Jai ganesha

№1
1. Check Babinski’s asynergy.
2. Examine anisocoria, miosis, mydriasis.
3. Examine sense of discrimination.
4. Methods of distinguishing different types of agnosia.

Variant-1
1. Check Babinski’s asynergy.
Patient lying on his back with folded arms is unable to get out of bed without
raising his legs
Static ataxia / synergy test
running shark instrument along the lateral border of the forefoot from the
calcaneuos produces extension of the big toe and fanning of the legs.. if it’s up it’s
negative effect.. if it’s down positive reflex.

2. Examine anisocoria, miosis, mydriasis.

anisocoria - (irregularity in pupil) : external eye structure Examination of
pupil size in dark and light ..
miosis-(narrowing of pupil):light reflex poor in one eye .. .
Mydriasis (dilation of pupil) -inspection of fundus and lens using mydriatic
eye drops to dilate or enlarge pupil

3.Examine sense of discrimination..

It is done by weber’s compress. Pricking with needles with 1-2 mm distance
Back 6 mm patient should say 2 pricks
Finger tips,tongue,back(least) (mm or cm)
Slowly move 2 needles frm a distance to each other and u will both needles
until 1-2 mm bcz at 1-2 mm it will be like there is 1 needle .
3 tactile discrimination to understand sense of touch with skin prick and cotton
rubbin and pricking the skin surface simultaneously

4.methods of distinguishing different types of agnosia.

Agnosia:a loss of ability to recognize familiar objects,sound,smell etc
Autotopagnosia: patient doesnt recognize own body part (eg, the head or leg is too
long or short or may be detached frm body)
Anosognosia : denied of ones own disease (eg, a paralitic patient says he doesent
have paralysis so he says that he is not moving willingly
Visual: lesion of occipital
Auditory,olfactory,gustotary: bilataral of temporal lobe Tactile: lesion of
sup.parietal lobe
4 Inpaired sensory cognition. Visual , tactile,auditory
№2
1. Examine pupillary reactions to light (reflexes).
2. Define muscle strength in legs.
3. Find sensory disturbance of conductive type.
4. Examine extrapyramidal hyperkineses.

Variant 2
1. Examine pupillary reactions to light (reflexes).
2 type : direct and indirect
Direct: we will cover one eye of patient and will show light on other eye & see
pupil dilation and construction
Indirect: will separate 2 eyes by a medium , then pass light in one eye and see
the reaction in another ,if reaction of both eyes are same then there is no
abnormality ,if there will be light,pupil constrict and pupil dilates
1)Have the patient look at a distant object
Look at size, shape and symmetry of pupils.
Shine a light into each eye and observe constriction of pupil.
Flash a light on one pupil and watch it contract briskly.
Flash the light again and watch the opposite pupil constrict (consensual reflex).
Repeat this procedure on the opposite eye.
Normal:
Pupils are subtle, mild anisocoria (unequal in size) by itself and not necessarily an
abnormal findings.
Pupil size is 3-5 mm in diameter.
They react briskly to light.
Both pupils constrict consensually.
Anisocoria:Irregularity of pupil
Miosis:Pupilconstriction
Mydriasis:Pupildialation

2. Define muscle strength in legs.

Barres low test : say the patient to lie on abdomen & say him to raise his both
legs from knee & tell them to hold for 10-15 sec.
The leg on the affected side drops before the normal side.
Lesion on corticomuscular tract
2)Muscular strength is determined by how much force you can exert or how much
weight you can lift.
Barrets Test:(5points)
4-slight paresis(slight abnormality is seen in R/L)
3-moderate paresis(cannot raise his leg for long time &can't perform movements in
raised position)
2-profound paresis(cannot lift but can make movements)
1-only movement of toes and fingers
0-paralysis(complete absence)
3. Find sensory disturbance of conductive type.
2 type
i. Conductive spinal type (paresthesia) :no sensation below the lesion of
spinal cord fibers
ii. Conductive cerebral type (hemiesthesia): no sensation in opposite half of
the body due to lesion of cerebral fiber
3)conductive type includes:
cerebral
Spinal cord
Thalamic
Dorsal funiculus
Lateral funiculus
Cortical
Capsular

4. Examine extrapyramidal hyperkineses.(increase movement)

Spontaneous, irregular ,purposeless, asymmetric involuntary movement
can be checked by muscle hypotonia
move patients Hand as you want if there is increased movement then there is
hypotonia
lesson on striatum

Extrapyramidal movement disorders comprise hypokinetic-rigid and hyperkinetic

or mixed forms, most of them originating from dysfunction of the basal ganglia
(BG)
The classification of hyperkinetic forms distinguishes the following: (1) chorea
(dancing like movements)and related syndromes;
(2) dystonias (dyskinesias);
(3) tics (rapid involuntary movemrnts)and tourette disorders;
(4) ballism;
(5) myoclonic (jerking movements)and startle disorders; and
(6) tremor(4-6seconds) syndromes.
7)Athetosis(snake like movements )

№3
1. Examine the function of CN II.
2. Check pathological oral reflexes.
3. Find sensory disturbance of polyneuritic type.
4. Check the Ganev-Noik’s test.

Variant 3
1 Examine the function of CN II.(optic nerve)
Check by visual field: patient and doctor sit in front ,doctor slowly move a
white object from periphery to centre in horizontal and vertical direction
Visual acuity: by snails chat (5m from patient)
Color vision (with special color glasses): standard definition of colors Red
blue green white
Ans-:The cranial nerve exam is a type of neurological examination. It is used to
identify problems with the cranial nerves by physical examination. It has nine
components. Each test is designed to assess the status of one or more of the twelve
cranial nerves (I-XII). These components correspond to testing the sense of smell
(I), visual fields and acuity (II)
*One component of the examination (III) uses the pupillary light reflex to assess
the status of the oculomotor nerve.

2. Check pathological oral reflexes.

Lesion on corticonuclear pyramidal tract
i. Bechterew's lip reflex: lip Rolls up into a tube after percussing with
hammer
ii. Nasolabial reflex : lips rolls up into a tube ,while percussing with hammer
on nose
iii. palmomental reflex : constriction of mental muscle (lower lip) when the
back side of hammer is rub on thenar imminance
iv. Distant oral : lips rolls into a tube when approaching hammer to mouth
Ans-The suck reflex is elicited by lightly touching or tapping on the lips with an
object such as a tongue blade, reflex hammer, or the examiner's finger. At times
the reflex is obtained merely by approaching the lips with an object. The snout
reflex is brought about by tapping the upper lip lightly.
*SNOUT REFLEX*-The Snout reflex (also orbicularis oris reflex[1]) or a "Pout"
is a pouting or pursing of the lips that is elicited by light tapping of the closed lips
near the midline. The contraction of the muscles causes the mouth to resemble a
snout.

This reflex is tested in a neurological exam and if present, is a sign of brain

damage or dysfunction. Along with the "suck", palmomental reflexes and other
reflexes, snout is considered a frontal release sign. These reflexes are normally
inhibited by frontal lobe activity in the brain, but can be "released" from inhibition
if the frontal lobes are damaged. They are normally present in infancy, however,
and until about one year of age, leading to the hypothesis that they are primitive or
archaic reflexes

3. Find sensory disturbance of polyneuritic type.

Sock and gloves type
Multiple injury of peripheral nerve of extremities
Doctor pricks on forearm and palm of same hand
Pricks sensation will be present in forearm and absent / decrease in palm.
Ans-Polyneuropathy is a condition in which a person’s peripheral nerves are
damaged. These are nerves that run throughout your body. Polyneuropathy affects
the nerves in your skin, muscles, and organs. When nerves are damaged, they can’t
send regular signals back to your brain. This condition does not affect the nerves in
your brain or spine, however.
TYPE-There are two major categories of polyneuropathy: acute and chronic
*ACUTE POLYNEUROPATHY
-Acute forms happen when you get the condition suddenly and the symptoms are
severe. This type is common when you have an autoimmune reaction or infection
causing the nerve damage. A disorder like Guillain-Barré syndrome may be the
cause. Acute cases can often be treated successfully in a short time.
*CHRONIC POLYNEUROPATHY
- Chronic forms happen when your symptoms last a long time and can’t be treated
quickly. This type can be caused by underlying conditions, such as diabetes or
kidney failure. There can be many different causes of chronic polyneuropathy. It’s
not always easy to figure out the cause, and some cases have no clear cause

*4. Check the Ganev-Noik’s test.

Ans- To test for parkinson sign- hyperkinetic and hypokinetic
- dr move patient hand clockwise direction and ask to patient to raise leg of
the same direction
Physiological - no changes in hand movement
Pathological - cogwheel movement is seen

№4
1. Examine the function of CN IV.
2. Reflexes of Gordon, Sheffer, Pussep.
3. Find sensory disturbance of segmental type.
4. Check Brudzinsky symptoms.

Variant 4
1. Examine the function of CN IV. (trochlear nerve)
M. Superior oblique (for looking downward and outward)
Doctor moves the hammer or object and ask the patient to follow the
movement of hammer (H ,X, I)
Patient complaints about double vision (stopped diplopa) on looking
downward.
And you can observe some restrictions while patient moves eyes downward.
The trochlear nerve (CN IV) is a paired cranial nerve that is responsible for
innervating the superior oblique muscle. As a result, it causes the eyeball to move
downward and inward. The nucleus of CN IV is located in the periaqueductal grey
matter of the inferior part of the midbrain.
Cranial nerve IV acts as a pulley to move the eyes down—toward the tip of the
nose.
To assess the trochlear nerve, instruct the patient to follow your finger while you
move it down toward his nose.

2. Reflexes of Gordon, Sheffer, Pussep.

*Gordon reflex*: squeeze gastro enemies muscle (shin) Known as paradoxical
flexor reflex
A normal (negative) response is no reaction at the toes • An abnormal (positive)
response is an ipsilateral extensor plantar reflex - extension of the hallux with
fanning of the other toes
**Sheffer's Reflex ** :is a clinical sign in which squeezing the Achilles tendon
elicits an extensor plantar reflex. It is found in patients with pyramidal tract lesions,
and is one of a number of Babinski-like responses
*Puusepp reflex* - pass the sharp end of hammer along the external border of
foot .
light stroking of the outer sole of the foot causes slow abduction of the fifth toe.

3. Find sensory disturbance of segmental type.

Affection of spinal cord (superficial sensation)
Dissociative disorders : pain and temp. Sensation absent . deep sensation
present (pressure,vibration, weight, articulomascular kinesthetive)
redicular=no sensation

Dissociative disorders are mental disorders that involve experiencing a

disconnection and lack of continuity between thoughts, memories, surroundings,
actions and identity.

4. Check Brudzinsky symptoms.

(for meningeal syndromes)
3 types:
Ask patient to lie on back
A. Do rigidity of occipital muscle test,if while doing this ,flexion of knees and
cocxal joint is seen , then positive upper brudzinsky symptoms
B. Press on the region of pubic symphisis,there will be flexion of knee and
cocxal joint ,if positive than middle brudzinsky synptom
C. While verifying kernings sign (flex the leg at right angle from knee then
extend the leg ) see the opposite legs knee and cocxal joint flexes .this is
lower brudzkinsky symptom.
Step 1. Patient in supine position

Step 2. Gently grasp the patient's head from behind and place the other hand on the
patient's chest

Step 3. Gently flex the neck, bringing chin to chest

Step 4. Positive sign is involuntary flexing of hips and knees (an involuntary
reaction to lessen the stretch on the inflamed meninges)

№5
1. Examine the function of CN XII. (hypoglossal nerve - motor nerve)
2. Check articulomuscular sensitivity on hands.
3. Find symptoms of extrapyramidal rigidity.
4. Pain symptoms of Laseg, Neri.

Variant . 5 :-
1.) Examine the function of CN XIl(hypoglossal nerve - motor nerve)
Ans. Ask the patient to protrude the tongue normally it should be in midline, if any
lesion then there will be deviation of tongue on the site of lesion,
also ask the patient to move and wiggle the tongue rapidly in and out and side to
side.

2.) Check articulomuscular sensitivity on hands.

Ans. Patient should be able to recognise passive movements of joints, starting from
fingers to shoulders with eyes closed. It is deep sensation
.
3.) Find symptoms of extra pyramidal rigidity(Parkinson disease). Ganev's noik
teat.
Ans. Symptoms:
Hypokinesia, rigidity, tremor, ANS disorder(hypersalivation) , psychiatry disorder,
Acheirokinesi. (Chalti vakhte hath nahi halta)

4.) Pain symptoms of Laseg(leg) , Neri(neck cervical area).

Ans. Pain in muscles of neck and leg (thigh) while doing occipital muscle rigidity
test and Kernig's signs respectively.

№6
1. Examine the function of CN XI.
2. Reflexes of Babinsky, Oppenheim, Chaddok.
3. Test of diadohokinesis.
4. Check the symptom of the “rigidity of the occipital muscles”.

Variant - 6:
1.) Examine the function of CN XI(accessory nerve).
Ans. Ask patient to:
- incline the head forward
- turn it asides
- shrug the shoulders
- raise the shoulders to horizontal line
- adduct the scapula to spinal column

2.) Reflexes of babinsky, oppenhem, cheddok.

Ans. Extension group reflexes
a) Babinsky - stimulate the skin of sole with back of hammer.
b) oppenhem - pass the fingers along tibial lines of legs.
c) cheddok - circular movement around lateral malleolus with back of hammer.

3.) Test of diadohokinesis.

Ans. Ask the patient to perform suppination and pronation of both hands rapidly
ans simultaneously while sitting.

4.) Check the symptoms of the " rigidity of occipital muscles".

Ans. Ask the patient to lie on back, passively inclines his head to touch chin to
anterior thoracic wall.

№7
1. Examine the functions of CN IX and X.
2. Check pathological flexion reflexes on feet.
3. Examine sense of localization.
4. Tests for hypermetria.

Variant-7
1. Examine the functions of CN IX and X.
1. *Glossopharyngeal and vagus (X and IX )*(mixed nerve)
(a) ask the patient to open mouth and pronounce "aaaaa….." and note the
location of uvula on midline and soft palate symmetrical
Soft - symetery , midinline - uvla
Check gag reflex

(b) to Pronounce few phrase aloud to check nasality of speech , ( nasal speech
avoid )

Ask to swollow few sips of of water should be natural

(C) few sips of H2O , swallowing should be done natural

2. Check pathological flexion reflexes on feet.

2. (i) *Rosolino Reflex* :- percussion of plantar surface 2cond and 5th toe with
hands-> flexion group .

(ii) *Zhukovskyi reflex* - Tap hammer on plantar surface 3rd and 4th- metatarasal
ossicles > flexion 2 and 5

(iii) *Bechterw* mental reflex - tap on dorsal 3,4 -metatarasal ossicles> flexion
3. Examine sense of localization.
*Complicated form of sensitive disorder -> sense of localisation*
Prick on one arm of patient with close eyes , tell him to point the exact
location with the finger of another hand
Closed eye - pin one point on one arm -> should show exact location on other hand

5. *Hypermetria* (test for dynamic ataxia )

Ask the patient to close their eyes and raise hands above the head .
Tell him to place his hands now in horizontal position towards chest.
If there is hypermetria, he will stop after some distance.
- closed eye - raised to horizontal level - arm lower to affected side .

№8
1. Examine the functions of CN VIII.
2. Check tendon reflexes on legs.
3. Check two-dimensional sensation (graphism).
4. Examine Kernig's symptom.

Variant 8
Q1)Examine function of CN VIII (vestibuloochlear)-->sensory nerve
Ans)a) Weiber’s test-Bang the tuning fork then place it on head of patient,ask if he
hears same in both ears
b) Rienne’s test-comparing air and bone conduction-bang tuning fork and place it
on mastoid process,ask patient to tell when he stops hearing,as soon as he stops
hearing place it in front of ear and note the time
-Normally air should be 2 times faster than bone conduction-note the difference
c) Schwabach’s test-tap the tuning fork handle against hand to start light
vibration,hold base of tuning fork against one side of pt mastoid process and ask if
tone is heard-comparison between patient and doctor’s bone conductivity
d) vestibular portion-rotate the patient in arm chair,patient develops ataxia,hands
constricted forwards and deviated sideways,missing aim with finger nose test and
nystagmus which disappears after sometime

Q2)Check tendon reflex on legs

Ans) a) Knee jerk-strike hammer below patella,leg extends at level of knee joint
(L3-L4)
b) Aschillis-Strike aschillis tendon with hammer stick,planter flexion occurs of
foot (reflex arch s1 - s2 ), (knee should be in right angle)

Q3) Check 2D sensation graphism

Ans)Take patients hand and ask him to close eyes,draw or write some or picture on
his palm and ask what was it

Q4) Examine Kernig’s symptoms

Ans) Flex the knee at 90degrees and then extend upwards,inability to extend
along with pain in back is kernig symptom

№9
1. Examine the functions of CN VII.
2. Check tendon reflexes on hands.
3. Check stereognosis.
4. Methods of distinguishing different types of apraxia

Variant-9
1. Examine the functions of CN VII. (Facial)
Motor
1) Raise both eyebrows upward
2) To knit the eyebrows upward
2) Frown
3) Close both eyes tightly so that you can not open them. Test muscular strength
by trying to open them
4) Show both upper and lower teeth
5) to Smile
6) Puff out both cheeks
To blow out the flame of match

Sensory : test for taste

2. Check tendon reflexes on hands.

Carporadial reflex : srike hammer on styloid process of redius ,the hand is
flexed in elbow joint (c5-c8)
Biceps reflex: srike hammer on tendon of biceps muscle, the arm will flex
(c5-c6)
Triceps reflex: srike hammer on tendon of triceps muscle, the arm will
extend (c7-c8)

Light touch
● Use the light touch of a finger, a piece of cotton wool or a piece of tissue paper.
•Ask the patient to close their eyes and tell you when they feel you touching them.
● Compare each limb in the same position.

Sharp touch (pinprick)

● Test using a dedicated disposable pin. A disposable hypodermic needle is too
sharp .
● Ask the patient to report hypoaesthesia (feels blunter) or hyperaesthesia (feels
sharper)

3. Check stereognosis.
Test stereognosis by asking the patient to close their eyes and identify the object
you place in their hand.
Place a coin or pen in their hand.
Repeat this with the other hand using a different object.
Astereognosis refers to the inability to recognize objects placed in the hand.

3. Methods of distinguishing different types of apraxia

3 type: patient cant perform action as instructed
A. Ideatory: tell him to comb hair ,how sugar is stiered in glass (with real and
imaginatory object)
B. Constructive: patient can perform actions after doctor performs it ,but
when told orally ,he is unable to do it
C. Motor: unable to perform at someones instruction or even after he is
shown how to perform it
Ideomotor- inability to carry out a motor command, limb or buccofacial
Ideational- inability to create a plan for or an idea of a specific movement
Constructional- inability to draw or construct simple configurations
Speech- impaired ability to speak
Gait- impaired coordination of leg movements

№ 10
1. Examine motor function of CN V.
2. Check the Barre test.
3. Examine complicated forms of sensitivity on hands.
4. Tests for diagnosing dynamic ataxia.

Variant-10
1. Examine motor function of CN V. (trigeminal nerve)
Put your hands on patients face between ear and mouth and laterally on side
of face
Ask him to open and close mouth
Degree of muscle tension is seen
Functions
1)sensational of face
2)Motor to muscle of mastication
3)Different arm of cornial reflex
4)Jaw jerk reflex

Test- 1)use mastication muscle to show reflex

2)Ask patient to close eye and say yes when pin touches his/her skin
3)Strike the mandible/chin part with hammer to check sensitivity

2. Check the Barre test.

4)slight paresis- slightly abnormally issues seen in right/left
3) moderate paresis-Cannot raise his leg for a long time and cannot perform
movement with it in raised position
2)profound paresis- Can not but can make movement with support
1)- Only movement of toe or finger
0-Paralysis completely absent

3. Examine complicated forms of sensitivity on hands.

Ans3) weber’compass -Pricking with needle with 1 to 2 mm distance back 6MM,
patient should say 2 pricks
Finger , tip , back
B- sence of localization- pin one point om one arm , should able to tell exactly the
other hand location
C- 2D spatial sensation graphism- complicated form of sensitivity writting letter on
skin of patient
d ) complicated form of sensitivity recognition of familar objects- closed types
Sense of discrimination, sense of localization,2D,3D

4. Tests for diagnosing dynamic ataxia.

Finger to nose test (close eyes)
Heal to knee test
adiadokinesis
4) dyanamic ataxia- lession of cerebral hemisphere
A)Finger to nose test -abduct arm aside touch nose with index finger (close eyes)
B)Heal knee shin test-Touch knee of Opposite leg with the heel of other leg over
shin downwards to ankle joint
C hypermetria
DFinger finger test- in synchronization with doctor’s finger
E) unable to write properly
F) Heal toknee test
G)adiadokinesis

№ 11
1. Examine sensory function of CN V.
2. Define muscle tone in legs.
3. Check deep forms of sensitivity on hands.
4. Methods of distinguishing different types of aphasia.

Variant - 11
Q 1) Examine sensory function or CN V (Trigeminal)

Ans) Prick at- supraorbital notch,infraorbital foramen and submandible- equal to

no pain is normal
Zeilders zone-a)lesion of upper portion of nucleus-oral bow
b)lesion it lower portion of nucleus- caudal bow
-no sensation near ear-lower nucleus lesion
-no sensation near mouth-upper n lesion

Q2) Define muscle tone in legs

Ans) determined by carrying out passive movements in joints(flexion extension)-
leg movements and tell patient to close his eyes

Q3) Check deep forms of sensitivity on hand.

Ans)a)articulo muscularis
b)Vibratory-tuning fork on wrist(16-20sec)
c)pressure-pressing a finger on body
d)Body weight-15-20grams different weights on outstretched arms
e)kinasthetic- skin fold is shifted in different direction,patient should indicate the
direction

Q4)Methods or distinguishing diff types of aphasia

Ans)a)Motor(Broca’s aphasia)-Patient understands speech but can’t speak or
improperly speaking,lost memory or articulation rules(lesion on frontal gyrus)
b)Sensory(wernike’s) aphasia-disturbance in understanding speech and loss of
control over own speech
c)Amnestic Aphasia-forgets name of subject but knows how it works-forgets name
of pen but says object with which we write
d)Sementic-speaks well but doesn’t understand shades of meaning of speech-
brother of father,father of brother__

№ 12
1. Examine the function of CN III.
2. Define muscle strength in hands.
3. Check superficial sensation on legs.
4. Tests for diagnosing static ataxia.

Variant 12
1. Examination of CN 3 (oculomotor)
Doctor moves the hammer or object and ask the patient to follow the
movement of hammer (H ,X, I)
Patient complaints about double vision (stopped diplopa) on looking
downward.
And you can observe some restrictions while patient moves eyes downward.
Ptosis (droping of eyelied ) is seen
Divergent stybusmus
A covering one eye and doing test again ,diplopia absent

General observation, determination of ptosis and examination of the pupil (size,

testing the reaction of the pupil to light, the convergence reflex). The oculomotor,
trochlear, and abducens nerves are tested together using the cardinal planes of gaze
(horizontal, vertical, and diagonal). Ocular rotations are tested by asking the
patient to turn the eyes in the six cardinal directions of gaze and by having the eyes
converge on a near point. Paralyses or weakness of a single or several ocular
muscles or of conjugate movements (movements of both eyes in the same direction)
and the presence or absence of nystagmus on conjugate deviation is observed.
Normally there is a great variation in the limits of upward and downward rotation,
but differences between the two eyes are readily recognized and are important in
the diagnosis of paralysis of single ocular muscles.

2. Define muscle strength in hands.

1) upper barre's test:- hold the hands in horizontal position while standing or sitting
2) finger constriction:- ask patient to constrict dr's fingers in cross form
3)ask the patient to restrict the extension of hand while dr. Is pulling it

3. Check superficial sensation on legs.

.ask patient to close eyes then
1.) touch /tactile:- light touch with hammer /wool/cotton/ by blunt object on both
sides nd ask the patient if it feels same on both sides.
2.) Pain:- prick by needle' sharp end on both side nd ask to say yes if it feels same
on both sides
3.) temperature:- by touching cold or warm object like cold metal rod

4. Tests for diagnosing static ataxia.

1) roemberg test :- ask patient to stand with feet close nd eyes close nd hands in
horizontal position towards chest, if pathology patient will tilt or fall on side
2)babinsky asynergy test
3)stuart holmes test :ask the patient to rises extension of his hand when you are
pulling and suddenly release your hand, if pathology patient will hit himself
4)ozbeskovsky test:- ask the patient to push ur palm and suddenly remove ur hand
If pathology patient will fall

№ 13
1. Examine the function of CN VI.
2. Examine Stuart-Holm’s test.
3. Check segmental sensitivity (according to Zelder’s zones) in the regions of the
face.
4. Check the Bernard-Horner’s sign

Variant 13
Q1) Examine function of CN VI (abducense nerve) motor
Ans)Lateral Rectus muscle-look down and upwards-move the hammer or object
and ask the patient to follow the movement of hammer-convergent strabismus
present

Q2)Examine Stuart Holme’s test

Ans)stuart holmes test :ask the patient to rises extension of his hand when you
are pulling and suddenly release your hand, if pathology patient will hit
himself

The patient is asked to resist the extension of his hand while you pull it-if
pathology-patient hits himself
Test for static ataxia

Q3)Check segmental sensitivity (Acc to zeilder zones in the region of face

Ans)Use needle to prick and then examine via zeilder zones:
Lesion or upper portion of nucleus-oral bow-no sensation near mouth
Lesion if lower portion of nucleus-caudal bow-no sensation near ear
Prick at- supraorbital notch,infraorbital foramen and submandible- equal to
no pain is normal Zeilders zone-
a) lesion of upper portion of nucleus-oral bow
b)lesion it lower portion of nucleus- caudal bow
-no sensation near ear-lower nucleus lesion
-no sensation near mouth-upper n lesion

Q4)Check Bernard Horner’s sign

Ans) lesion of m tarsalis
Ptosis- drooping of eyelids-narrowing of palpebral fissure
Miosis-narrowing of pupil
Enopthalmous- posterior displacement of eyeball within orbit cuz of changes
in orbit-paresis of smooth muscular fibres of retrobulbar fat
Lesion of sympthematic nerve

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