DTRs

Question 1

Biceps DTR (muscle stretch reflexes)

Answer 1

C5, C6
musculocutaneous nerve

anterior to elbow

Question 2

Triceps DTR (muscle stretch reflexes)

Answer 2

C6, C7
radial nerve

posterior to elbow

Question 3

Brachioradialis DTR (muscle stretch reflexes)

Answer 3

C5, C6
radial nerve

10 cm up forearm on radial aspect of forearm

Question 4

Knee (patellar, quadriceps) DTR (muscle stretch reflexes)

Answer 4

L2, L4
femoral nerve

inferior to patella

Question 5

Ankle (Achilles) DTR (muscle stretch reflexes)

Answer 5

S1 (sacral 1)
tibial nerve

Achilles tendon, dorsiflex the foot, hit Achilles –>plantar flexion

Question 6

focal hyporelfexia

Answer 6

radiculopathy (pinched nerve root in spinal column; bone spurs, stenosis, herniated disc; CT, NSAIDS, PT, steroids, weight loss)
acute stroke
neuropathy
spinal cord injury

Question 7

generalized hyporeflexia

Answer 7

hypercalcemia
hypermagnesemia 
hypothyroid 
coma 
severe polyneuropathy e.g. Guillain Barre (autoimmune disorder of nerve, plasma and immunoglobulin therapy, PT) 

overview of neurological disorders: MS, ALS, Guillain Barre, and Myasthenia Graves (ACh)
https://www.youtube.com/watch?v=khxjmo-dweU

Question 8

focal hyperreflexia

Answer 8

acute stroke
neuropathy
early ALS

Amyotrophic lateral sclerosis
neurogenerative disease of unknown cause; deterioration of motor nerves ==> decreased muscle control, speech, dysphagia, respiratory paralysis in 3-5 years
dx: r/o and symptoms
no cure

• maintain airway
• palliative consult

Question 9

generalized hyperreflexia

Answer 9

hypocalcemia
hypomagnesemia
hyperthyroid 
Serotonin syndrome 
eclampsia 
Advanced ALS