Term
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Definition
Olfactory (CN I) Sensory and smell
-Test for odor identification (not tested) |
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Term
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Definition
Optic (CN II) Sensory and visual acuity
Test for visual acuity
Test visual fields
Perform ophthalmologic examination
With patient wearing glasses, test each eye separately on eye chart/ card using an eye cover.
Examine visual fields by confrontation by wiggling fingers 1 foot from pt's ears, asking which they see move. • Keep examiner's head level with patient's head.
If poor visual acuity, map fields using fingers and a quadrant-covering card.
Look into fundi. |
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Term
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Definition
Oculomotor, trochlear, and abducens (CN III, IV, and VI)
Motor and eye movement, pupil size, eyelid opening
Inspect eyelids for drooping.
Inspect pupils for size and equality.
Test consensual response and accommodation.
Test extraocular eye movements.
-Look at pupils: shape, relative size, ptosis.
-Shine light in from the side to gauge pupil's light reaction. • Assess both direct and consensual responses. • Assess afferent pupillary defect by moving light in arc from pupil to pupil. unne).
-Follow finger with eyes without moving head":
-test the 6 cardinal points in an H pattern. •
-Look for failure of movement, nystagmus [pause to check it during upward/ lateral gaze].
-Convergence by moving finger towards bridge of pt's nose.
-Test accommodation by pt looking into distance, then a hat pin 30cm from nose. |
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Term
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Definition
Trigeminal (CN V) Mixed: muscle tone and sensation
Inspect face for atrophy or tremors.
Palpate jaw for tone and strength.
Test for pain and sensation (sharp and dull)
Test corneal reflex. |
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Term
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Definition
Facial (CN VII) Mixed: facial expressions and taste
Inspect facial symmetry.
Test tongue for salt and sweet |
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Term
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Definition
Acoustic (CN VIII) Sensory, hearing, and balance
Test hearing.
Compare bone and air conduction (Weber or Rhine)
Test for sound lateralization. |
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Term
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Definition
Glossopharyngeal (CN IX) Mixed: taste and swallowing
Test tongue for sour and bitter.
Test gag reflex and swallow. |
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Term
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Definition
Vagus (CN X) Mixed: swallowing and speech
Inspect palate and uvula for symmetry.
Inspect for swallow difficulty.
Evaluate guttural speech sounds
IX and X tests:
Voice: hoarse or nasal.
Pt. swallows, coughs (bovine cough: recurrent laryngeal). Examine palate for uvular displacement. (unilateral lesion: uvula drawn to normal side).
Pt says "Ah": symmetrical soft palate movement.
Gag reflex not tested |
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Term
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Definition
Spinal accessory (CN XI) Motor and muscle strength
Test trapezius and sternocleidomastoid muscle strength (shoulder shrug & turning head against resistance). |
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Term
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Definition
Hypoglossal (CN XII) Motor and tongue strength
Inspect tongue for symmetry/tremors/atrophy.
Test tongue movement.
Test tongue strength.
Evaluate lingual speech sounds. |
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Term
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Definition
All Pts listed are for maximum levels:
-Eye Opening Response-Spontaneous--open with blinking at baseline-4 Pts
-Verbal Response-oriented-5 Pts
-Motor Response-Obeys commands for movement-6 Pts
!5 Pts max |
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Term
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Definition
-submental
-submandibular
-tonsillar
-parotid
-preauricular
-postauricular
-occipital
-Anterior Cervical
-Posterior Cervical
-Supraclavicular |
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Term
| Deep Tendon Reflexes (DTRs) |
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Definition
Scale: 0 not present 1=sluggish/dimished 2=active/expected response 3= more brisk or slightly hyperactive than expected 4=Brisk/hyperactive w/ intermittient or transient clonus
-Biceps (arm at 45 deg angle, locate tendon on AC space and apply thumb. Strike hammer on thumb).
-Brachioradial-forearm at 45 deg w/ hand slightly pronated. Strike tendon w/flat side of hammer
-Triceps-elbow @ 90 degrees, arm relaxed/supported w/ examiners hand. Palpate tendon directly above elbow and strike w/ hammer
-Patellar-knee @ 90 deg, leg hanging loosely. Strike patellar tendon just below patella.
-Achilles-support heel and dorsiflex ankle up to 90 deg and strike Achilles tendon at the level of the malleoli.
-Clonus-support knee in partially flexed position & briskly dorsiflex foot w/ other hand while maintaining foot in flexion. Checking for rhythmic oscillating movements (abnormal). |
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Term
| ROM assessment for MS system |
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Definition
Resistance/strength applied to major limbs & measured 0-5, with normal being +5
---Cervical spine-flexion: 45 deg-chin to chest
-extension: head back towards ceiling expect 45 deg side to side against resistance tests CN XI
---Thoracic & Lumbar spine-flexion: bending forward to touch toes w/o bending knees 76-90 deg expected Verbalize inspection of spine for scholios, lordosis and kyphosis.
hyperextension: bending backward @ waist-30 deg.
lateral bending-move torso side to side-expect 30 deg each side
rotation-swing torso in circular motion w/o moving pelvis. expected 30 degrees of rotation
---Shoulder- forward flexion-swing arms from side up above head-expect 180 deg hyperextension-swing arms straight back behind waist expect 50 deg adduction-arm raised straight out and swung across body expect 50 deg abduction-arm brought out and up away from body raised straight up expect 180 deg Internal & external rotation- "hand cuff" position behind back and hands behind head "pre-arrest/hammock" pose expect 90 deg for both
---Elbow-flexion "biceps curl" position expect 160 deg and extension arm flat out, elbow fully extended expect 180 deg..
pronation: elbow @ 90 deg and hand moving inward to place palm toward table ..supination: same position, but hand moves down to place top of hand on table both expect 90 deg
---Hip: flexion-laying flat, raise one leg straight up-90 deg expected bilaterally.. abduction-laying flat and slide leg distally expect 45 deg adduction-swing leg medially across midline expect 30 deg...external rotation-
heel placed on opp leg knee and flex bent knee towards table expect 45 deg
---knee: flexion-standing up, Pt bends knee back to lift calf towards back expect 130 deg..hyperextension-move knee to extend calf and ankle straight out expect 15 deg
---ankle-dorisflexion- toes/ankle straight up expect 20 deg..plantar flexion-toes pointing down to ground expect 45 deg..eversion-feet flat and ankle moved to midline w/ lateral side of foot lifted expect 20 deg..inversion-ankle moved away from midline while big toe side of foot is lifted..expect 30 deg.. |
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