ISCEs - Neurology

Question 1

what is the main purpose of a neurological exam

Answer 1

localise where in the nervous system the problem is e.g. is it an upper motor neurone (brain/spinal cord) or lower motor neurone (nerve roots, peripheral nerve, NMJ, muscle)

Question 2

what does pronator drift indicate?

Answer 2

UMN lesion

Question 3

what are the abnormalities of tone you are assessing for in the upper limb?

Answer 3

spasticity, rigidity, cog-wheeling, hypotonia

Question 4

what is spasticity vs rigidity?

Answer 4

both increased tone

spasticity: associated with pyramidal tract lesions e.g. stroke
velocity dependant, faster you move the limb the worse it is
typically increased tone in the initial part of the movement which suddenly reduces past a certain point (clasp knife spasticity)

rigidity: associated with extrapyramidal tract lesions e.g. Parkinson’s
velocity independent
e.g. cogwheel, lead pipe

Question 5

what myotome is being assessed in shoulder abduction

Answer 5

C5 (axillary nerve)

Question 6

myotome being assessed in shoulder adduction

Answer 6

c6/7 (thoracodorsal)

Question 7

myotome in elbow flexion

Answer 7

c5/6 (musculocutaneous and radial nerve)

Question 8

myotome in elbow extension

Answer 8

c7 (radial nerve)

Question 9

myotome in wrist extension

Answer 9

c6 (radial nerve)

Question 10

myotome in wrist flexion

Answer 10

c6/7 (median nerve)

Question 11

myotome for finger extension

Answer 11

c7 (radial nerve)

Question 12

myotome for finger abduction

Answer 12

T1 (ulnar nerve)

Question 13

myotome for thumb abduction

Answer 13

t1 (median nerve)

Question 14

patterns of muscle weakness in motor neurone lesion

Answer 14

UMN = upper limb extensors & lower limb flexors

LMN = only muscles directly innervated by damaged neurones affected

Question 15

MRC muscle power assessment scale

Answer 15

0 = no contraction
1 = flicker/trace of contraction
2 = active movement, with gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and resistance
5 = normal power against gravity and full resistance

Question 16

what myotome is biceps reflex testing

Answer 16

c5/6

Question 17

myotome for bracioradialis reflex

Answer 17

c5/6

Question 18

myotome for bracioradialis reflex

Answer 18

c5/6

Question 19

myotome for triceps reflex

Answer 19

c7

Question 20

dermatomes to test for upper limbs

Answer 20

c4 = clavicle
c5 = lateral aspect of the lower edge of the deltoid muscle
c6 = palmar side of thumb
c7 = palmar side of middle finger
c8 = palmar side of little finger
T1 = medial side of antecubital fossa

Question 21

what tracts do light touch sensation involve

Answer 21

dorsal column and spinothalamic

Question 22

what tract does pin prick (pain) sensation involve

Answer 22

spinothalamic

Question 23

what tract is tested with vibration sensation

Answer 23

dorsal columns

Question 24

what tract is tested with proprioception

Answer 24

dorsal column

Question 25

patterns of sensory loss

Answer 25

mononeuropathy
peripheral neuropathy (diabetes, chronic alcohol excess)
radiculopathy (nerve roots)
spinal cord damage
thalamic lesions e.g. stroke (contralateral side)
myopathies (symmetrical proximal muscle weakness)

Question 26

significance of finger to nose test

Answer 26

can show dysmetria (lack of co-ordination) and intention tremor = ipsilateral cerebellar pathology

Question 27

what does dysdiadochokinesia test?

Answer 27

feature of ipsilateral cerebellar pathology
patients with cerebellar ataxia may struggle to carry out this task, movements slow and irregular

Question 28

what to ask the patient before preceding with the examination

Answer 28

do they have any pain?