2014预防-病史采集及神经系统检查重点.pptVIP

Test Extraocular Movements Stand or sit 3 to 6 feet in front of the patient. Ask the patient to follow your finger with their eyes without moving their head. Check gaze in the six cardinal directions using a cross or H pattern. Pause during upward and lateral gaze to check for nystagmus. [6] Check convergence by moving your finger toward the bridge of the patients nose. Test Pupillary Reactions to Light Dim the room lights as necessary. Ask the patient to look into the distance. Shine a bright light obliquely into each pupil in turn. Look for both the direct (same eye) and consensual (other eye) reactions. Record pupil size in mm and any asymmetry or irregularity Test Temporal and Masseter Muscle Strength Ask patient to both open their mouth and clench their teeth. Palpate the temporal and massetter muscles as they do this Test the Three Divisions for Pain Sensation Explain what you intend to do. Use a suitable sharp object to test the forehead, cheeks, and jaw on both sides. [7] Substitute a blunt object occasionally and ask the patient to report sharp or dull Test the Corneal Reflex ++ Ask the patient to look up and away. From the other side, touch the cornea lightly with a fine wisp of cotton. Look for the normal blink reaction of both eyes. Repeat on the other side. Watch and palpate the sternomastoid muscle on the opposite side Pain Use a suitable sharp object to test sharp or dull sensation. [7] Test the following areas: Shoulders (C4) Inner and outer aspects of the forearms (C6 and T1) Thumbs and little fingers (C6 and C8) Front of both thighs (L2) Medial and lateral aspect of both calves (L4 and L5) Little toes (S1) Temperature Often omitted if pain sensation is normal. ++ Use a tuning fork heated or cooled by water and ask the patient to identify hot or cold. Test the following areas: Shoulders (C4) Inner and outer aspects of the forearms (C6 and T1) Thumbs and little fingers (C6 and C8) Front of both thighs (L2) Me