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1、Preparing the patient and the physician 1Six basic tools nThereflexhammernThe256hertztuningforknTheophthalmoscopenVisualacuitycardnAlargeQ-tipnSoap2The reflex hammer3The 256 hertz tuning fork nthe512isbetterforauditoryevaluationnthe126isoptimalforvibratoryexaminationnthe256hertzforkisadequateforanin
2、itialexaminationofbothmodalities4Visual acuity cardnHandheldcardSnellen chart 5Q-tips6nGeneralAppearancenMentalStatusExaminationnTestingCranialNervesnSensationExaminationnMotorExaminationnDeepTendonReflexesExaminationnCoordinationExamination7General Appearance nLevelofconsciousnessnPersonalHygienean
3、dDressnPostureandMotorActivitynHeight,BuildandWeightnVitalSigns8vital sign acquisition 9Mental Status Examination 10Examination of the Cranial Nerves nI-SmellnII-Visualacuity,visualfieldsandocularfundinII,III-PupillaryreactionsnIII,IV,VI-Extra-ocularmovements,includingopeningoftheeyesnV-Facialsensat
4、ion,movementsofthejaw,andcornealreflexesnVII-FacialmovementsandgustationnVIII-HearingandbalancenIX,X-Swallowing,elevationofthepalate,gagreflexandgustationnV,VII,X,XII-VoiceandspeechnXI-ShruggingtheshouldersandturningtheheadnXII-Movementandprotrusionoftongue11Cranial Nerve I 12Cranial Nerve II 13Norm
5、al findings14Pathology found on opthalmologic examination 1nPapilledemanOpticAtrophy15Pathology found on opthalmologic examination 2nCentralRetinalArteryOcclusionnCentralRetinalVeinOcclusion16Pathology found on opthalmologic examination 3nProliferativeDiabeticRetinopathynCytomegalovirusRetinitis17Cr
6、anial Nerves II and III 18Cranial Nerves III,IV and VI 19 nRightCN3LesionnleftCN6lesion20CN3 palsynRightCN3Lesion21CN6 palsyleft CN6 lesion 22Horners sign23Adies pupilnRecoveredabilitytofocusupclose24Cranial Nerve V 25Cranial Nerve V26Cranial Nerve VII 27Cranial Nerve VII28 Cranial Nerve VIInCentral
7、paralysisnRightcentralCN7dysfunction29Cranial Nerve VIInPeripheralparalysisnLeftperipheralCN7dysfunction30Jaw Jerk 31Cranial Nerve VIII32Cranial Nerves IX and X 33nnormalnLeftCN9Dysfunction34Cranial Nerve XI 35Cranial Nerve XII 36 Cranial Nerve XIIntonguedeviationnLeftCN12DysfunctionLower Motor Neur
8、on Syndrome37Dysarthria nPa：CN7nKa：CN10nLa：CN1238The Motor System Examination nbodypositioningninvoluntarymovementsntheappearanceormuscularityofthemuscle(wasted,highlydeveloped,normal).nmuscletonenmusclestrength.39AppearancenWingingofscapula40muscle strengthnParesis：weakness,partiallossofmovement,or
9、impairedmovement.nParalysis(-Plegia)：completelossofmusclefunctionforoneormoremusclegroups41 The major muscle groupsnThedeltoidmusclenC5ntheaxillarynerve42The major muscle groupsShoulder Abduction 43 The major muscle groupsnShoulderAdductionnC5thruT1nthePectoralisMajorntheLatissiumus44 nPronator45 nT
10、hebicepsmusclenC5andC6nthemusculocutaneousnervenElbowFlexion46 nThetricepsmusclenC6andC7ntheradialnervenElbowExtension47 nThewristextensorsnC6andC7ntheradialnervenWristflexionnC7,8,T1ntheMedianandUlnarNerves48 nFingerflexionnC8nthemediannerve49 nFingerabductionnT1ntheulnarnerve50Finger adduction 51
11、nThumboppositionnC8andT1nthemediannerve52 nHipflexionnL2andL3nthefemoralnerve53 nAdductionofthehipnL2,L3andL454 nHipAbductionnL4,L5andS155 nHipextensionnL4andL5ntheglutealnerve56 nKneeextensionnL3andL4nthefemoralnerve57 nKneeflexionnL5andS1nthesciaticnerve58 nAnkledorsiflexionnL4andL5ntheperonealner
12、ve59nAnkleplantarflexionnS1andS2nthetibialnerve60 nmovethelargetoeuptowardsthepatientsfacenL561The Sensory System Examination nPainsensation(pinprick)nLighttouchsensation(brush)nPositionsensenStereognosianGraphesthesianExtinction.62 Pain and Light Touch Sensation 63The corresponding nerve root for e
13、ach area n1.posterioraspectoftheshoulders(C4)2.lateralaspectoftheupperarms(C5)3.medialaspectofthelowerarms(T1)4.tipofthethumb(C6)5.tipofthemiddlefinger(C7)6.tipofthepinkyfinger(C8)7.thorax,nipplelevel(T5)8.thorax,umbilicallevel(T10)9.upperpartoftheupperleg(L2)10.lower-medialpartoftheupperleg(L3)11.m
14、ediallowerleg(L4)12.laterallowerleg(L5)13.soleoffoot(S1)64 nPositionSense65nvibratorysensation66 nStereognosia67 nGraphesthesia68 nExtinction69Deep Tendon Reflexes4+Very brisk,hyperreflexive,with clonus 3+Brisker or more reflexive than normally 2+Normal 1+Low normal,diminished 0 No response 70 Deep
15、Tendon Reflexes nThebicepsandbrachioradialisreflexesnC5andC671 nThetricepsreflexnC6andC7,predominantlybyC772 nTheBrachioradialisReflex73 nThekneejerkreflexnL3andL4,mainlyL474 nTheanklejerkreflexnS175Ankle clonus 76Patella clonus 77Hoffman response78Abdorminal reflex79Cremasteric reflex nL1andL280 Ba
16、binskis sign 81Chaddocks reflex nTheplantarreflex(Chaddock)82Oppenheim sign 83Gordensign 84Primitive reflex nGlabellarreflexnPalmomentalreflexnSucklingreflexnSnoutingreflexnGraspreflex85 CoordinationnRapidlyAlternatingMovementEvaluation86 Coordinationnfinger-to-nosetestnheel-knee-tibiatest87tandem g
17、ait 88tandem gait89 CoordinationnRombergTest90Meningeal irritation nneckstiffness91Meningeal irritationnKernigstestLasegues Test 92Meningeal irritationnBrudzinskistest93GaitnParkinsons94 nrisingfromthesittingposition95The Examination of a Comatose or Stuporous Patient Glascow Coma Scale I.Motor Resp
18、onse 6-Obeys commands fully 5-Localizes to noxious stimuli 4-Withdraws from noxious stimuli 3-Abnormal flexion,i.e.decorticate posturing 2-Extensor response,i.e.decerebrate posturing 1-No responseII.Verbal Response 5-Alert and Oriented 4-Confused,yet coherent,speech 3-Inappropriate words,and jarbled phrases consisting of words 2-Incomprehensible sounds 1-No soundsIII.Eye Opening 4-Spontaneous eye opening 3-Eyes open to speech 2-Eyes open to pain 1-No eye openingGlascow Coma Scale=I+II+III.A lower score indicates a deeper coma and a poorer prognosis.96Thank you!97