CLINICAL CN Exam Yellow Q's Flashcards
Describe the gait in foot drop. What neurological lesion results in “foot drop”?
- High steppage gait is seen in foot drop by raising the thigh up in an exaggerated fashion whilst walking, as if climbing the stairs. For example, dragging the foots and toes, scraping of the toes across the group and uncontrolled slapping of the toes against the ground.
- Neurological lesion of the peroneal/common fibular nerve result in foot drop
Hemiplegia
- Paralysis on one side of the body
Diplegia
- paralysis of corresponding parts on both sides of the body, typically affecting the legs more severely than the arms
Paraplegia
Complete or incomplete paralysis affecting the legs and possibly also the trunk, but not the arms.
Quadriplegia
Paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso
In a patient with hemiplegia describe the difference in posture between the upper limb and lower limb. Why does this occur?
- Posture of upper limb: Abnormal posture with adduction of the shoulder, flexion in the elbow, wrist and fingers. The tone is increased. The power is weak especially on extension. The co-ordination and sensation are normal.
- Posture of lower limb: Abnormal posture with external rotation and extension. The tone of the affected leg is increased. The muscle power is weak. The sensation may be abnormal if the sensory cortex is also involved. On walking the foot tends to circumduct and rotate in a semi-circle with each step.
Outline the MRC Scale for grading muscle strength
- This is a reliable and validated scale for assessing muscle weakness out of 5.
- Each muscle is graded as follows:
0. No movement
1. Flicker is perceptible in the muscle
2. Movement only if gravity eliminated
3. Can move limb against gravity
4. Can move against gravity and some resistance exerted by examiner
5. Normal power
Define proximal myopathy. What actions would the patient have difficulty with? Which diseases is this associated with?
- Proximal myopathy: Presentation of symmetrical muscle weakness of proximal upper and/or lower limbs
- Difficult actions: Rising from chairs, climb stairs, brushing hair
- Associated diseases: Thyroid diseases, osteomalacia
If a patient had polio affecting his left leg, what signs would you expect to elicit and why?
Non-paralytic symptoms: Pain/stiffness in left leg
AND
Paralytic symptoms: Loose/floppy limbs, muscle pain, loss of reflexes, deformed limbs, severe spasms, sudden paralysis
Why? The virus attacks the nervous system LMNs (i.e. reflex loss, fasciculations, tone loss)
Define the term clonus. In what conditions might you be able to elicit clonus?
- Clonus definition: muscular spasm involving repeated, often rhythmic, contractions.
- Causes: MS, Huntington disease, damage to the spinal cord, meningitis
UMN sign
Describe a grading system for reflex response
- Reflexes are graded using a 0 to 4+ scale: o 0: Absent o 1+: Hypoactive o 2+: normal o 3+: Hyperactive, without clonus o 4+ : Hyperactive, with clonus
—2 is normal—-
What is Babinki’s sign?
- The reflex is normal in infants when the sole of the foot is firmly stroked and the hallux moves upwards whilst the remaining toes fan out
aka Extensor plantar response
What is a “superficial reflex”? Give 3 examples
- Definition: Any withdrawal reflex elicited by noxious/tactile stimulation of the skin, cornea or mucous membrane
- Examples: abdominal, cremasteric reflex, corneal
UMN lesion S/S
Atrophy: No Fasciculation: No Weakness: Yes Reflexes: increased Tone: Increase
LMN lesion S/S
Atrophy: Yes Fasciculation: Yes Weakness: Yes Reflexes: Decreased Tone: Decrease
