10 minute screening examination
Remember practice makes perfect. You should aim to become sufficiently proficient to complete the examination in 10 minutes, by examining every patient you work up
General observationsYou can learn a lot about functional difficulties by watching the person
- walk paying attention to getting up from a chair, initiation of walking, arm swing, step size, base and posture.
- Remove shoes and socks and if appropriate undress
- Get on to the examining couch - may reveal hip flexor weakness
Mental statusInformally assess mental status, the level of consciousness and memory from interactions during history taking, and any observations passed on by receptionists, care givers or relatives. If there is reason to suspect a problem see the detailed Mental Status examination section.
Cranial nerve II
- Test visual acuity with glasses or if needed a pin hole in each eye separately, using a Snellen or a near vision chart. Often both are needed to clarify complaints of blurred vision or visual loss, and to establish the state of visual function with refractive error minimised.
- Test visual fields with finger movement confrontation looking for for hemi and quadrantic field defects in one or both eyes.
- Examine the fundi looking at the optic disks, for venous pulsation which implies normal intracranial pressure, and at the adjacent blood vessels and retina
Cranial nerve III, IV, VI
- Test the pupil reactions to light
- Check for ptosis and pupil asymmetry by comparing the upper eyelid margin position relative to to the centre of the pupil
- Check the ability to make voluntary eye movements right, left up and down.
- Check eye alignment in primary and 6 cardinal positions using a target that ensures accommodation (a picture or text stuck to a tongue depressor works well).
Cranial nerve V
- Check for lateral deviation on jaw opening
- Test facial sensation in the three divisions of the trigeminal nerve for light touch and pinprick
Cranial nerve VII
- Test facial movement for lid closure and teeth showing
Cranial nerve VIII
- Test hearing for a whispered voice at arms length, while masking the other ear by rubbing hair between your fingers.
Cranial nerve IX and X
- ask the patient to say ''Ah'' and observe palate movement on phonation
- Demonstrate adduction of the vocal cords by asking the person to make an explosive cough
Cranial nerve XII
- Inspect the tongue relaxed in the floor of the mouth for wasting and fasiculation, and for weakness producing deviation on protrusion
Power testing in arms and legsTest the power of the following movements on every patient, including inspection of muscles for wasting and fasciculation:
- Shoulder abduction
- Elbow flexion and extension
- Wrist extension
- Finger extension, flexion and abduction
- Thumb abduction in a plane perpendicular to the palm
- Hip flexion and extension
- Knee extension and flexion
- Ankle inversion, dorsiflexion, eversion and plantar flexion
Tonetest tone looking for spasticity
- in the arms by rapidly pronating, supinating, flexing and extending the arms at the elbow
- roll the legs from side to side, rapidly flex and extend the legs at the knee,
- sharply dorsiflex the ankle with knee bent to evoke clonus.
- finger nose test
- heel - shin test
- heel - toe walking
- plantar responses
SensationTest with eyes closed
- position sense
- light touch