(CPA) lower limbs exam

Question 1

what position and exposure is required for the lower limbs exam?

Answer 1

sitting at a 45-degree angle with as much of the leg exposed (i.e. thigh downwards)

Question 2

how is the tone of the lower limb assessed?

Answer 2

leg roll

leg lift

ankle clonus

Question 3

how is the leg roll assessment carried out?

Answer 3

ask patient to relax legs and go floppy

roll each leg turn by turn

Question 4

how is the leg lift assessment carried out?

Answer 4

ask patient to relax legs and go floppy

quickly lift the leg off the bed at the knee joint

(heel should remain in contact with the bed)

Question 5

how is ankle clonus assessment carried out?

Answer 5

lift the patient’s foot after asking them to flex their knee

quickly dorsiflex and partially evert the foot

Question 6

which joints of the lower limb are assessed for power in the lower limbs exam?

Answer 6

hip joint

knee joint

ankle joint

Question 7

how is power assessed at the hip joint in a lower limbs exam?

Answer 7

1) assess flexion
2) assess extension
3) assess abduction
4) assess abduction

(ask the patient to perform the action while you provide resistance)

Question 8

how is power assessed at the knee joint in a lower limbs exam?

Answer 8

1) assess flexion
2) assess extension

(ask the patient to perform the action while you provide resistance)

Question 9

how is power assessed at the ankle joint in a lower limbs exam?

Answer 9

1) assess dorsiflexion
2) assess plantarflexion
3) assess inversion
4) assess eversion

(ask the patient to perform the action while you provide resistance)

Question 10

what is the Trendelenburg test?

Answer 10

evaluate the motor loss of the hip abductors (gluteus medius and minimus) of the hip joint

Question 11

describe how a Trendelenburg test is carried out

Answer 11

ask patient to stand on both legs = both right and left pelvis should remain at same level without any tilt

ask the subject to raise one leg off the ground

pelvis should remain horizontal on one leg

(if pelvis on the unsupported, leg-lifted side drops downward = positive Trendelenberg test = loss or weakness of the motor function of the hip abductors of opposite leg)

Question 12

what does a positive Trendelenburg test mean?

Answer 12

loss or weakness of the motor function of the hip abductors of opposite leg

Question 13

which muscle group and nerve is responsible for knee extension?

Answer 13

quadriceps

femoral nerve

Question 14

which muscle group and nerve is responsible for knee flexion?

Answer 14

hamstrings

sciatic nerve

Question 15

which nerve enables dorsiflexion?

Answer 15

deep fibular nerve

Question 16

which nerve enables plantarflexion?

Answer 16

tibial nerve

Question 17

at which joint does ankle eversion and inversion take place?

Answer 17

subtalar joint

Question 18

which reflexes are elicited as part of the lower limbs exam?

Answer 18

patellar tendon reflex

ankle-jerk reflex

Question 19

describe how the patellar tendon reflex is elicited

Answer 19

ensure that the patient’s legs are hanging freely over the side of the bed and is
completely relaxed

tap the patellar tendon w the hammer

Question 20

describe how the calcaneal tendon reflex (ankle jerk) is elicited

Answer 20

support the leg such that their hip is slightly abducted, the knee Is flexed, and
the ankle is dorsiflexed

tap the Achilles tendon w the tendon hammer

Question 21

which spinal levels are linked to the patellar tendon reflex?

Answer 21

L3-L4

Question 22

which spinal levels are linked to the calcaneal tendon reflex?

Answer 22

S1-S2

Question 23

how can difficult reflexes be reinforced and elicited?

Answer 23

instruct patient to do the Jendrassik manoeuver (clenching the teeth and
flexing both sets of fingers in a hook-like form)

Question 24

which dermatomes are assessed for sensation in the lower limb exam?

Answer 24

L1
L2
L3
L4
L5
S1
S2

Question 25

explain how sensation is assessed in a lower limb exam

Answer 25

sensation for light touch is done w a cotton ball

assess sensation on the patient’s sternum

assess sensation across each of the lower limb dermatomes, comparing left to right at equivalent regions

Question 26

where is the L1 dermatome assessed for sensation?

Answer 26

near the mid-inguinal point

Question 27

where is the L2 dermatome assessed for sensation?

Answer 27

lateral side of thigh

Question 28

where is the L3 dermatome assessed for sensation?

Answer 28

lower medial side of thigh (just above knee joint)

Question 29

where is the L4 dermatome assessed for sensation?

Answer 29

great toe

Question 30

where is the L5 dermatome assessed for sensation?

Answer 30

middle three toes

Question 31

where is the S1 dermatome assessed for sensation?

Answer 31

little toe

Question 32

where is the S2 dermatome assessed for sensation?

Answer 32

back of upper thigh