Posted by Mitchell on June 17, 2001, at 19:47:32
In reply to Pdocs doing physical exams?????????, posted by Cecilia on June 16, 2001, at 4:31:11
The Virtual Naval Hospital offers the following checklist for an examination of mental and neurological status, including an assessment of cranial nerves and cerebellar status. Generalized psychicatric complaints are sometimes secondary to more illusive neurological problems. Discovery of neurological problems involves examination procedures that are not always included in a routine physical examination. Many examinations for neurological problems involve physical tests that are not easily adapted to remote, text-based relationship such as Internet based medical care.
Neuro/Mental Status
http://www.vnh.org/Shipwreck/Shipwreck.html#20Do all 6 components:
1st- Mental Status Exam
Always check this on all patients: Observation is your best tool, These can be assessed without provoking the pt. Observe the following:
Level of consciousness.
Dress, grooming and personal hygiene.
Facial Expression, posture and motor activity.
Thought content: Perceptions, interpretation of external stimulus.
Manner, affect, and mood.
Thought Process: Sequence, logic, coherence, relevance of thought.
Speech and language.
Insight and judgement.If anything does not seem right in the routine MS exam then check these cognitive Functions:
Test for memory (recent, remote)
Test for calculation ability
Test for orientation x3 (person, place, time)
Test for abstract thinking
Test for judgement
Test for general knowledge
Test constructional abilities
Test for new learning ability2nd Cerebellar Functions
Station
Romberg
Pronator sign
Heel to toe walk
Heel to shin drag
Rapid alternating movements (RAM's)
flipping hands on thighs
index finger to thumb DIP
3rd Motor TestingBilaterally check:
Cranial nerves III, IV, V, VI, VII, IX, X, XI, XII
C5 - T1
L4 - S1
Dermatones4th Sensory Testing
Bilaterally check:
Cranial nerves I, II V, VII, IX, X,
C5 - T1
L4 - S1
DermatonesSensory specific tests: Sharp/dull, 2 point discrimination, Temperature, Vibratory, Pain, Light touch, Proprioception, Stereognosis, Graphesthesia
5th Reflex TestingBilaterally check:
Cranial nerves V, IX, X,
Deep Tendon Reflexes:
C5 - Biceps
C6 - Brachioradialis
C7 - Triceps
L4 - Patellar
S1 - Achilles
Superficial reflexes:
Abdominal reflex -upper T7 - T10
-lower T10 - L1Cremasteric reflex
- L1, L2Superficial Anal reflex
- S2, S3, S4Bulbocavernosus reflex
- sacral sparringBabinski sign
- upper motor neuron lesion6th Cranial Nerve Exam
I- Olfactory
Sensory - smellII- Optic
Sensory - Visual Acuity, Peripheral vision by confrontation.-- FundoscopicIII- Oculomotor
Motor - EOM, accommodation.(lateral rectus, superior oblique)IV- Trochlear
Motor - EOM (superior oblique)
V- Trigeminal
Motor- clench teeth (palpate)
Sensory- bilateral 3 sections of face
Reflex- cornealVI- Abducens
Motor- EOM (lateral rectus)VII Facial
Motor- raise eyebrow, frown, smile, puff cheeks, show teeth, shut eyes tightly.
Sensory: taste to anterior of tongueVIII Vestibulocochlear
Sensory- watch tick, rub fingers, weber, rinne.IX/X Vagus/Glossopharyngeal
Motor- Listen to voice, say "AH"
Sensory- Taste to Posterior tongue
Reflex- gagXI Spinal accessory
Motor- Turn head, Shrug shouldersXII Hypoglossal
Motor- stick out tongue
poster:Mitchell
thread:66682
URL: http://www.dr-bob.org/babble/20010612/msgs/66906.html