STEP 2 CS NEURO EXAMINATION

MMSE :

- i would like to ask u some question about orientation,memory and concentration.
-can u tell me ur name and age?

 Orientation
- do u know whr u r now?
- do u know the date today?
- do u know what this is? (show ur pen)

Memory
-i will name 3 objects and i want u to repeat them after a few minutes,ok? "chair ,pen,bed"
-do u remember what u had for lunch?
-when did u get mariied?
-are u right handed or left handed?
- now can u repeat for me the names of the 3 objects that i mentioned to u?

3 step command
-i will give u a piece of paper. i want u to take the paer in ur right hand,fold the paper in half,and put it on the table.

concentration
-can u please spell world forward and backward for me
-can u please take 7 away from 100 and tell me what number u get,and then keep taking 7 away until i tell u to stop.

judgement:
what would u do if u saw a fire coming out of a paper basket?

Cranial Nerves:
2- vision
pupils(size,position)
visual acuity
pupilary light reflex
accomodation reflex
fundoscopy
3,4,6- extraocular movements, cover test
5- facial sensation(forehead,cheek,jaw),muscle of mastication
7-smile,lift ur brows,close ur eyes and dont let me open them
8- weber,rinne test
9,10 - symmetrical palate movement, gag reflex
11-shrug ur shoulder
12- stick ur tongue out

Motor system:
-passive motion

Active motion: 

Shoulders
1. abduction - dont let me push ur shoulders down
2. adduction - dont let me pull ur arms away
 
 
Elbow

1. flexion-dont let me pull your arm away from u
2. extension - dont let me push ur arm towards u

 
Wrist
extension -cock ur wrists back and dot let me pull them down
flexion - point ur  wrist downward and dont let me pull them up


 
Fingers
1 spread ur fingers aparts, 
2 close ur fist
3 thumb abduction - point ur thumbs to the ceiling and dont let me push them down.

Legs
1 knee extension (kick out), 
2 knee flexion (pull in)
 
 
Hip

1. flexion - raise ur leg off the bed and stop me from pushing it down
2. extension -stop me from lifting your leg off the bed
3. abduction -move your leg away from the midline
4. adduction - stop me from moving your leg away from the midline.

 
Ankles
 1- dorsiflexion-point ur foot toward ur head & dont let me push it down
 2- plantarflexion -press against my hand with the sole of ur foot
 3- inversion - push ur foot against my hand 
 4- eversion - push ur foot out against my hand




Big toes
extension - dont let me push your big toe down
http://geekymedics.com/lower-limb-neurological-examination/
 https://informatics.med.nyu.edu/modules/pub/neurosurgery/motor.html

REFLEXES 

1. biceps
2. triceps
3. brachioradialis
4. patellar
5. achilles
6. babinski

 Sensory system

1. sharp(pin)/dull(cotton swab)
2. vibration
3. position sense

 CEREBELLUM

1. Gait- heel to toe gait, romberg test 
2. speech - ask pt to repeat the following phrases : baby hipopotamus/ british constitution/ 42 west register street
3. coordination - finger to nose, dysdiadokinesia, heel to shin test

 http://geekymedics.com/cerebellar-examination-osce-guide/

MEningeal sign

1. brudzinski sign
2. kernig sign
3. neck stiffness