduction deafness.
If air conduction and bone conduction are both absent, it indicates sensorineural deafness

Front 34

Barany's Whirling Chair Test

Back 34

Observe patient's eyes while spinning them in a chair

The fast component of nystagmus in the direction of the spin is a normal indication

Front 35

Fukuda Step Test
aka...

Back 35

Mittlemeyer's Test
Patient marches in place for 50 steps, eyes open and closed

A turning to one side indicates the side of vestibular lesion

Front 36

Vestibulo-ocular reflex

Back 36

Keep your eyes on my nose as I turn your head. Dr. turns patients head into rotation, lateral flexion, and flexion/extension

Normal patient will maintain eye contact with eyes moving at the same speed in the opposite direction of head movement
If the patient exhibts nystgamus within 2-5 secs that disappears within 30 secs, it indicates a peripheral lesion
If the patient has constant nystagmus at rest without vertigo, it indicates a medullary lesion

Front 37

Hallpike Dix Test

Back 37

Rotate patients head 45 deg. in seated position, then quickly tilt them back into supine position with head hanging off the table

Nystagmus after 2-5 seconds indicates peripheral vestibular lesion

Front 38

Glossopharyngeal and Vagus Nerve Examination

Back 38

1. Have you had any change in the hoarseness of you voice? Have you had a change in the bitter taste sensation on the posterior 1/3 of your tongue?
2. Uvula reflex - shine light in patients mouth and depress tongue if necessary while the patient says "ah"
If the palate does not rise, it indicates bilateral lesion of the vagus nerve
If one side of the palate does not rise and the uvula deviates to the normal side, it indicates unilateral paralysis of the vagus nerve
3. Gag reflex: Say" I would have the patient open their mouth and touch the back of their throat with a cotton swab
4. Have the patient swallow while you palpate the thyroid cartilage
5. Carotid sinus reflex - establish a pulse and then press the carotid area. Heart rate should slow down, then speed back up

Front 39

Spinal Accessory Nerve Examination

Back 39

1. Inspect, palpate and muscle test the trapezius - have pt shrug shoulders and you push down
2. Inspect, palpate, and muscle test the SCM - rotate head and slightly flex

Front 40

Hypoglossal Nerve Examination

Back 40

1. Inspect tongue for atrophy, fasciculations, and deviations
2. Muscle test the tongue bilaterally - tongue in cheek
If the patient has unilateral paralysis, the protruded tongue will deviate to the opposite side

Front 41

L'Hermitte's Sign

Back 41

With patient supine, examiner flexes patient's head toward chest

Electric shock-like sensations down the spine and/or through the extremities indicates dural irritation, severe spinal cord injury or degeneration (MS patients exhibit a positive 30% of the time)

Front 42

Kernig's Sign

Back 42

Patient supine, passively flex patients hip and knee to 90, extend fully at knee

Neck pain indicates meningeal irritation or meningitis

Front 43

Brudzinski's Sign

Back 43

With patient supine, examiner flexes patient's head to chest

Involuntary knee flexion indicates meningeal irritation or nerve root lesion (classic test for meningitis)

Front 44

Soto-Hall Sign

Back 44

Instruct: Patient supine, take a knife edge hold over sternum and press down while fully flexing the neck with the other hand

Positive: Generalized pain in the cervical region which may extend down to the level of T2

Indicates: Non-specific test for structural integrity of cervical region

Front 45

Jackson Compression

Back 45

Patient is seated with examiner standing behind. Examiner laterally flexes patients head and exerts increasing downward pressure at an angle with clasped hands

Exacerbation of localized cervical pain indicates foraminal encroachment without nerve root compression or facet pathology

Exacerbation of cervical pain with a radicular component indicates foraminal encroachment with nerve root compression or facet pathology

Front 46

Foraminal Compression Test

Back 46

Instruct: Stand behind patient, clasp hands and exert gradually increasing downward pressure on their head. Patient looks straight, left, and right

Exacerbation of localized cervical pain indicates foraminal encroachment without nerve root compression or facet pathology

Exacerbation of cervical pain with a radicular component indicates foraminal encroachment with nerve root compression or facet pathology

Front 47

Maximal Cervical Compression

Back 47

Patient seated with examiner standing behind. Ask patient to rotate then hyperextend their neck

Localized pain on the concave side indicates foraminal encroachment without nerve root compression
Radicular pain on the concave side indicates foraminal encroachment with nerve root compression
Pain on the convex side indicates a muscular strain

Front 48

Valsalva Maneuver

Back 48

Instructs: Take a deep breath and hold, bear down as if you're having a difficult bowel movement, relax

Positive: local or radiating pain from site of lesion

Indicates: Space occupying lesion (tumor, osteophyte, disc protrusion)

Front 49

Bakody Sign

Back 49

Patient seated, examiner instructs patient to place the palm of the affected side flat on top of their head

Decrease or absence of radiating pain indicates cervical foraminal compression or nerve root entrapment (usually C5/C6 level b/c this motion elevates the subscapular nerve and relieves traction on the upper brachial plexus)

Front 50

Cervical Distraction Test

Back 50

Instruct: Using the entire thumb, hook under the base of the occiput (just medial to mastoid pcs), place index finger on temple and gradually exert upward pressure

Diminished or absence of local pain indicates foraminal encroachment

Diminished or absence of radicular pain indicates nerve root compression

Increase of cervical pain indicates muscular strain, ligamentous sprain, myospasm, or facet capsulitis

Front 51

Adam's Sign

Back 51

With patient standing, examiner looks for evidence of scoliosis. Instruct patient to bend forward at the waist with fingers extended and hands together. Observe for changes in scoliosis

If the "c" or "s" shaped scoliosis straightens, it indicates a functional scoliosis
If the "c" or "s" shaped scoliosis does not straighten (rib humping, muscular imbalance, and asymmetry in hand length), it indicates pathologic or structural scoliosis as well as trauma or subluxation

Front 52

Schepelmann's Sign

Back 52

Patient seated, with arms straight up, patient laterally flexes throacic spine bilaterally

Pain on the concave side indicates intercostal neuritis

Pain on the convex side indicates fibrous inflammation of the pleura or possible intercostal myofascitis

Front 53

Beevor's Sign

Back 53

Patient supine, does a parial sit-up with arms across chest

Superior movement of the umbilicus indicates a spinal cord lesion at the level of T10 or lower abdominal weakness (lower muscles not working)

Inferior movement of the umbilicus indicates T7-T10 nerve root involvement (upper muscles not working)

Front 54

Roo's Test
aka...

Back 54

EAST - elevated arm stress test
With both arms to the square, patient opens and closes fists at a moderate pace for up to 3 minutes

Ischemic pain, heaviness of the arms, or numbness and tingling of the hand indicates thoracic outlet syndrome on side involved

Front 55

Adson's Test
aka...

Back 55

Scalene Maneuver / Scalenus Anticus Test
Patient is seated, establish pulse. With patients elbow fully extended, slightly abduct affected arm and have patient take a deep breath and hold. Instruct patient to rotate head and elevate chin toward examiner. If negative, rotate head to opposite side and repeat procedure

Pain and/or paresthesia, decreased or absent amplitude of pulse, and pallor indicates compression of the neurovascular bundle by scalenus anticus or cervical rib

Front 56

Halstead's Maneuver

Back 56

Patient seated, with patients arm in neutral position, doctor monitors radial pulse with one hand and tractions arm down with other. Examiner instructs patient to rotate head and hyperextend their neck. If negative, patient rotates head to the opposite side and repeats

Pain and/or paresthsia, decreased or absent pulse, and pallor indicates compression of the neurovascular bundle by scalenus anticus or cervical rib

Front 57

Phalen's Sign

Back 57

Instruct: At the level of the shoulder's hold the backs of your hands together at maximal wrist flexion. Hold until point of pain or 60 secs. 58, 59, 60, relax

Positive: Reproduction of pain and or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral half of the 4th digit)

Indicates: Carpal tunnel syndrome

Front 58

Costoclavicular Maneuver
aka...

Back 58

Eden's Test
Patient seated, establish pulse and instruct patient to sit erect, force shoulders back, chest out, and touch chin to chest

Pain and/or paresthesia, decreased or absent pulse, and pallor indicate compression of the neurovascular bundle between the clavicle and first rib

Front 59

Hyperabduction Maneuver
aka...

Back 59

Wright's Test
Patient seated, establish pulse and slowly hyperabduct the patient's arm

Pain and/or paresthesia, decreased or absent pulse, and pallor indicate compression of the axillary artery by pectoralis minor or coracoid process. Thoracic Outlet Syndrome

Front 60

Reverse Phalen's ...
aka...

Back 60

Prayer Sign
Instruct: At the level of the shoulder's have patient hold palmar side of hand together in maximum wrist extension for 60 seconds or until the point of pain

Positive: Reproduction of pain and or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral half of the 4th digit)

Indicates: Carpal tunnel syndrome

Front 61

Tinel's Elbow Sign

Back 61

Tap over the ulnar groove with a Taylor Reflex Hammer

Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (fingers 4,5) indicates neuroma of the ulnar nerve and neuritis

Front 62

Tinel's Wrist Sign

Back 62

Instruct: With wrist supinated, tap in carpal tunnel region with pointed edge of Taylor reflex hammer

Positive: Reproduction of pain, tenderness, and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral half of the 4th digit)

Indicates: Carpal Tunnel Syndrome

Front 63

Fromet's Paper Sign

Back 63

Hold a piece of paper between any two adducted fingers

If the patient is unable to maintain grip on the paper, it indicates ulnar nerve paralysis

Front 64

Minor's Sign

Back 64

Observe patient as they stand up

Knee flexion of affected leg while supporting upper body weight (hand on back or thigh) on unaffected side indicates sciatica, lumbosacral, or sacroiliac joint lesion

Front 65

Milgram's Test

Back 65

Instruct: Patient supine, raise both legs of patient 2-3 inches off table and have patient hold leggs off table for 30 secs

Positive: Inability to perform test and/or low back pain

Indicates: weak abdominal muscles or space occupying lesion

Front 66

Belt Test
aka...

Back 66

Supported Adam Test, Supported Forward Bending Test
Observe patient bending forward on their own. With patient standing, brace your hip against their sacrum and have them bend forward while you immobilize the pelvis

Positive: low back pain
Lumbar involvement if pain during unsupported and supported bending
Pelvic involvement if pain during unsupported and no pain during supported bending.

Front 67

Heel Walk

Back 67

Instruct: Patient walks on heels

Positive: Inability to perform test

Indicates: L4-L5 disc problem (L5 nerve root)

Front 68

Toe Walk

Back 68

Instruct: Patient walks on toes

Positive: Inability to perform test

Indicates: L5-S1 disc problem (S1 nerve root)

Front 69

Kemp's Test

Back 69

Patient seated or standing with arms crossed over chest. Examiner stand behind and stabilizes opposite PSIS. Put patient in lateral flexion (opposite stabilization) grasp patient's lower shoulder, passively extend and rotate shoulder (put it in the PSIS you're stabilizing)

1. Pain, usually radicular, that recreates existing sciatic pain indicates a disc protrusion. In medial disc protrusion, Kemps will be positive as patient is leaning away from the side of pain. In lateral disc protrusion, Kemps will be positive as the patient is leaning into the side of pain

2. Local pain indicates lumbar spasm or facet capsulitis

Front 70

Straight Leg raiser

Back 70

Instruct: With patient supine, raise leg slowly to 90 or until point of pain

Positive: Radiating pain and/or dull posterior thigh pain

Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35 and 70 degrees indicates a possible discogenic sciatic radiculopathy. Pain after 70 degrees indicates tight hamstrings

Front 71

Lindner's Sign

Back 71

Patient supine, examiner flexes patient's head toward their chest

Pain along the sciatic distribution or sharp, diffuse leg pain indicates sciatic radiculopathy

Front 72

Turyn's Sign
aka...

Back 72

Turyn's Toe
Patient supine, examiner dorsiflexes the big toe of the affected extremity

Pain in the gluteal region or radiating sciatic pain indicates sciatic radiculopathy

Front 73

Bragard's Sign

Back 73

Instruct: With the patient supine, examiner performs a Straight Leg Raiser to the point of pain, then lowers it 5 degrees and sharply dorsiflexes the ankle.

Positive: Radiating pain in posterior thigh

Indicates: Sciatica

Front 74

Sicard's Sign

Back 74

Examiner performs SLR, then lowers it 5 degrees from the point of pain and dorsiflexes patients big toe

Posterior thigh and leg pain indicates sciatic radiculopathy, usually from disc lesion

Front 75

Bonnet Sign

Back 75

Patient supine, examiner internally rotates and adducts affected leg across the midline, then performs a SLR (toward opposite shoulder)

Pain in posterior thigh or leg indicates sciatica or possibly piriformis syndrome if the pain is immediate or before the SLR

Front 76

Fajersztajn's Test
aka...

Back 76

Well-Leg Raising Test of Fajersztajn or Cross-over Sign
Patient supine, perform SLR on patient unaffected leg to 75 deg or until it produces pain down the affected leg. If no pain is produced, examiner dorsiflexes the foot

If there is pain down the affected leg (cross-over sign), it indicates medial disc protrusion

If there is a decrease in pain down the affected leg, it indicates a lateral disc protrusion

Front 77

Femoral Stretch Test
aka...

Back 77

Femoral Nerve Traction Test
Patient lies on the side of the unaffected leg with hip and knee slightly flexed, patient straightens back and flexes neck. Examiner extends affected leg at the hip about 15 deg and fully flexes the knee (stretching femoral nerve)
Anterior thigh pain (femoral nerve) indicates traction on the femoral nerve indicating involvement of the 2nd, 3rd, and 4th lumbar nerve roots

Front 78

Tinel's Foot Sign

Back 78

Doctor taps the region of the medial plantar nerve (posterior to the medial malleolus) with the pointed side of a hammer

Paresthesia radiating into the foot indicates Tarsal Tunnel Syndrome

Front 79

Morton's Test

Back 79

Instruct: Patient supine, with webs of both hands, squeeze metatarsal heads

Positive: sharp pain in the forefoot

Indicates: metatarsalgia or neuroma (3rd or 4th toe is Morton's Neuroma)

Front 80

Perform the following Deep Tendon Reflexes

Back 80

1. Biceps (w/pointy end)
2. Brachioradialis
3. Triceps
4. Patellar
5. Achilles

Front 81

Westphal Sign

Back 81

absence of any deep tendon reflex

indicates LMNL

Front 82

Jendrassik Maneuver
aka...

Back 82

Reinforcement Test or Cortical Distraction Test
cortical distraction that brings out a reflex when hard to elicit. Patient hooks hands together by flexed fingers, crosses feet, or clenches teeth at the moment the reflex is performed

Front 83

Direct Light Reflex

Pathway

Back 83

Ipsilateral pupillary constriction when light is shined in the eye

Afferent: Optic Nerve
Integrating Center: Midbrain
Efferent: Oculomotor Nerve

Front 84

Indirect Light Reflex

Pathway

Back 84

Contralateral pupillary constriction when light is shined in the eye

Afferent: Optic Nerve
Integrating Center: Midbrain
Efferent: Oculomotor Nerve

Front 85

Accomodation

Pathway

Back 85

Convergence of the eyes and pupillary constriction when following object between eyes

Afferent: Optic Nerve
Integrating Center: Occipital Cortex
Efferent: Oculomotor Nerve

Front 86

Carotid Sinus Reflex

Back 86

Reduction in heart rate when examiner presses the carotid sinus

Afferent: Glossopharyngeal Nerve
Integrating Center: Medulla
Efferent: Vagus Nerve

Front 87

Occulocardiac Reflex

Pathway

Back 87

Reduction in heart rate when examiner presses they eye

Afferent: Trigeminal Nerve
Integrating Center: Medulla
Efferent: Vagus Nerve

Front 88

Ciliospinal Reflex

Pathway

Back 88

Pupillary dilation when examiner pinches the base of the neck at the cervical sympathetic chain

Afferent/Efferent: Cervical Sympathetic Chain
Integrating Center: T1-T2 Spinal Cord

Front 89

Corneal Reflex

Pathway

Back 89

Blinking and tearing of the eye upon touching the cornea with a cotton wisp

Afferent: Trigeminal Nerve
Integrating Center: Pons
Efferent: Facial Nerve

Front 90

Gag/Pharyngeal Reflex

Pathway

Back 90

Gagging upon touching the back of the throat with a tongue depressor

Afferent: Glossopharyngeal Nerve
Integrating Center: Medulla
Efferent: Vagus Nerve

Front 91

Uvular/Palateal Reflex

Pathway

Back 91

Raising of the uvula upon phonation, or touching with a tongue depressor

Afferent: Glossopharyngeal Nerve
Integrating Center: Medulla
Efferent: Vagus Nerve

Front 92

Interscapular reflex

Back 92

Drawing inward of scapula when skin or interscapular space is irritated

Move a brush I-S along rhomboids looking for asymmetry

Afferent: T2-T7 Spinal Nerves
Integrating Center: T2-T7 Spinal Cord
Efferent: Dorsal Scapular Nerve

Front 93

Abdominal reflex

Pathway

Back 93

Umbilicus deviation to the stroked side.
Absence is normal only if bilateral

Stroke in 4 quadrants away from umbilicus looking for asymmetry

Afferent/Efferent: Upper: T7-T10, Lower: T11-T12
Integrating Center: Spinal Cord T7-T12

Front 94

Plantar reflex

Pathway

Back 94

Plantar flexion (curling) of toes upon stroking sole of foot
Toe extension is normal
Run back of hammer up the foot

Afferent/Efferent: Tibial Nerve
Integrating Center: Spinal Cord S1-S2

Front 95

Glabella Reflex
aka...

Back 95

McCarthy Reflex

Tap glabella with fingertip

Abnormal: Contraction of orbicularis occuli (closes the eyelid) upon percussion of supraorbital ridge (glabella - right between eyes)

Front 96

Hoffman Reflex

Back 96

Abnormal: Clawing of the fingers and thumb (flexion and adduction of thumb with flexion of the fingers) upon flicking the tip of the index finger into extension

Front 97

Tromner Reflex

Back 97

Flexion of the fingers and thumb upon tapping palmar surface or tips of middle three fingers

Front 98

Ankle Clonus Reflex

Back 98

Continued involuntary contraction (sustained plantar flexion) of foot upon quick forcible dorsiflexion of the foot

Front 99

Babinski Reflex

Back 99

Dorsiflexion of the big toe and fanning or splaying of other toes upon stimulation of the plantar surface of the foot (medial to lateral)

Front 100

Oppenheim Sign

Back 100

Alternative way to elicit Babinski's Sign

application of pressure to anterior tibia stroking downward

Front 101

Chaddock Sign

Back 101

Alternative way to elicit Babinski's Sign

stroking down the lateral leg around the lateral malleolus

Front 102

Gordon Sign

Back 102

Alternative way to elicit Babinski's Sign

squeezing the calf

Front 103

Schaefer Sign

Back 103

Alternative way to elicit Babinski's Sign

squeezing the achilles tendon

Front 104

Nerve Root C5

Back 104

"The disc level is C4"

Shoulder abduction: "deltoid innervated by the axillary nerve
Forearm flexion: "biceps innervated by the musculocutaneous nerve"

Reflex: biceps

Sensation: C4,C5,C6 dermatomes

Front 105

Nerve Root C6

Back 105

"The disc level is C5"

Wrist extension - "extensor carpi radialis longus and brevis, and extensor carpi ulnaris innervated by the radial nerve"

Reflex: brachioradialis

Sensation: C5,C6,C7 dermatomes

Front 106

Nerve Root C7

Back 106

"The disc level is C6"

Elbow extension - "triceps innervated by the radial nerve"
Wrist flexion - "flexor carpi radialis innervated by the median nerve and flexor carpi ulnaris innervated by the ulnar nerve"
Finger extension - "extensor digitorum communis, extensor indicis profundus, and extensor digiti minimi innervated by the radial nerve"

Reflex: triceps

Sensation: C6,C7,C8 dermatomes

Front 107

Nerve Root C8

Back 107

"The disc level is C7"

Finger flexion - "flexor digitorum superficialis, flexor digitorum profundus, and lumbricals innervated by the median and ulnar nerves

Reflex: none

Sensation: C7,C8,T1 dermatomes

Front 108

Nerve Root T1

Back 108

"The disc level is T1"

Finger abduction - "dorsal interossei innervated by the ulnar nerve"
Finger adduction - "palmar interossei innervated by the ulnar nerve"

Reflex: none

Sensation: C8,T1,T2 dermatomes

Front 109

Nerve Root L4

Back 109

"The disc level is L3"

Foot dorsiflexion and inversion: "tibialis anterior innervated by deep peroneal nerve"

Reflex: Patellar Tendon

Sensation: L3, L4, L5 dermatomes

Front 110

Nerve Root L5

Back 110

"The disc level is L4"

Foot dorsiflexion: "tibialis anterior and extensor hallicus longus innervated by deep peroneal nerve"
Big toe dorsiflexion: "extensor hallucis longus innervated by deep peroneal nerve"
Toes 2,3,4 dorsiflexion: "extensor digitorum longus and brevis innervated by deep peroneal nerve"
Hip and Pelvis abduction: "gluteus medius and minimus innervated by superior gluteal nerve"

Reflex: none

Sensation: L4,L5,S1 dermatomes

Front 111

Nerve Root S1

Back 111

"The disc level is L5"

Foot Plantarflexion: "Gastrocnemius and soleus innervated by tibial nerve"
Foot plantar flexion and eversion: "peroneus longus and brevis innervated by superficial peroneal nerve"
Hip extension: "gluteus maximus innervated by inferior gluteal nerve"

Reflex: Achilles

Sensation: L5,S1,S2 dermatomes

Front 112

Deep Tendon Reflexes:
Biceps

Pathway

Back 112

afferent/efferent: Musculocutaneous nerve

Integrating center: C5 spinal cord

Front 113

Deep Tendon Reflexes
Brachioradialis

Pathway

Back 113

Afferent/Efferent: Radial nerve

Integrating center: C6 Spinal Cord

Front 114

Deep Tendon Reflexes
Triceps

Pathway

Back 114

Afferent/Efferent: Radial nerve

Integrating center: C7 Spinal Cord

Front 115

Deep Tendon Reflexes
Patellar

Pathway

Back 115

Afferent/Efferent: Femoral nerve

Integrating center: L2,3,4 Spinal Cord

Front 116

Deep Tendon Reflexes
Achilles

Pathway

Back 116

Afferent/Efferent: Tibial nerve

Integrating center: S1,2 Spinal Cord

Front 117

Evaluate the sense of smell in your patient

Back 117

With eyes closed and one nostril occluded at a time, have them sniff two odors one at a time:
Do you smell anything?
Can you identify the substance?

Front 118

Visual Acuity

Back 118

read sentence, identify shapes and colors

Front 119

Confrontation test

Back 119

directly in front, come in from 8 directions one eye at a time (sometimes wiggle finger)

Front 120

Extraocular eye movements

Back 120

Patient follows finger as you make a wide H in the air

Front 121

Evaluate the motor branch of CN V

Back 121

Have patient clench teeth while you palpate masseter and temporalis muscles

Front 122

Evaluate light touch of CN V

Back 122

Touch 3 points per division with wisp of cotton. Patient closes eyes and tells you when they feel it

Front 123

Evaluate sharp/dull of CN V

Back 123

Pain discrimination: Touch 3 points per division and ask patient to tell you whether they feel sharp or dull. Bilateral

Front 124

Evaluate light touch of the anterior 2/3 of the tongue

Back 124

Light touch to anterior 2/3 of tongue, inside cheeks, and hard palate with a toothpick. View inside of mouth with a penlight

Front 125

Evaluate the motor branch of CN VII

Back 125

Observing for asymmetry, ask patient to: raise eyebrows, close eyes tightly, puff out cheeks, smile, show teeth, frown

Front 126

Evaluate the sensory branch of CN VII

Back 126

Have you had a change in your ability to taste sweet, salty, and sour on the anterior 2/3 of your tongue?

Front 127

Finger Rub Test

Back 127

Starting next to patients ear, rub your fingers together as you move away and ask patient to tell you when they can't hear it anymore

Front 128

Whisper Test

Back 128

Patient closes eyes and repeats what you whisper starting 2 feet away from their ear. Vary the distance

Front 129

Labyrinthine Test for Positional Nystagmus

Back 129

Pt seated, examiner inspects patient for spontaneous nystagmus, then inspects each of the following for 30 secs for nystagmus
Supine, head turned to each side, head hanging off table, back to seated position
Nystagmus within 2-5 secs that disappears within 30 secs indicates peripheral lesion
Constant nystagmus at rest without vertigo indicates medullary lesion

Front 130

Evaluate taste to the posterior 1/3 of tongue

Back 130

Have you had a change in the bitter taste sensation on the posterior 1/3 of your tongue?

Front 131

Evaluate the motor branch of CN X

Back 131

1. Have you had any change in the hoarseness of you voice?
2. Uvula reflex - shine light in patients mouth and depress tongue if necessary while the patient says "ah"
If the palate does not rise, it indicates bilateral lesion of the vagus nerve
If one side of the palate does not rise and the uvula deviates to the normal side, it indicates unilateral paralysis of the vagus nerve
3. Have the patient swallow while you palpate the thyroid cartilage