After proper handwashing, introduce yourself, explain the procedure, and gain consent.

Then begin the neurologic examination starting with the Mental Status Examination which consists of five
components: (MURAG GA TINAN.AWAY RA TA ANI NA PART FROM # 1-4)

1. First is the appearance and behaviour. This is where you integrate the observations you have
made throughout the history and physical examination, including the following:
- level of consciousness,
- Posture and Motor Behavior,
- Dress, Grooming, and Personal Hygiene
- Facial Expression
- Manner, Affect, and Relationship to People and Things

2. Then for speech and language

- Note the following characteristics of the patient’s speech such as the quantity, rate, volume,
articulation of words, and fluency

3. Next is mood
- Ask the patient to describe his or her mood, including usual mood level and fluctuations
related to life events.

4. thoughts and perceptions

- this includes thought processes, thought content, perceptions, insight, and judgement

5. and lastly, cognitive functions and as well as higher cognitive functions. For cognitive
functions:first, assess the patients orientation.
- You can usually assess ORIENTATION during the interview. You can ask the patient’s name,
time of day, day of the week, month, season, date and year, duration of hospitalization, the
patient’s residence, the names of the hospital, city, and state
- Then test for the patient’s ATTENTION by asking the patient to spell backward. Say a five-
letter word, spell it, for example, W-O-R-L-D, and ask the patient to spell it backward.
- Also asses the patient’s remote and recent memory.
- Assess for new learning ability. Give the patient three or four words, Ask the patient to repeat
them so that you know that the information has been heard and registered. Then After 3 to 5
minutes, ask the patient to repeat those words.
-
6. Then for higher cognitive functions this involves the patient’s
- Information and Vocabulary
- Calculating Ability
- Abstract Thinking
- Constructional Ability. For constructional ability, The task here is to copy figures of
increasing complexity onto a piece of blank unlined paper. Show each figure one at a time
and ask the patient to copy it as well as possible. In another approach, ask the patient to
draw a clock face complete with numbers and hands . (finally ga lihok nata ani)

CRANIAL NERVES

CN I is your olfactory nerve.

- Test the sense of smell by presenting the patient with familiar nonirritating odors. Then ask
the patient to close both eyes. Occlude one nostril and test smell in the other with substances
 like cloves, coffee, soap, or vanilla. Ask the patient to identify each odor. Then also Test
smell on the other side.

CN II is your optic nerve.

- Here we test for the patient’s visual acuity by using a Snellen chart. Stand the patient at 6
metres from the Snellen chart. Ask the patient to cover one eye and read the lowest line
they are able to.Record the lowest line the patient was able to read (e.g. 6/6 (metric) which is
equivalent to 20/20 (imperial)). Test each eye separately, and both eyes together.
- Then ask the patient to read a paragraph to assess near vision. (kato ni basa tas menu)
- Then test for pupillary light reflex. Dim the lights in the assessment room to allow you to
assess pupillary reflexes effectively. (katong ga penlight2 ta I butang ra tanan hahahhahaa
or kato nlng naka dim na ang lights)
- Then assess the visual fields. Ask the patient to cover one eye with their hand. If the patient
covers their right eye, you should cover your left eye (ang patient ra nag cover sa eyes sa
atong vid pero bahala na) Assess the patient’s peripheral visual field by comparing to your
own and using the target. Start from the periphery and slowly move the target towards the
centre, asking the patient to report when they first see it. If you are able to see the target but
the patient cannot, this would suggest the patient has a reduced visual field.

Cranial Nerves III, IV, and VI—Oculomotor, Trochlear, and Abducens.

- Test the extraocular movements in the six cardinal directions of gaze, and look for loss of
conjugate movements in any of the six directions, which causes diplopia. (Insert video nga ga
pandago sa ilaw ta sa penlight pero katong wala ta ga cover sa one eye)
- Check convergence of the eyes. (kato ipa duol ang penlight nga malibat ta)
- (For more yawyaw) Identify any nystagmus. Note the direction of gaze in which it appears,
the plane of the nystagmus (horizontal, vertical, rotary, or mixed), and the direction of the
quick and slow components.

Cranial nerve V trigeminal.

- For the motor division: Palpate the temporal and masseter muscles then ask the patient to
firmly clench the teeth. Note the strength of muscle contraction.
- For sensory: test the forehead, cheeks, and chin on each side for pain sensation. With the
patient’s eye closed, Use a suitable sharp object such as a pin or cotton swab. Ask the
patient to report whether each stimulus is “sharp” or “dull” and to compare sides.
- To test for Corneal reflex: Ask the patient to look up and away from you. Avoiding the
eyelashes, lightly touch the cornea with a fine wisp of cotton. Inspect for blinking of both eyes
which is the normal reaction to this stimulus.

Cranial Nerve VII—Facial.

- Ask the patient to: (copy paste ras bates check ra video if same order)

1. Raise both eyebrows.

2. Frown.
3. Close both eyes tightly so that you can
not open them. Test muscular strength
by trying to open them, as illustrated in
Figure 17-13.
4. Show both upper and lower teeth.
5. Smile.
6. Puff out both cheek

Cranial Nerve VIII—Acoustic and Vestibular.

- Test for air and bone conduction, using the Rinne test, and lateralization, using the Weber
test.
Cranial Nerves IX and X—Glossopharyngeal and Vagus
- Ask the patient to say “ah” or to yawn as you watch the movements of the soft palate and the
pharynx.
- Warn the patient that you are going to test the gag reflex. This reflex consists of elevation of
the tongue and soft palate and constriction of the pharyngeal muscles. Stimulate the back of
the throat lightly on each side in turn and observe the gag reflflex.
Cranial Nerve XI—Spinal Accessory.
- look for atrophy or fasciculations in the trapezius muscles, and compare one side with
the other.
- Ask the patient to shrug both shoulders upward against your hands. Note the strength and
contraction of the trapezii.
- Then, Ask the patient to turn his or her head to each side against your hand. Observe the
contraction of the opposite sternocleidomastoid (SCM) muscle and note the force of the
movement against your hand.

Cranial Nerve XII—Hypoglossal.

- with the patient’s tongue protruded, look for asymmetry, atrophy, or deviation from the
midline. Ask the patient to move the tongue from side to side, and note the symmetry of the
movement