How to do a 4-Minute Neurologic Exam | Merck Manual Professional Version


[music] The fundamentals of the neurological exam can be completed in about four minutes yet still detect deficits in any of the major components. Normal findings are reassuring. Abnormal findings should trigger a more detailed examine that component. To maximize efficiency, components may be done out of the standard sequence. Careful wording of commands and demonstration by the examiner as commands are given speed the exam and minimize difficulties due to deficits in hearing, cognition, and language comprehension. Examiner: Just look at my nose. How many fingers? Patient: Four. Examiner: Good. How many now? Patient: Two. Examiner: Good. Just keep looking at me for a minute. I’m going to shine my light in your eyes. Great. Stay with me. Good. Now watch the light and just follow it as it moves. And down, and up. Very good. Look at me again. Show me a big smile. Stick your tongue out. Very good. Shrug your shoulders up. Great. Good. Now, I’m going to whisper number in your ear, you just tell me the number. Patient: Six. Examiner: Very good. Patient: Four. Examiner: Very good. Arms out in front, palms to the ceiling, close your eyes please. Good, you can open your eyes. Give me a hard squeeze, really good. Alright, great. Arms up, don’t let me pull you down Be strong. Strong on the side. Good, now push me away. Good, push me away. Very good. Nice and relaxed for a minute. Real loose, real loose. Good. Take this hand and tap very fast. Good. The other one.Very fast. Good. Take that finger and touch your nose and then touch my finger go back and forth and back and forth.Good, with the other hand do the same. Very good, excellent. Alright now hold onto the stretcher. Hike your knee up to my hand, keep it up, strong. Good, bring this one up. Be strong, good. Alright, push me away, great. Push me away, very good. Bring your foot up, pop your toes up toward your head, don’t let me push you down. Be strong, very good. On the other side, strong. Hold them up, very good. Alright, so what I’m going to want to do is I’m going to hold your foot up, I want you to put your heel on your knee and make a straight line down your shin. Very good, excellent. Do the same thing with that one. Great. Now, I have to scratch the bottom of your foot. Patient: Ok. Examiner: It’s annoying, sorry. Patient: That is. [laughs] Examiner: Yeah, alright, there you go. Ok, very good. Now I just want to see how you feel things, alright? So I have a piece of cotton here and I’m going to take that piece of cotton, just tell me are they about the same? Roughly? Patient: Yes. Examiner: How about here and here, roughly the same? Patient: Same. Examiner: Here, here, and here, roughly the same? Patient: The same. Examiner: Ok, now this will be a little bit sharp. Patient: Ok. Examiner: Is that sharp? Roughly the same? Patient: Yes. Examiner: Good. Here, roughly, the same? Here, roughly the same? Patient: Yes. Examiner: Very good, I have a tuning fork, it makes vibration. Buzz. And buzz. About the same? Patient: Same. Examiner: Good, and here and here, roughly the same? Patient: The same. Examiner: Good, now I’m going to touch your right hand, your left hand, or both. You just tell me what. Patient: Ok. Examiner: Eyes closed. What did I touch? Patient: Both. Examiner: Very good. You can open your eyes. I’m going to just tap you here. I want you to be nice and relaxed. Patient: Ok. Examiner: Nice and relaxed, that’s great, just like you’re doing. Perfect. Nice and relaxed. Good. Alright, very good. Can you come on down and just stand. Alright, now bring your heels together like a soldier at attention. Eyes closed. Don’t let me push you over. Very good, you can open your eyes. Can you just walk over about five feet. Good and come on back. Good, a couple times fast as if you’re trying to catch the bus. Back and forth, back and forth, good. Stop. Alright stop, walk backwards, stop. Come forward one foot in front of the other heel touching your toe. Great. Have a seat back up here. I need to ask you a few questions just to check on your thinking and then we’re all done. Patient: Ok. Examiner: So what day is it today? Patient: Today is Monday. Examiner: Great and how about the date? Patient: It is June 7th. Examiner: Really good, and what year? Patient: 2015 Examiner: Good, I’ll spot you a day, that’s alright. Who’s our President? Patient: Obama. Examiner: And what’s going on in the news ? Any topic you want. Patient: What’s going on in the news… umm, the basketball playoffs are going on. Examiner: Okay, very good. Can you put your right pointing finger on your left ear? Can you do that for me? Good, you can bring it down. How much is 20 multiplied by 30? Im saying 20 x 30. Patient: 600. Examiner: Very good. There’s an old saying that goes, “don’t put all your eggs in one basket.” What is the point of that? Patient: Umm, don’t put everything, you might lose the chance to do something different. Examiner: Very good. One of these things? Patient: They’re glasses. Examiner: What part of the glasses do I actually look through? Patient: The lenses. Examiner: Very good. Say after me: no, ifs, ands, or buts. Patient: No ifs, ands ,or buts. Examiner: Apple, pear, and peach. What are they? Patient: fruits Examiner: Bed, table, and chair. Patient: Furniture. Examiner: Excellent, good. Thank you very much. Patient: Ok.

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