Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
108 Cards in this Set
- Front
- Back
|
Mental Status:
Orientation |
Ask:
1. patient's name 2. present location 3. today's date |
|
|
Mental Status:
Level of alertness, attention, and cooperation |
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 |
|
|
Mental Status:
Memory |
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?" |
|
|
Mental Status:
Language |
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 |
|
|
Mental Status:
Calculations |
Ask them to do a simple addition or subtraction problem with at least 2 steps
|
|
|
Mental Status:
Apraxia |
Ask them to do a complex motor command, like pretending to comb your hair or brush your teeth
|
|
|
Mental Status:
Sequencing tasks |
Show how and ask patient to perform a sequencing task like rock, paper, scissors on table
|
|
|
Mental Status:
Abstraction |
Ask patient to interpret a proverb or colloquialism like "The early bird gets the worm"
|
|
|
Coordination and Gait:
Diadochokinesia Area of CNS involved? |
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 Cerebellum |
|
|
Coordination and Gait:
Dysmetria in both upper and lower extremity Area of CNS involved? |
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 Cerebellum |
|
|
Coordination and Gait:
Gait Area of CNS involved? |
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 Cerebellum |
|
|
Sensory Exam:
Topognosis; aka... Area of CNS involved? |
Point Localization
Touch patient with dull side of neurotip and the have them point to where you touched them with their opposite hand Spinalthalamic |
|
|
Sensory Exam:
Pain Area of CNS involved? |
Pinprick
Touch patient with sharp end of neurotip and have them tell you when they feel it Spinal thalamic |
|
|
Sensory:
Vibration; aka... Area of CNS involved? |
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? Dorsal columns |
|
|
Sensory:
Light Touch Area of CNS involved? |
Stroke the skin of hand/arm with a wisp of cotton or camel hair brush in 5 different places going distal to proximal
Spinalthalamic |
|
|
Sensory:
Joint Position Sense Area of CNS involved? |
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
Dorsal columns |
|
|
Sensory:
Romberg's Test Area of CNS involved? |
Patient stands with eyes open, then closed for 20-30 seconds each; note any swaying
Dorsal columns |
|
|
Sensory:
Sharp vs Dull Discrimination Area of CNS involved? |
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
Spinalthalamic |
|
|
Sensory:
Stereognosis Area of CNS involved? |
Ask them to close their eyes, give them a familiar object in each hand, and ask them to identify it through touch
Somato-sensory system |
|
|
Sensory:
Graphesthesia Area of CNS involved? |
With their eyes closed, trace a number or letter on the palm of their hand and ask them to identify it
Somato-sensory system |
|
|
Sensory:
Barognosis Area of CNS involved? |
With their eyes closed, place an object of different weight into their hands and have them identify the heavier one
Somato-sensory system |
|
|
Sensory:
Two Point Discrimination Area of CNS involved? |
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
Dorsal columns |
|
|
Sensory:
Double Simultaneous Tactile Stimulation Positives/indicators Area of CNS involved? |
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 Soomato-sensory system |
|
|
Weber's Test
|
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 |
|
|
Rinne's Test
|
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 |
|
|
Barany's Whirling Chair Test
|
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 |
|
|
Fukuda Step Test
aka... |
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 |
|
|
Vestibulo-ocular reflex
|
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 |
|
|
Hallpike Dix Test
|
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 |
|
|
L'Hermitte's Sign
|
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) |
|
|
Kernig's Sign
|
Patient supine, passively flex patients hip and knee to 90, extend fully at knee
Neck pain indicates meningeal irritation or meningitis |
|
|
Brudzinski's Sign
|
With patient supine, examiner flexes patient's head to chest
Involuntary knee flexion indicates meningeal irritation or nerve root lesion (classic test for meningitis) |
|
|
Jackson Compression
|
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 |
|
|
Foraminal Compression Test
|
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 |
|
|
Maximal Cervical Compression
|
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 |
|
|
Bakody Sign
|
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) |
|
|
Cervical Distraction Test
|
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 |
|
|
Adam's Sign
|
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 |
|
|
Schepelmann's Sign
|
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 |
|
|
Beevor's Sign
|
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) |
|
|
Roo's Test
aka... |
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 |
|
|
Adson's Test
aka... |
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 |
|
|
Halstead's Maneuver
|
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 |
|
|
Phalen's Sign
|
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 |
|
|
Costoclavicular Maneuver
aka... |
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 |
|
|
Hyperabduction Maneuver
aka... |
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 |
|
|
Tinel's Elbow Sign
|
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 |
|
|
Tinel's Wrist Sign
|
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 |
|
|
Fromet's Paper Sign
|
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 |
|
|
Minor's Sign
|
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 |
|
|
Milgram's Test
|
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 |
|
|
Belt Test
aka... |
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. |
|
|
Heel Walk
|
Instruct: Patient walks on heels
Positive: Inability to perform test Indicates: L4-L5 disc problem (L5 nerve root) |
|
|
Toe Walk
|
Instruct: Patient walks on toes
Positive: Inability to perform test Indicates: L5-S1 disc problem (S1 nerve root) |
|
|
Kemp's Test
|
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 |
|
|
Lindner's Sign
|
Patient supine, examiner flexes patient's head toward their chest
Pain along the sciatic distribution or sharp, diffuse leg pain indicates sciatic radiculopathy |
|
|
Turyn's Sign
aka... |
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 |
|
|
Bragard's Sign
|
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 |
|
|
Sicard's Sign
|
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 |
|
|
Bonnet Sign
|
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 |
|
|
Fajersztajn's Test
aka... |
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 |
|
|
Femoral Stretch Test
aka... |
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 |
|
|
Tinel's Foot Sign
|
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 |
|
|
Westphal Sign
|
absence of any deep tendon reflex
indicates LMNL |
|
|
Jendrassik Maneuver
aka... |
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 |
|
|
Direct Light Reflex
Pathway |
Ipsilateral pupillary constriction when light is shined in the eye
Afferent: Optic Nerve Integrating Center: Midbrain Efferent: Oculomotor Nerve |
|
|
Indirect Light Reflex
Pathway |
Contralateral pupillary constriction when light is shined in the eye
Afferent: Optic Nerve Integrating Center: Midbrain Efferent: Oculomotor Nerve |
|
|
Accomodation
Pathway |
Convergence of the eyes and pupillary constriction when following object between eyes
Afferent: Optic Nerve Integrating Center: Occipital Cortex Efferent: Oculomotor Nerve |
|
|
Carotid Sinus Reflex
|
Reduction in heart rate when examiner presses the carotid sinus
Afferent: Glossopharyngeal Nerve Integrating Center: Medulla Efferent: Vagus Nerve |
|
|
Occulocardiac Reflex
Pathway |
Reduction in heart rate when examiner presses they eye
Afferent: Trigeminal Nerve Integrating Center: Medulla Efferent: Vagus Nerve |
|
|
Ciliospinal Reflex
Pathway |
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 |
|
|
Corneal Reflex
Pathway |
Blinking and tearing of the eye upon touching the cornea with a cotton wisp
Afferent: Trigeminal Nerve Integrating Center: Pons Efferent: Facial Nerve |
|
|
Gag/Pharyngeal Reflex
Pathway |
Gagging upon touching the back of the throat with a tongue depressor
Afferent: Glossopharyngeal Nerve Integrating Center: Medulla Efferent: Vagus Nerve |
|
|
Uvular/Palateal Reflex
Pathway |
Raising of the uvula upon phonation, or touching with a tongue depressor
Afferent: Glossopharyngeal Nerve Integrating Center: Medulla Efferent: Vagus Nerve |
|
|
Interscapular reflex
|
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 |
|
|
Abdominal reflex
Pathway |
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 |
|
|
Plantar reflex
Pathway |
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 |
|
|
Glabella Reflex
aka... |
McCarthy Reflex
Tap glabella with fingertip Abnormal: Contraction of orbicularis occuli (closes the eyelid) upon percussion of supraorbital ridge (glabella - right between eyes) |
|
|
Hoffman Reflex
|
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
|
|
|
Tromner Reflex
|
Flexion of the fingers and thumb upon tapping palmar surface or tips of middle three fingers
|
|
|
Ankle Clonus Reflex
|
Continued involuntary contraction (sustained plantar flexion) of foot upon quick forcible dorsiflexion of the foot
|
|
|
Babinski Reflex
|
Dorsiflexion of the big toe and fanning or splaying of other toes upon stimulation of the plantar surface of the foot (medial to lateral)
|
|
|
Oppenheim Sign
|
Alternative way to elicit Babinski's Sign
application of pressure to anterior tibia stroking downward |
|
|
Chaddock Sign
|
Alternative way to elicit Babinski's Sign
stroking down the lateral leg around the lateral malleolus |
|
|
Gordon Sign
|
Alternative way to elicit Babinski's Sign
squeezing the calf |
|
|
Schaefer Sign
|
Alternative way to elicit Babinski's Sign
squeezing the achilles tendon |
|
|
Deep Tendon Reflexes:
Biceps Pathway |
afferent/efferent: Musculocutaneous nerve
Integrating center: C5 spinal cord |
|
|
Deep Tendon Reflexes
Brachioradialis Pathway |
Afferent/Efferent: Radial nerve
Integrating center: C6 Spinal Cord |
|
|
Deep Tendon Reflexes
Triceps Pathway |
Afferent/Efferent: Radial nerve
Integrating center: C7 Spinal Cord |
|
|
Deep Tendon Reflexes
Patellar Pathway |
Afferent/Efferent: Femoral nerve
Integrating center: L2,3,4 Spinal Cord |
|
|
Deep Tendon Reflexes
Achilles Pathway |
Afferent/Efferent: Tibial nerve
Integrating center: S1,2 Spinal Cord |
|
|
Evaluate the sense of smell in your patient
|
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? |
|
|
Visual Acuity
|
read sentence, identify shapes and colors
|
|
|
Confrontation test
|
directly in front, come in from 8 directions one eye at a time (sometimes wiggle finger)
|
|
|
Extraocular eye movements
|
Patient follows finger as you make a wide H in the air
|
|
|
Evaluate the motor branch of CN V
|
Have patient clench teeth while you palpate masseter and temporalis muscles
|
|
|
Evaluate light touch of CN V
|
Touch 3 points per division with wisp of cotton. Patient closes eyes and tells you when they feel it
|
|
|
Evaluate sharp/dull of CN V
|
Pain discrimination: Touch 3 points per division and ask patient to tell you whether they feel sharp or dull. Bilateral
|
|
|
Evaluate light touch of the anterior 2/3 of the tongue
|
Light touch to anterior 2/3 of tongue, inside cheeks, and hard palate with a toothpick. View inside of mouth with a penlight
|
|
|
Evaluate the motor branch of CN VII
|
Observing for asymmetry, ask patient to: raise eyebrows, close eyes tightly, puff out cheeks, smile, show teeth, frown
|
|
|
Evaluate the sensory branch of CN VII
|
Have you had a change in your ability to taste sweet, salty, and sour on the anterior 2/3 of your tongue?
|
|
|
Finger Rub Test
|
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
|
|
|
Whisper Test
|
Patient closes eyes and repeats what you whisper starting 2 feet away from their ear. Vary the distance
|
|
|
Labyrinthine Test for Positional Nystagmus
|
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 |
|
|
Evaluate taste to the posterior 1/3 of tongue
|
Have you had a change in the bitter taste sensation on the posterior 1/3 of your tongue?
|
|
|
Evaluate the motor branch of CN X
|
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 |
|
|
CN XI examination
|
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 |
|
|
CN XII examination
|
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 |
