Hello and welcome everybody this is Eric Gordon with med geeks and today we are finishing up our discussion on the neurologic exam

Last week we talked about the cranial nerves and the motor exam and this week for part two we're going to be discussing reflexes and the

sensory exam.

At the end I'm going to go over the flow that I use in the emergency department and at the

end of the show we're going to be answering a couple questions.

One of them is about Nestagmus, and the other one is about right ventricular am I's.

So let's get started.

You've checked the cranial nerves, you've checked a motor exam, now we're going to check reflexes so to start I usually start with deep tendon reflexes the dtr

The key to being successful with dtr's is you have to have a relaxed and distracted patient.

If there's any tension in their body it's not going to work so well when you're

checking those reflexes. So you can have them clench their jaw, you can have them

pull their hands apart in front of their

chest.

I usually like to have them do a combination of things.

I'll usually ask them what's nine times six for whatever reason.

I can never remember what nine times six is. If your patient actually knows that the answer is 54, then I'll actually be like, no, it's actually 58. And then they're confused enough to be distracted and then I can get a good reflex exam.

When you check reflexes, you want to check them bilaterally

and you want to compare two things.

What's the threshold stimulus to get that response?

And what's the magnitude of the actual reaction.

Just a reminder on the grading, normal is 2 out of 4.

1 over 4 is considered hypoactive and 0 is absent.

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