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Examination of The Neurological System
Examination of The Neurological System
(92)
Time
(30:00 min)
Pass Repeat
Correctly
Completed
1.
Wash hands.
VITAL SIGNS
2.
3.
4.
5.
Pain Assessment
MENTAL STATUS
6.
7.
8.
9.
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.)
11.
12.
13.
Perform funduscopy for color, sharpness of margins and cup to disc ratio.
14.
15.
16.
17.
Near reaction.
18.
Assess six cardinal directions of gaze for symmetry and conjugate movements,
including nystagmus.
19.
20.
Palpate temporal and masseter muscles during teeth clenching and relaxation.
Student
Correctly
Completed
Trigeminal (C.N.V) (sensory) - patients eyes closed
Scattered
21.
22.
Pain.
23.
24.
Light Touch.
25.
26.
Inspect face in conversation and at rest for asymmetry, tics and involuntary
movements.
27.
28.
Assess hearing. (If hearing is diminished, conduct Weber and Rinne tests.)
29.
30.
31.
32.
33.
34.
35.
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
Lower
36.
39.
Scattered.
37.
40.
Bilateral, Compare.
38.
41.
Trunk:
42.
Student
Correctly
Completed
Light Touch (patients eyes closed)
Anterior trunk:
43.
Upper
44.
47.
Scattered.
45.
48.
Bilateral, Compare.
46.
49.
Vibratory Sensation (Use low pitch tuning fork: 128 or 256 Hz)
50.
51.
52.
Great toes.
53.
Index fingers.
Discrimination Sense
54.
55.
56.
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.
Arms.
58.
Legs.
Muscle Strength
Compare strength bilaterally:
59.
Elbow flexion.
60.
Elbow extension
61.
Wrists extension
62.
Grip.
63.
Abduction of fingers.
64.
Opposition of thumbs.
65.
Hip flexion.
Student
Correctly
Completed
66.
Hip extension.
67.
Hip abduction.
68.
Hip adduction.
69.
Knee extension.
70.
Knee flexion.
71.
72.
COORDINATION
Assess rapid alternating movements, bilaterally. Note speed, rhythm, smooth
movement.
Upper extremities:
73.
74.
Tap distal joint of thumb with the tip of the forefinger rapidly.
Lower extremities:
75.
76.
With eyes open: touch nose to the examiners moving, then stationary, finger.
77.
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.
Biceps.
80.
Triceps.
81.
Brachioradialis.
82.
Patellar.
83.
Ankle.
84.
Plantar response.
85.
Clonus.
Student
Correctly
Completed
(patient standing)
86.
Walk across room, turn and walk back. Observe posture, balance, arm swing,
leg movement and smoothness of turns.
87.
88.
Walk on toes.
89.
Walk on heels.
Further assessment may include hopping on one foot and shallow knee bending.
90.
Rhomberg test. (Eyes open, place feet together; close eyes and hold position
for 20-30 seconds.)
91.
Pronator drift. (Arms extended forward, palms up and eyes closed for 20
seconds.)
92.
Repeat
PRESENTATION
INTERPERSONAL SKILLS
COMMENTS:
3/09