The Nonspecific Neurological Exam

This is a hot case where the candidate is led to a random patient, and asked to "examine their neurological system".

The key to success is to look like you've done it before. Therefore, the candidate is expected to produce a series of smooth dance steps.

A suggestion made by an ex-examiner is as follows:

  • Start by asking whether there is a language barrier.
  • Observe the respiratory pattern.
  • Start with the GCS. In the completely unconscious patient, you should ask before inflicting pain.
  • Next, ask whether anything precludes you from moving the neck.  Check for neck stiffness.
  • Then, start with the cranial nerves.
    • CN II and III: pupillary reflex
    • CN III and V: corneal reflex
    • CN III, IV, VI: note any gaze deviation
    • CN VII:  painful stimulus over the orbit
    • CN VII: oculocephalic or caloric reflex
    • CN IX and X: gag reflex, cough reflex
    • CN XII, tongue fasciculation
  • Then, go on to examining the rest of the neurological system:
    • Observe the exposed patient
    • Tone
    • Power (may have to inflict pain again)
    • Reflexes
    • Clonus
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