Bates- Neuro Physical Exam Questions and Answers

Bates- Neuro Physical Exam Questions and Answers How do you test the function of CN I? -Answer-1. occlude each nostrils and test for patency 2. ask the pt to close their eyes 3. bring a smell to each of their nostrils and ask them to identify it How do you test the function of CN II? -Answer-1. Test Visual Acuity 2. Fundoscopic- optic disc enlargement, pallor, and bulging 3. Confrontation Test How do you test the function of CN II and III? -Answer-1. inspect pupils for size difference (aniscoria >0.04mm) 2. test pupillary light rxns (direct/consenual) 3. Near response (accommodation) How do you test the function of CN III, IV, and VI? -Answer-1. Test EOMs (if pt has diplopia, what direction makes it worse?) 2. Check for convergence If there is binocular diplopia, what could that be a sign of? -Answer-CN III, IV, VI neuropathy Nystagmus is seen in -Answer-cerebellar disease Ptosis could be normal, or it could suggest -Answer-Third Nerve Palsy, Horner's Syndrome, or Myasthenia Gravis How do you test the motor function of CN V? -Answer-Ask the pt to clench the teeth and note the strength of muscle contraction in masseter and pterygoid Ask pt to move jaw side to side How do you test the sensory function of CN V? -Answer-Test the forehead, cheeks, and jaw for pain sensation, sharp vs. dull on 3 places on face Abnormality found: temperature sensation How do you test CN VII? -Answer-Ask pt to raise eyebrows, frown, close both eyes tightly, show upper and lower teeth, smile, puff out both cheeks Bell's Palsy -Answer-CN VII injury How do you test Cranial Nerve VIII? -Answer-Whispered Voice Test, and if there is a problem determine if its conductive or sensorineural from weber and rinne test You inspect the patients voice for hoarseness or nasalness to test for what CN? - Answer-IX and X How do you test for a lesion of CN X? -Answer-Ask the pt to say ah and watch the movement of the soft palate and pharynx A "gag reflex" involves what 3 actions -Answer-elevation of the tongue and soft palate, constriction of the pharynx Unilateral absence of the gag reflex suggests -Answer-CN IX lesion and possible CN X lesion How do you test CN XI? -Answer-Inspect atrophy or fasciculations on the trapezius Ask pt to shrug their shoulders against your hands Ask pt to turn their head against your hands The articulation of a pts speech depends on -Answer-5 7 10 12 To test CN XII Ask the pt to stick their tongue out and check for -Answer-asymmtery, atrophy, or lateral deviation from the mideline When noting involuntary movements, note their ____________ and relation to ____________. -Answer-location, quality, rate, rhythm and amplitude, and their relation to posture, activity, fatigue, emotion Fasciculations with atrophy &muscle weakness suggests -Answer-disease of peripheral motor unit To test muscle tone, feel the muscles... -Answer-resistance to passive strength What is spasticity? -Answer-velocity-dependent increased tone that worsens at the extremes of range rate dependent- increasing with rapid movement Rigidity -Answer-increased resistance throughout the range of movement and in both directions not rate dependent Test muscle strength by asking the patient to -Answer-actively resist your movement A muscle is strongest when __________ and weakest when __________ -Answer- shortest, longest T or F: A person's dominant side is usually slightly stronger than the nondominant side - Answer-true How do you eliminate gravity when testing muscle strength? -Answer-Move the muscle in a horizontal plane Scale of Grading Muscle Strength -Answer-0: No contraction detected 1: Small flicker of contraction 2: Active movement with gravity eliminated 3: Active movement against gravity