So we just covered a lot of
material on the Neurologic Exam.
Let me just highlight
a few key points here.
So we went through all of the cranial
nerves and we were highlighting
the motor function and the sensory
function of a variety of these nerves,
acknowledging that there are
many functions of these nerves,
which we can't readily
assess on the physical exam.
In terms of coordination,
we talked about distinguishing
between limb ataxia,
and gait ataxia.
Not to mention distinguishing
gait ataxia from sensory ataxia,
ataxia that's caused
by cerebellar problems
versus that caused by sensory problems
from the peripheral nervous system.
We also talked how
to assess for tremor,
whether there's resting
tremor or action tremor.
We reviewed tests of higher
starting with just
and then talking about mental
status, for example,
dementia and delirium.
we looked at some of those tests
we've used historically
acknowledging that they're
not particularly useful
when making a bedside diagnosis.
Which of the following assesses the
function of the accessory nerve?
A. Sticking out the tongue.
B. Asking the patient to bite down
while palpating the masseter muscles.
C. Assessing for midline uvula.
Or D. Asking the patient to
shrug his or her shoulders.
So sticking out the tongue is a test of
the twelfth cranial nerve, the Hypoglossal.
Asking a patient to bite down while
palpating the masseter muscles
would help us to identify a problem with
the fifth cranial nerve, the Trigeminal.
Assessing for a midline uvula is
a feature of the Glossopharyngeal
with some contributions
from the vagal nerve.
So the answer is D.
Asking patients to shrug their shoulders
is a test of the eleventh
or accessory cranial nerve.
Which of the following would not be
used to assess cerebellar function?
A. The Romberg
or D. the Heel-shin test.
So the Romberg is actually really
used to look for a sensory ataxia.
When a patient closes their
eyes if they were relying
upon visual input to help
maintain their balance
due to a loss of
you would see that person
start to lose their balance.
Cerebellar functioning is
more about coordination
and that's what Dysdiadochokinesia,
and the Heel-shin tests are
designed to investigate.
So the answer is letter A.