Benchmarks for the Neurologic Exam

On completion of FCM, you should be able to demonstrate each of the following, on a patient or on an Objective Structured Clinical Encounter (OSCE)

Assess mental status

  • Level of consciousness
  • Orientation
  • Speech

Assess cranial nerves II-XII

  • Test visual acuity and visual fields for each eye alone (CN II)
  • Test pupillary reaction (CN II and III)
  • Test extra-ocular movements (CN III, IV, VI), observing for nystagmus (CN VIII)
  • Test facial sensation & muscles of mastication (CN V)
  • Test muscles of facial expression (CN VII)
  • Test hearing (CN VIII)
  • Test palatal rise to phonation (CN IX and X)
  • Test sternocleidomastoid & upper trapezius muscle strength (CN XI)
  • Test tongue protrusion (CN XII)

Assess motor function

  • Evaluate strength and bulk of:
    • Upper extremity muscle groups: Shoulder abductors, arm flexors and extensors, wrist flexors and extensors, finger flexors, finger abductors
    • Lower extremity muscle groups: Hip flexors, extensors, abductors and adductors; knee flexors and extensors, foot dorsiflexors and plantar flexors
  • Assess for pronator drift

Assess reflexes

  • Upper extremity: Biceps, triceps, and brachioradialis
  • Lower extremity: Patellar, Achilles and plantar

Assess sensation

  • Compare light touch on the bilateral arms and legs
  • If your patient reports sensory changes, assess multiple sensory modalities. Modify your choice of the four sensory modalities to match the patient’s sensory complaints: pin prick, vibration, joint position sense, or light touch.

Assess cerebellar function

  • Finger to nose test
  • Heel to shin test
  • Gait
  • Romberg test (tests sensation and cerebellar function)

Perform hypothesis-driven exam maneuvers

  • Assess muscle tone
  • If you suspect cognitive impairment, perform the Mini-Cog
  • If you suspect a disorder of the eye or visual pathways, test visual fields.
  • If your patient reports sensory changes, assess multiple sensory modalities

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