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