Neuro

Mental status
o Appearance, behavior, LOC
Cognitive ability
o Mood/affect
o Memory
intermediate- listen and rpt 4 words later,
recent-listen and rpt 4 words,
remote- where did you go to high school),
abstract reasoning- bird in the hand is worth 2 in the bush,
judgement- if a signal light turns red what would u do,
calculation- simple math
ID by name and number and test all cranial nerves
o CN1 Olfactory- nostrils patency and smell
Occlude one nostril while introducing a smell to the open nares then alternate
smells and sides.
o CN2 Optic- test vision(near), explain Snellen chart test
o CN3 Oculomotor- PERRLA (including pupil size) 3-4-6
Pen light then accommodation look at distant then present something 10cm
from face pupils should constrict when eyes focus on near object. Bring eyes
through H test and ceiling to floor.
o CN4 Trochlear- EOM with 3-4-6
o CN 5 Trigeminal- motor: muscles of the mastication, sensory: sensation of the 3 regions
of face
Clinch jaw. Q tip soft and sharp all three areas. Forehead, cheek, chin/jaw
o CN6 Abducens- EOM with 3-4-6
o CN7 Facial- motor: puff cheeks, smile, clench teeth, show teeth, open and close eyes,
purse lips. Sensory: describe testing of taste. Test taste by applying solutions of CN9
posterior third tongue (bitter in the back, then sour), then CN7anterior 2/3 tongue
(salty, then sweet) asking the pt to identify sensation after application. Have pt rinse
mouth after each solution is tested. Pt should ID correctly bilaterally.
o CN8 Acoustic- whisper test, weber and rinne
Whisper test- stand 2 feet away bilaterally ask pt to occlude opposite ear and
whisper 3-6 letters/number and ask pt to rpt 50% correct is expected.
Weber- test for unilateral hearing loss, tuning fork on head ask if sound heard
better on either side or equal on both
Rinne- test for bone bone verses air conduction of sound. Place tuning fork on
mastoid bone til sound no longer heard then move to 2cm from ear fork open
then til sound no longer heard. Ratio should be air conduction 2:1
o CN9 Glossopharyngeal- Motor: swallowing, speech quality. Sensory: describe taste
posterior 1/3 of tongue.
 o CN10 Vagus- Motor: Swallowing sip water, speech quality. Sensory: Say AH assess
palate movement and uvula, Gag reflex: posterior wall of pharynx noting palate to
moving upward and uvula remain midline.
o CN11 Spinal Assesory- shoulder shrug and turn head verses resistance
o CN12 Hypoglossal- tongue strength and movement: rpt light, tight, dynamite. Extand
tongue out and ^v>< ask pt to push tongue against cheek as you apply resistance
externally.
Test cerebellar function
o Gait: walking and tandem- heel to toe
o Romberg test- stand arms at side and close eye. Expected is little or no sway. Be ready
to catch
o Coordination- nose to finger, knee-shin, rapid moving finger nose
Test perception
o Sharp vs dull
o Position sense of finger and toes
o Stereognosis- give them key tell them to ID object
o Graphesthesia- draw letter in palm of hand and have them ID letter
Test Reflexes
o Bicep-
o Tricep
o Brachioradialis
o Patellar
o Achilles
o Plantar- stroke the lateral plantar surface from heel to across ball of foot: all toes flex
downward
o Ankle clonus- support LE then briskly induce dorsiflexsion and observe ankle for rpt
plantar flexion. Expected none

Cardiovascular

Inspect and discuss landmarks and finding for each

Lying flat
o Apical Impulse- MCL L 4thor 5th ICS. Inspect while sitting up for PMI
o Apex-L lateral assessment
o Base- L and R sternal borders 2nd ICS
o Lifts/Heaves- None noted
Sitting 30*
o Inspect for Jugular Vein Distention- 30* side angle penlight
Palpate precordium for
o Apical impulse
o Thrills- palpable mummer check at base
o Lifts/heaves- bounding apical impulse
Auscultate using diaphragm then bell and list landmarks
o Aortic- R 2nd ICS at sternal border
o Pulmonic- L 2nd ICS at sternal border
 o Erbs point- L 3rd ICS at sternal border
o Tricuspid- L 4th ICS at sternal border
o Mitral- L 5th ICS at MCL
o S1-S2= S1 closure of AV valves and beginning of systole. S2 closure of semilunar valves
and represents end of systole
Assess and describe apical heart rate
o Beat per minute- at 5th ICS L @ MCL
o Regularity
Identify the location of the following pulses and describe strength
o Radial-2+
o Brachial
o Femoral
o Popliteal
o Posterior tibial
o Dorsalis pedis
o Carotid- palpate and auscultate for bruit
Describe nails and nail bed for
o Color- pink
o Contour-
o Cap refill- brisk
Evaluate lower extremities for edema
o Describe findings and grade if present
o