Neurologic Examination

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Cranial Nerve Examination

  • CN II (optic): visual fields; pupillary reaction and accommodation
  • CN III, IV, VI (Oculomotor, Trochlear, Abducens): extraocular movements; convergence
  • CN V (trigeminal): sensory (sharp) and motor (clenches teeth while examiner palpates masseter and temporalis)
  • CN VII (facial): smile, frown, puff cheeks, raise eyebrows, shut eyes while examiner attempts to pry them open
  • CN VIII (auditory): finger rubs
  • CN IX and X (glossopharyngeal, vagus): articulation; "ah" and note palate movement
  • CN XI (accessory): shoulder shrug and neck strength against resistance
  • CN XII (hypoglossal): stick out the tongue and move side to side

Special Considerations: CNVIII

  • Use tuning fork is decreased hearing (Weber test)

Motor Exam: compare side to side

  • Observe for bulk and abnormal movements
  • Testing tone: passively flex and extend elbows
  • Strength Testing against resistance
  • Abduct shoulder
  • Flex and extend elbow
  • Spread fingers
  • Thumb opposition to pinkie
  • Flex hips
  • Flex and extend knee
  • Dorsiflex and plantarflex ankle

Coordination and Gait: Cerebellar Function

  • Finger to nose testing
  • Heel to shin testing
  • Rapid alternating movements
  • Romberg Testing
  • Gait: walking and turning
  • Tandem gait
  • Walking on heels and toes

Reflex Examination: Tendon reflexes

  • Biceps
  • Triceps
  • Brachioradialis
  • Knee
  • Ankle
  • Babinski

Special Considerations: Reflexes

  • Test for clonus by quickly dorsiflexing the foot on both sides

Sensory Examination

  • Vibratory sensation bilaterally on index finger and great toe
  • Subjective light touch tested symmetrically on upper and lower extremities

Special Considerations: Sensory Examination

  • Position sense or proprioception bilaterally on index finger and great toe
  • Two point discrimination
  • Graphesthesia
  • Stereognosis

ONLINE PHYSICAL EXAM TEACHING ASSISTANT

The UF College of Medicine Harrell Center