Introduction: Introduce yourself and explain what you will be doing.

1) Vitals: Ask for the vitals beforehand.

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2) General: pt is sitting comfortably with no apparent distress

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3) Orientation: Name, Place & time (MMSE in psych cases)

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4) Cranial Nerves exam:

• I: Can you please tell me what do you smell? Coffee, alcohol

• II: Visual Acuity, Visual Field, Color vision (ishara plates), Pupillary reflex & fundoscopic exam (for edema, retinal hemorrhage, neovascularisation, nicking of the veins)

• III, IV, VI: By inspection, both eyes appear symmetrical. There is no deviation, nystagmus, head tilting, or ptosis + H movements (no nystagmus or double vision were noted)

• V: Motor (inspect for muscle atrophy, Clench, open mouth against resistance, move jaw to sides), Sensory (cover the ophthalmic, maxillary, and mandibular areas), Reflexes (I would normally do Corneal reflex), taste (Any taste changes)

• VII: Crease your forehead, close your eyes (close against resistance), Puff cheeks and show your teeth

• VIII: Rinne & Weber + whisper

• IX: gag reflex

• X: Speaking + check for uvula deviation while patient says “Ahh”

• XI: Shrug shoulder and move head against resistance

• XII: inspection for wasting or fasiculations + stick tongue out (notice any deviation)

 

5) Cerebellar exam:

Gait: Ask the patient to Stand up, Walk normally, walk heel to toe, Romberg test (normal, shuffling, waddling, scissoring or swinging gait + Arm swing)

Coordination: Finger to nose test, dysdiadochokinesia (claping with dorsal and palmar), heel to shin test

 

6) Special tests:

Meningitis: neck stiffness

Kernig: while neck is flexed extend LL

Brodzinski: Bringing chin to chest causes pain

Babinski: Scratch the bottom of your feet