Clinical correlates of the motor exam

Question 1

UMN vs LMN

Answer 1

UMN has increased tone (spasticity), clonus, hyperreflexia, babinski sign. Finger extension, hip flexion.

LMN has atrophy, fasciculations, depressed/absent reflexes, no clonus.

Question 2

Flexor vs extensor strength in arms and legs

Answer 2

Arms = Flexor stronger
Legs = extensor stronger

Question 3

Hemiplegic gait

Answer 3

Arm held in flexion, fingers clenched, outward swinging of leg.

Question 4

Spastic Gait

Answer 4

Legs appear stiff and there is toe walking with hyperreflexia

Question 5

Frontal gait

Answer 5

Seen in normal pressure hydrocephalus.

Question 6

ALS

Answer 6

Anterior horn cell motor neuron disease, has both UMN and LMN abnormalities. Intact bowel/bladder

Question 7

Primary lateral sclerosis

Answer 7

UMN disease, slowly progressive spastic quadriparesis. Onset after age 40.

Question 8

Riluzole for ALS

Answer 8

Prolongs survival probably about 2-3 months. Costs so much.

Question 9

Cervical spondylosis

Answer 9

Compression of spinal cord. No involvement above foramen magnum but UMN and LMN signs. Have wasting 1st dorsal interosseus muscle. C8-T1

Question 10

Guillain Barre Syndrome

Answer 10

Rapidly progressive paralysis, commonly ascending, often following infection. Facial weakness, breathing difficulty. IMPORTANT: Increased CSF protein without increased cells. Medical emergency.

Question 11

Miller Fisher Syndrome

Answer 11

Opthalmoplegia, ataxia, areflexia.

Question 12

Steppage gait

Answer 12

Foot drop, hyporeflexia. LMN

Question 13

Myasthenia Gravis

Answer 13

Most common disorder of the NMJ. Antibodies attack the nACh receptor and reduce its numbers. Symptoms are fluctuating, and muscles are fatiguable.

Question 14

Myotonia

Answer 14

Disorder of muscle membranes

Question 15

Botulism

Answer 15

Toxin produced by C. botulinum prevents ACh release. Flaccid paralysis. Starts in muscles of face then spreads to limbs. Respiratory failure follows.