DTR

Question 1

Check the deep tendon reflexes in a

Answer 1

relaxed and symmetric position, since these factors can

influence reflex amplitude.

Question 2

it is important to compare each reflex

Answer 2

immediately with its contralateral counterpart so that any asymmetries can be detected.

Question 3

If you cannot elicit a reflex, you can sometimes bring it out by

Answer 3

certain reinforcement procedures. For
example, have the patient gently contract the muscle being tested by raising the limb very
slightly, or have them concentrate on forcefully contracting a different muscle group just at the
moment when the reflex is tested

Question 4

clonus is sometimes seen

Answer 4

When reflexes are very brisk, . This
is a repetitive vibratory contraction of the muscle that occurs in response to muscle and tendon
stretch.

Question 5

Deep tendon reflexes are often rated according to the following scale:

Answer 5

0: absent reflex
1+: trace, or seen only with reinforcement
2+: normal
3+: brisk
4+: nonsustained clonus (i.e., repetitive vibratory movements)
5+: sustained clonus

Question 6

Deep tendon reflexes are normal if they

Answer 6

are 1+, 2+, or 3+ unless they are asymmetric or there is a dramatic difference between the arms and the legs. Reflexes rated as 0, 4+, or 5+ are usually considered abnormal.

Question 7

In addition to clonus, other signs of hyperreflexia include

Answer 7

spreading of
reflexes to other muscles not directly being tested and crossed adduction of the opposite leg
when the medial aspect of the knee is tapped.

Question 8

Deep tendon reflexes may be

diminished by abnormalities in

Answer 8

muscles, sensory neurons, lower motor neurons, and the
neuromuscular junction; acute upper motor neuron lesions; and mechanical factors such as joint
disease.

Question 9

Abnormally increased reflexes are associated with

Answer 9

upper motor neuron lesions.
* Note
that deep tendon reflexes can be influenced by age, metabolic factors such as thyroid
dysfunction or electrolyte abnormalities, and anxiety level of the patient.

Question 10

C5, C6

Answer 10

Biceps

Question 11

C6

Answer 11

Brachioradialis

Question 12

C7

Answer 12

Triceps

Question 13

L4

Answer 13

Patellar

Question 14

S1

Answer 14

Achilles Tendon

Question 15

Pin Prick

Answer 15

Light touch is best tested with a cotton-tipped swab, but a light finger touch will often suffice, as long as care is taken to make the stimulus fairly reproducible. You can test the relative
sharpness of pain by randomly alternating stimuli with the sharp or dull end of a safety pin
(always use a new pin for each patient).