1. Higher Mental Functions:
1. Level of Consciousness:
- Determine if the individual is:
- Fully awake/alert
- Drowsy
- Lethargic
- Unconscious/comatose
2. Response to Stimuli:
- Evaluate how the person responds to:
- Verbal commands
- Visual stimuli (e.g., waving a hand)
- Painful stimuli (e.g., sternal rub)
3. Orientation: Awareness of surroundings, time, and personal identity.
- Assess if the person is oriented to:
- Person: Do they know who they are?
- Place: Are they aware of where they are?
- Time: Do they know the date, time, and current events?
4. Memory: Ability to retain and recall information, including short-term and long-term memory.
- Test memory function by assessing:
- Immediate recall (e.g., repeating three objects)
- Recent memory (e.g., recalling events from the past few hours)
- Remote memory (e.g., recalling significant life events)
5. Cognitive Function:
- Evaluate cognitive abilities such as:
- Attention (Capacity to focus on specific stimuli while filtering out distractions)
- Concentration
- Language (Understanding and production of spoken and written language)
- Communication skills
- Problem-solving and abstract thinking
- Executive Function: Higher-order cognitive processes like planning, problem-solving, and decision-making.
These functions are crucial for daily functioning and are assessed to diagnose and manage conditions such as dementia, traumatic brain injury, ADHD, and schizophrenia
NOTES:
- Mini-Mental State Examination (MMSE): A widely used test to assess cognitive function, including orientation, memory, attention, and language.
- Clock Drawing Test: Evaluates visuospatial/executive function and can indicate cognitive impairment.
- Hamilton Rating Scale for Depression (HAM-D): Assesses mood, insight, and psychomotor activity in individuals with depression.
2. Cranial Nerve Examination:
- Cranial Nerve I (Olfactory):
- Smell Identification Test: Assesses olfactory function.
- Cranial Nerve II (Optic):
- Visual Acuity Test (Snellen Chart): Measures distance vision.
- Visual Field Examination (Confrontation Test): Screens for visual field defects.
- Fundoscopic Examination: Evaluates the optic nerve head and retina.
- Cranial Nerves III, IV, VI (Oculomotor, Trochlear, Abducens):
- Extraocular Movements (EOM) Test: Assesses eye movement in different directions.
- Pupillary Light Reflex Test: Checks pupillary reaction to light.
- Cranial Nerve V (Trigeminal):
- Corneal Reflex Test: Tests sensory function of the trigeminal nerve.
- Jaw Jerk Reflex Test: Evaluates motor function of the trigeminal nerve.
- Cranial Nerve VII (Facial):
- Facial Symmetry Test: Assesses facial muscle strength and symmetry.
- Taste Sensation Test: Evaluates taste sensation on anterior two-thirds of the tongue.
- Cranial Nerve VIII (Vestibulocochlear):
- Audiometry: Assesses hearing acuity.
- Vestibular Function Tests: Evaluate balance and inner ear function.
- Cranial Nerves IX, X (Glossopharyngeal, Vagus):
- Gag Reflex Test: Checks the gag reflex and swallowing function.
- Cranial Nerve XI (Accessory):
- Shoulder Shrug Test: Assesses trapezius muscle strength.
- Head Rotation Test: Evaluates sternocleidomastoid muscle function.
- Cranial Nerve XII (Hypoglossal):
- Tongue Movement Test: Assesses tongue movement and strength.
NOTE:
1. Cranial Nerve I - Olfactory Nerve (Smell):
- Abnormality: Anosmia - Loss of sense of smell, which can result from various conditions such as nasal trauma, sinus infections, or neurological disorders.
2. Cranial Nerve II - Optic Nerve (Vision):
- Abnormality: Visual Field Defects - Loss of vision in specific areas of the visual field, which can occur due to conditions like glaucoma, optic neuritis, or stroke.
3. Cranial Nerves III, IV, VI - Oculomotor, Trochlear, Abducens (Eye Movements):
- Abnormality: Diplopia - Double vision, often caused by weakness or paralysis of the extraocular muscles due to conditions like cranial nerve palsies or muscle disorders.
4. Cranial Nerve V - Trigeminal Nerve (Sensation of Face and Jaw Movement):
- Abnormality: Trigeminal Neuralgia - Intense, stabbing facial pain along the distribution of the trigeminal nerve, typically triggered by touch or movement.
5. Cranial Nerve VII - Facial Nerve (Facial Expression and Taste):
- Abnormality: Bell's Palsy - Unilateral facial paralysis resulting in weakness or inability to control facial muscles, often due to inflammation or compression of the facial nerve.
6. Cranial Nerve VIII - Vestibulocochlear Nerve (Hearing and Balance):
- Abnormality: Sensorineural Hearing Loss - Loss of hearing due to damage to the inner ear or auditory nerve, resulting in difficulty hearing faint sounds or understanding speech.
7. Cranial Nerves IX, X - Glossopharyngeal, Vagus Nerves (Swallowing and Speech):
- Abnormality: Dysphagia - Difficulty swallowing, which can occur due to neurological disorders, stroke, or structural abnormalities in the throat or esophagus.
8. Cranial Nerve XI - Accessory Nerve (Head and Shoulder Movement):
- Abnormality: Shoulder Droop - Weakness or paralysis of the trapezius muscle, resulting in difficulty elevating the shoulder on the affected side.
9. Cranial Nerve XII - Hypoglossal Nerve (Tongue Movement):
- Abnormality: Tongue Deviation - Weakness or paralysis of the tongue muscles, causing the tongue to protrude or deviate to one side when extended.
- Snellen Eye Chart: Measures visual acuity for the optic nerve (CN II).
- Fundoscopic Examination: Evaluates the retina and optic disc for signs of pathology related to CN II.
- Corneal Reflex Test: Evaluates the integrity of CN V (trigeminal) and CN VII (facial) by stimulating the cornea and observing the blink response.
- Taste Strips: Tests taste sensation for CN VII (facial) and CN IX (glossopharyngeal).
- Rinne and Weber Tests: Assess hearing for CN VIII (vestibulocochlear).
3. Sensory System:
- Light Touch Test: Evaluates tactile sensation using cotton wool or a brush.
- Sharp/Dull Discrimination Test: Tests pain sensation using a safety pin.
- Temperature Discrimination Test: Assesses temperature sensation using warm and cold objects.
- Vibration Sensation Test (Tuning Fork): Checks vibration sense in distal extremities.
- Proprioception Test: Assesses joint position sense and awareness of limb position.
NOTE:
- Pinprick Test: Assesses pain sensation.
- Temperature Test: Evaluates temperature sensation.
- Two-Point Discrimination Test: Measures tactile discrimination and assesses touch sensation.
- Vibration Test (Rydel-Seiffer tuning fork): Evaluates proprioception
4. Motor System:
- Muscle Strength Testing (Manual Muscle Testing): Evaluates strength of major muscle groups using standardized grading.
- Muscle Tone Assessment (Modified Ashworth Scale): Determines muscle tone at rest and with passive movement.
- Coordination Tests:
- Finger-to-Nose Test: Assesses coordination and accuracy of movements.
- Heel-to-Shin Test: Evaluates coordination and smoothness of movements.
- Rapid Alternating Movements (RAM): Tests coordination and motor planning.
NOTE:
- Manual Muscle Testing (MMT): Evaluates muscle strength using a scale from 0 to 5.
- Modified Ashworth Scale: Assesses muscle tone, particularly in individuals with spasticity.
- Finger-to-Nose Test: Evaluates coordination and is sensitive to cerebellar dysfunction.
5. Reflexes:
- Deep Tendon Reflexes (DTR):
- Biceps Reflex
- Triceps Reflex
- Brachioradialis Reflex
- Patellar Reflex
- Achilles Reflex
- Superficial Reflexes:
- Plantar Reflex (Babinski Sign)
- Abdominal Reflexes
NOTES :
- Deep Tendon Reflexes (DTR):
- Biceps Reflex: Tests C5-C6 nerve roots.
- Patellar Reflex: Tests L2-L4 nerve roots.
- Plantar Reflex (Babinski Sign): Tests the integrity of the corticospinal tract and can indicate upper motor neuron lesions.
6. Gait:
- Observation of Gait: Assesses posture, rhythm, speed, and stability during walking.
- Tandem Walking Test: Assesses balance and coordination by asking the patient to walk heel-to-toe in a straight line.
-Romberg Test: Evaluates proprioception and vestibular function by assessing balance with eyes open and closed.
- Gait Speed Test: Measures the time taken to walk a specific distance to assess mobility and functional status.
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