EXAMINATION OF THE NEUROLOGICAL SYSTEM Student________________________ Date____________ Examiner TOTAL POINTS Correctly Completed 1. Wash hands.

sh hands. (92) Time (30:00 min) Pass Repeat

VITAL SIGNS 2. 3. 4. 5. Take blood pressure bilaterally. Palpate radial arteries for rate, rhythm and symmetry. Determine respiratory pattern and rate. Pain Assessment

MENTAL STATUS 6. 7. 8. 9. Assess orientation (name, date, place) Assess speech (pt. repeats a common phrase) Assess mood (pt. describes mood) Assess memory (list 3 items, pt. repeats, pt. recalls list in 5 mins.)

CRANIAL NERVES Olfactory C.N. I 10. Assess patency and sense of smell. (With patients eyes closed, occlude one nostril at a time and present single odors to identify.)

Optic (C.N. II) 11. 12. 13. Assess visual acuity (best corrected vision). Assess visual fields by confrontation. Perform funduscopy for color, sharpness of margins and cup to disc ratio.

Occulomotor (C.N. III) 14. 15. Check position of upper lids. Check pupil size and shape.

Assess pupillary reaction to light: 16. 17. Direct and consensual. Near reaction.

Trochlear (C.N.IV) and Abducens (C.N. VI) 18. 19. Assess six cardinal directions of gaze for symmetry and conjugate movements, including nystagmus. Check for convergence.

Trigeminal (C.N. V) (motor) 20. Palpate temporal and masseter muscles during teeth clenching and relaxation.

Student Correctly Completed Trigeminal (C.N.V) (sensory) - patients eyes closed Ophthalmic, maxillary and mandibular areas: Bilateral 22. 24. Pain. Light Touch.

Scattered

21. 23.

If pain and light touch are abnormal, assess temperature sensation. Corneal areas: 25. Assess corneal sensation bilaterally.

Facial (C.N. VII) 26. 27. Inspect face in conversation and at rest for asymmetry, tics and involuntary movements. Assess facial movements.

Accoustic (C.N. VIII) 28. Assess hearing. (If hearing is diminished, conduct Weber and Rinne tests.)

Glossopharyngeal (C.N. IX), Vagus (C.N. X) and Hypoglossal (XII) 29. 30. 31. 32. 33. Observe palate with phonation of ahh or a yawn. Assess gag reflex on each side of the pharynx. Assess ability to swallow. Inspect tongue at rest in mouth for fasciculation. Inspect protruding tongue for symmetry, atrophy and deviation.

Spinal Accessory (C.N. XI) 34. 35. Shrug shoulders against resistance. Turn head from side to side and front to back against resistance.

SENSORY ASSESSMENT Pain Sensation (Patient supine with eyes closed) Upper and lower extremities: Upper 36. 37. 38. Lower 39. 40. 41. Trunk: 42. Bilateral. Compare RUQ to LUQ; RLQ to LLQ. Scattered. Bilateral, Compare. Distal and Proximal, Compare.

If pain sensation is abnormal, assess temperature sensation.

Student Correctly Completed Light Touch (patients eyes closed) Anterior trunk: 43. Bilateral. Compare RUQ to LUQ; RLQ to LLQ.

Upper and lower extremities: Upper 44. 45. 46. Lower 47. 48. 49. Scattered. Bilateral, Compare. Distal and proximal, Compare.

Vibratory Sensation (Use low pitch tuning fork: 128 or 256 Hz) 50. 51. Assess DIP joint of each index finger. Assess DIP joint of each great toe.

Position Sense (bilaterally) (patients eyes closed) 52. 53. Great toes. Index fingers.

Discrimination Sense 54. Assess for stereognosis.

If impaired, assess for graphesthesia, 2-point discrimination, point location and extinction. MOTOR ASSESSMENT (patient seated) 55. 56. Observe body positioning and involuntary movements at rest and while moving. Inspect and compare body bulk for signs of atrophy in the shoulders, arms, hands, thighs and legs.

Muscle Tone Assess for resistance to passive stretch: 57. 58. Arms. Legs.

Muscle Strength Compare strength bilaterally: 59. 60. 61. 62. 63. 64. 65. Elbow flexion. Elbow extension Wrists extension Grip. Abduction of fingers. Opposition of thumbs. Hip flexion.

Student Correctly Completed 66. 67. 68. 69. 70. 71. 72. Hip extension. Hip abduction. Hip adduction. Knee extension. Knee flexion. Dorsiflexion of the ankle. Plantar flexion of the ankle.

COORDINATION Assess rapid alternating movements, bilaterally. Note speed, rhythm, smooth movement. Upper extremities: 73. 74. Pronate and supinate hand rapidly. Tap distal joint of thumb with the tip of the forefinger rapidly.

Lower extremities: 75. Tap ball of foot to examiners hand rapidly.

Assess point-to-point movement bilaterally. Upper extremities: 76. 77. With eyes open: touch nose to the examiners moving, then stationary, finger. With eyes closed: touch nose to the examiners stationary finger.

Lower extremities: 78. With eyes closed: place heel to opposite knee and run down the shin to great toe.

REFLEXES Deep Tendon Reflexes Assess bilaterally: 79. 80. 81. 82. 83. 84. 85. Biceps. Triceps. Brachioradialis. Patellar. Ankle. Plantar response. Clonus.

Student Correctly Completed (patient standing) 86. 87. 88. 89. Walk across room, turn and walk back. Observe posture, balance, arm swing, leg movement and smoothness of turns. Walk heel to toe in straight line. Walk on toes. Walk on heels.

Further assessment may include hopping on one foot and shallow knee bending. 90. 91. 92. Rhomberg test. (Eyes open, place feet together; close eyes and hold position for 20-30 seconds.) Pronator drift. (Arms extended forward, palms up and eyes closed for 20 seconds.) Tap extended arms briskly downward, noting ability to return arms to horizontal position.

Additional tests to be discussed in lab: abdominal reflexes and meningeal signs.

Repeat PRESENTATION INTERPERSONAL SKILLS COMMENTS: 1 1 2 2 3 3 4 4 5 5 P P F F

3/09