7. MEMORY
• IMMEDIATE
MEASURE OF ATTENTION
3 OBJECTS
• SHORT TERM
What he / she ate yesterday ?
( ask the patient to recall the same objects 5 and 15 min later)
• LONG TERM
HISTORICAL EVENTS
PERSONAL EVENTS
12. CRANIAL NERVE EXAM
• I - OLFACTORY
– DON’T USE A NOXIOUS STIMULUS
– COFFEE, LEMON EXTRACT
• II - OPTIC
– VISUAL ACUITY
– COLOUR VISION
– PUPILLARY REFLEX
– VISUAL FIELDS
– FUNDOSCOPIC EXAM
13. CRANIAL NERVE EXAM
• III/IV/VI OCULMOTOR, TROCHLEAR, ABDUCENS
– OBSERVE LIDS FOR PTOSIS
– SQUINT
– EYE MOVEMENTS IN CARDINAL POSITIONS
– NYSTAGMUS
• V – TRIGEMINAL
– MOTOR – MUSCLES OF MASTICATION
– SENS - ALL 3 DIVISIONS
– CORNEAL REFLEX
– JAW JERK
14. CRANIAL NERVES
• VII – FACIAL
Motor
– Observe for facial asymmetry
– Forehead wrinkling, eyelid closure, whistle / show
teeth / blow cheeks
Sensory
- Taste ( ant 2/3 rd of tongue)
- Not to speak during examination
22. STRENGTH
• STRENGTH
– GRADED 0 – 5
– 0 - NO MOVEMENT
– 1 - FLICKER
– 2 - MOVEMENT WITH GRAVITY REMOVED
– 3 - MOVEMENT AGAINST GRAVITY
– 4 - MOVEMENT AGAINST RESISTANCE
– 5 - NORMAL STRENGTH
23. STRENGTH EXAM
• UPPER AND LOWER EXTREMITIES
• DISTAL AND PROXIMAL MUSCLES
• EXTENSORS / FLEXOR GROUP OF
MUSCLES
26. CO ORDINATION / CEREBELLAR
FUNCTION
• FINGER TO FINGER TO NOSE TESTING
• RAPID ALTERNATING MOVEMENTS
• HEEL –SHIN
• HEEL TOE TEST OF GAIT
– TANDEM
27. Gait evaluation
• Include walking and turning
• Examples of abnormal gait
– High steppage
– Waddling
– Hemiparetic
– Shuffling
– Ataxic
28. Romberg Sign
Stand with feet together
- assure patient stable
- have them close eyes
• Romberg is positive if they do worse with eyes closed
• Measures
Cerebellar function
Frequently poor balance with eyes open and closed
Proprioception
Frequently do worse with eyes closed
30. SENSORY EXAM
• PIN PRICK
• TEMPERATURE
• Touch – crude / fine
• VIBRATION
– 128 hz tuning fork
• JOINT POSITION SENSE
31. HIGHER CORTICAL
SENSATIONS
• Point localisation
• Graphesthesia
• Stereognosis
• Two point localisation
Lip 2-3 mm Pulp of finger 2-4 mm Dorsum of finger 4-6 mm
Palm 6-8 mm Dorsum of hand 8-12 mm
Foot 10-20 mm Back 20- 30 mm
• Sensory inattention
