Neurological Exam

We recently learned to perform the neurological exam. The key is to keep it logical. There are so many different parts and tests that you have to maintain a set way of conducting the exam so that you don't omit any key components. The other issue with the neuro exam is that a lot of it is very subjective. We have to assess muscle bulk, tone, and reflexes, and I find that difficult. Only through examining many, many patients do you get an idea of the range of "normal." Everyone has a different baseline for these things.

We spent a few hours practicing on classmates, learning to get the patellar reflex and do the finger-nose-finger test for coordination. It's fun playing around with reflex hammers and tuning forks. Then that very afternoon, I had my neurology apprenticeship. I was assigned to a neurology resident at San Francisco General Hospital with a few other classmates. We each got individual patients to see. After spending some time taking a history and doing an examination, we presented our patients in a sort of "Morning Conference" fashion. Then we rounded on the patients and discussed pertinent findings. It was interesting! Doing the neuro exam was very difficult because I did things out of order, forgot important maneuvers, and didn't know how to evaluate my findings. But it's something to keep working on.