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Questions and Answers
What score indicates no muscle contraction on the muscle power scale?
What score indicates no muscle contraction on the muscle power scale?
Which reflex is associated with the L3 and L4 spinal segments?
Which reflex is associated with the L3 and L4 spinal segments?
Which of the following is NOT a typical part of the neurological examination?
Which of the following is NOT a typical part of the neurological examination?
What is the grading for brisk reflexes on the reflex grading scale?
What is the grading for brisk reflexes on the reflex grading scale?
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What is the primary focus of a neurological examination?
What is the primary focus of a neurological examination?
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In which situation would you likely NOT perform a motor examination of the lower limbs?
In which situation would you likely NOT perform a motor examination of the lower limbs?
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Sustained clonus more than three beats is considered which of the following?
Sustained clonus more than three beats is considered which of the following?
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Which cranial nerve is assessed by asking a patient to identify common odors?
Which cranial nerve is assessed by asking a patient to identify common odors?
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Which of the following is NOT a method of examining coordination?
Which of the following is NOT a method of examining coordination?
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Which condition is typically associated with flaccidity?
Which condition is typically associated with flaccidity?
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What kind of weakness did the 23 year old girl exhibit?
What kind of weakness did the 23 year old girl exhibit?
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What condition is suggested by a family history of similar weakness?
What condition is suggested by a family history of similar weakness?
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What characterizes spasticity in terms of motor neuron involvement?
What characterizes spasticity in terms of motor neuron involvement?
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Which of the following reflexes is NOT considered a required reflex?
Which of the following reflexes is NOT considered a required reflex?
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Which examination technique is NOT included in the OSCE for the nervous system?
Which examination technique is NOT included in the OSCE for the nervous system?
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What is a potential finding in a neurological examination if a patient has anosmia?
What is a potential finding in a neurological examination if a patient has anosmia?
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What does a visual acuity of 6/18 indicate?
What does a visual acuity of 6/18 indicate?
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Which of the following tests is used to assess color vision?
Which of the following tests is used to assess color vision?
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Which reflexes should be examined when assessing the pupillary reflexes?
Which reflexes should be examined when assessing the pupillary reflexes?
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What does the confrontation test evaluate?
What does the confrontation test evaluate?
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Which cranial nerves are involved in the H-test?
Which cranial nerves are involved in the H-test?
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Which of the following is a symptom associated with parkinson disease?
Which of the following is a symptom associated with parkinson disease?
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What does 'LMNL' stand for in the context of nerve lesions?
What does 'LMNL' stand for in the context of nerve lesions?
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What test would you use to evaluate the motor component of the trigeminal nerve?
What test would you use to evaluate the motor component of the trigeminal nerve?
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Which of the following tests assesses coordination and requires a person to touch their nose with their finger?
Which of the following tests assesses coordination and requires a person to touch their nose with their finger?
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What is a sign not typically associated with Upper Motor Neuron Lesions (UMNL)?
What is a sign not typically associated with Upper Motor Neuron Lesions (UMNL)?
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What was the muscle tone of the left arm?
What was the muscle tone of the left arm?
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Which sensory test assesses the ability to recognize an object by touch?
Which sensory test assesses the ability to recognize an object by touch?
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Which reflexes were absent in the left arm?
Which reflexes were absent in the left arm?
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What finding would most likely indicate a Lower Motor Neuron Lesion based on the case scenario?
What finding would most likely indicate a Lower Motor Neuron Lesion based on the case scenario?
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Which of the following describes a typical response of the left arm in the case scenario?
Which of the following describes a typical response of the left arm in the case scenario?
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How did the muscular power of the right arm compare to the left arm?
How did the muscular power of the right arm compare to the left arm?
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What findings were noted regarding cerebellar coordination in the left arm?
What findings were noted regarding cerebellar coordination in the left arm?
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Which coordination test evaluates the ability to perform movements rapidly and alternately?
Which coordination test evaluates the ability to perform movements rapidly and alternately?
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What was noted about the right arm compared to the left in terms of reflexes?
What was noted about the right arm compared to the left in terms of reflexes?
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What observation would suggest normal cerebellar function based on the assessments?
What observation would suggest normal cerebellar function based on the assessments?
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Which reflex was found to be average or normal in the right arm during the assessment?
Which reflex was found to be average or normal in the right arm during the assessment?
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Study Notes
Nervous System Examination OSCE
- OSCE stations for nervous system are part of Internal Medicine modules
- Common OSCE stations in nervous system include cranial nerve examination, motor system examination, and sensory system examination.
- Essential components of the nervous system examination include:
- Cranial nerves
- Motor system
- Coordination
- Sensory system
Cranial Nerve Examination
-
Olfactory nerve (I):
- Test by presenting common odors and asking the patient to identify them.
- Anosmia (loss of smell) is a feature of Parkinson's disease.
- Parosmia (distorted smell) and olfactory hallucinations are a feature of temporal lobe epilepsy.
-
Optic nerve (II):
- Involves four steps:
- Visual acuity: Use the Snellen chart for distant vision and reading tests for near vision.
- Visual field: Use the confrontation test to assess peripheral and central fields.
- Color vision: Use the Ishihara chart to test for color vision.
- Pupillary reflexes: Examine the pupil for size, shape, symmetry, and direct and consensual light reflexes, and accommodation reflex.
- Involves four steps:
-
Oculomotor (III), Trochlear (IV), and Abducent (VI) nerves:
- Examine using the "H" test.
- Lesions can cause:
- Lateral rectus palsy (LMNL of the sixth nerve)
- Superior oblique palsy (LMNL of the fourth nerve)
- Ptosis, dilated pupil, and difficulty moving eye in all directions (LMNL of the third nerve)
- Uncal herniation can result in a fixed, dilated pupil that doesn't react to light.
-
Trigeminal nerve (V):
- Motor component: Examine by inspecting and palpating the masseters, and by testing jaw opening against resistance.
- Sensory component: Test light touch and superficial pain in the three divisions of the nerve (ophthalmic, maxillary, and mandibular).
- Reflexes: Test the corneal reflex and jaw jerk.
-
Facial Nerve (VII):
- Motor and sensory component.
- Motor component examination:
- Inspect for asymmetry.
- Test raising eyebrows, showing teeth, and blowing air against resistance with the mouth closed.
- Sensory component examination:
- Test taste on the anterior 2/3 of the tongue.
- Check for hyperacusis (increased sensitivity to sound).
- Lesions can be either upper motor neuron lesions (UMNL) or lower motor neuron lesions (LMNL).
Motor System Examination
-
Muscle tone: Refers to resistance to passive movement.
- Normal muscle tone is characterized by a slight resistance to passive movement.
- Abnormalities in muscle tone include:
- Hypotonia (decreased muscle tone): Characterized by floppiness, flaccidity.
- Hypertonia (increased muscle tone):
- Spasticity: Increased resistance to passive movement, which increases with speed and decreases with sustained stretch.
- Rigidity: Persistent and increased resistance to passive movements that is independent of speed and sustained stretch.
- Clonus: Repetitive rhythmic involuntary contractions in response to a sudden stretch.
-
Muscle power:
- The scale for muscle power:
- 0 = No muscle contraction.
- 1 = Muscle contraction but no joint movement.
- 2 = Joint movement with gravity.
- 3 = Joint movement against gravity with no resistance.
- 4 = Joint movement against gravity and resistance.
- 5 = Normal power.
- The scale for muscle power:
-
Reflexes:
- Required reflexes to test:
- Biceps jerk (C5, C6)
- Triceps jerk (C6, C7)
- Supinator jerk (C5, C6)
- Knee jerk (L3, L4)
- Ankle jerk (S1)
- Babinski's reflex (plantar reflex).
- Grading of reflexes:
- 0 = Absent.
- 1 = Present.
- 2 = Brisk.
- 3 = Very brisk.
- 4 = Clonus.
- Required reflexes to test:
- Muscle bulk: Inspect for muscle atrophy or hypertrophy
-
Involuntary movements:
- Fasciculations: Localized, twitching movements of muscle fibers.
- Tremors: Rhythmic, oscillatory movements.
- Myoclonus: Sudden, involuntary twitches or jerks of a muscle or group of muscles.
Upper Motor Neuron Lesions (UMNL) vs. Lower Motor Neuron Lesions (LMNL)
-
UMNL
- Hypertonia (spasticity)
- Hyperreflexia
- Weakness with a tendency to affect the proximal muscles more than the distal muscles.
- Loss of superficial reflexes, such as the abdominal reflex and cremasteric reflex.
-
LMNL
- Hypotonia (flaccidity)
- Hyporeflexia or areflexia
- Atrophy of the muscles
- Fasciculations
-
Other considerations:
- The presence of babinski's sign is a pathognomonic sign of UMNL
- Clonus can be present in both UMNL and LMNL
- Spasticity is associated with UMNL and is characterized by increased resistance that is speed-dependent.
- Rigidity is associated with Parkinson's disease and is characterized by increased resistance that is not speed or stretch-dependent.
Coordination Examination
- Speech ability: Assess articulation and voice quality.
- Romberg test: Assess balance with feet together, eyes closed.
- Finger-to-nose test: Assess coordination and accuracy of fine motor movements.
- Rapid alternating movements: Assess speed, rhythm, and accuracy of alternating movements.
- Rebound phenomena: Assess the ability to stop a rapid movement abruptly.
- Heel-to-shin test: Assess coordination and smoothness of the gait.
- Nystagmus: Assess involuntary eye movements.
Sensory System Examination
- Light touch: Test using a wisp of cotton or a fingertip.
- Superficial pain: Test using a pinprick.
- Temperature: Test using a tuning fork or two test tubes filled with hot and cold water.
- Vibration: Test using a tuning fork placed on a bony prominence.
- Joint position sensation: Test by moving a patient's finger or toe and asking them to identify its position.
- Two-point discrimination: Test by using two points simultaneously and asking the patient to identify if they are feeling one or two points.
- Stereognosis: Test by placing an object in the patient's hand and asking them to identify it without looking.
- Graphesthesia: Test by writing a number or letter on the patient's palm and asking them to identify it.
- Sensory inattention: Examine if there's a tendency to neglect sensory stimuli from one side of the body.
- **
- Note:* The text provided does not mention any specific disease or condition. This content provides general information on performing a nervous system examination based on the notes. It's important to note that this information is for educational purposes only and should not be used as a substitute for seeking medical advice from a qualified healthcare professional.
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Description
Test your knowledge on the nervous system examination as part of Internal Medicine modules. This quiz covers key OSCE stations, including evaluations of cranial nerves, motor systems, and sensory systems. Challenge yourself to identify essential components and techniques used in neurological assessments.
