MENTAL STATUS: ____ 1. Observe mood, affect and behavior ____ 2. Observe spontaneous speech ____ 3.

Speech - check naming ____ 4. Speech - check repetition ____ 5. Orientation to person, place, time ____ 6. Concentration - subtract serial 7's from 100 or serial 3's from 20 ____ 7. Short and long term memory CRANIAL NERVES:

____ 8. Test Nerve I: Ask patient if there has been any change in smell or taste. Formal testing of sense of smell is not usually done in screening exams. ____ 9. Test Nerve II: (May be done with EENT) a. Visual acuity b. Visual fields c. Ophthalmoscopic (disc, blood vessels, retina) ____ 10. Test Nerves III, IV, VI: (May be done with EENT) a. Pupillary reaction to light b. Extraocular movements, ptosis ____ 11. Test Nerve V: Sensory function: Briefly test all 3 divisions with light touch and pin prick (Test corneal reflex bilaterally) ____ 12. Test Nerve VII: (May be done with EENT). Motor function in mimetic musculature of the face: a. Raise eyebrows or forced eyelid closing (upper) b. Show teeth, puff out cheeks, or smile (lower) ____ 13. Test Nerve VIII: Hearing (may be done with EENT examination) ____ 14. Test Nerves IX and X: a. Observe elevation of palate vocalizing "ah" (may be done with EENT) b. Gag reflex (both sides) ____ 15. Test Nerve XI: (may be done with Head and Neck Exam) a. Test rotation of patient's head against resistance b. Test shoulder shrug against resistance ____ 16. Test Nerve XII: Observe midline protrusion of the tongue. (may be done with examination of the mouth) MOTOR STATUS: Examine functional groups of muscles for bulk, tone, consistency, strength, and abnormal movements.

Upper Limb: ____ 17. Proximal muscles. (test for drift of outstretched arms with eyes closed and palms up is most sensitive) ____ 18. Forearm (Test for strength of dorsiflexed wrist) ____ 19. Test patient's grip ____ 20. Have patient form ring with thumb and index finger which examiner tries to overcome using both hands Lower Limb: Observe gait (alternate maneuvers in brackets for non-ambulatory patients) ____ 21. Have patient walk on toes [have patient push down with forefoot against examiner's hand] ____22. Have patient walk on heels [have patient push up with forefoot against examiner's hand] ____23. Have patient hop on each foot [have patient raise entire leg off bed] ____24. Have patient do a deep knee bend or get out of a chair without using hands. [have patient straighten knee against resistance] ____25. Tandem gait [heel to toe] ____ 26. Ask patient to push down (plantar flex) and then lift up (dorsiflex) the great toe against resistance REFLEXES: Deep tendon reflexes: (test symmetrically) ____ 27. Test biceps reflex [patient supine, with hands resting on abdomen] ____ 28. Test brachioradialis reflex [patient supine, with hands resting on abdomen] ____ 29. Test triceps reflex [Patient supine, with hands resting on abdomen and elbow supported by examiner] ____ 30. Test patellar reflex [patient supine, knee resting on examiner's wrist] ____ 31. Test Achilles reflex [patient supine rest ankle to be tested just above opposite knee] Cutaneous reflexes: ____ 32. Test plantar reflexes CEREBELLAR FUNCTION: ____ 33. Test rapid alternating movements - hands ____ 34. Test finger-to-nose bilaterally ____ 35. Test heel-to-shin bilaterally SENSORY STATUS: ____ 36. Test light touch and pin prick on both sides of trunk ____ 37. Test light touch and pin prick on 4 limbs ____ 38. Test position sense at least in feet ____ 39. Test vibration sense in at least both ankles ____ 40. Romberg done with patient standing