Lower limb neuro exam

Question 1

Three methods of testing tone in a lower limb neuro exam

Answer 1

leg fully relaxed, hold the knee to fix leg to the bed then roll the thigh left and right repeatedly (check foot position)

sharply pull the knee up and check to see if the foot comes off the bed

ankle clonus

Question 2

what motor function is tested in a lower limb neuro exam?

Answer 2

hip flexion and extension
knee flexion and extension
foot dorsiflexion / plantarflexion

Question 3

instruction given when testing hip flexion?

Answer 3

“keeping your knee straight, lift your leg off the bed”

Question 4

muscle + nerve tested for hip flexion

Answer 4

psoas -> femoral nerve

Question 5

instruction given for hip extension

Answer 5

“Push your leg down”

Hold underneath their thigh.

Question 6

muscle + nerve tested for hip extension

Answer 6

gluteus maximus -> inferior gluteal nerve

Question 7

muscle + nerve tested for knee flexion

Answer 7

hamstrings -> sciatic nerve

Question 8

muscle + nerve tested for knee extension

Answer 8

quads -> femoral nerve

Question 9

muscle + nerve tested for dorsiflexion

Answer 9

tibialis anterior (+ others) -> deep peroneal

Question 10

muscle + nerve tested for plantarflexion

Answer 10

gastronemeus -> tibial nerve

Question 11

three reflexes in lower limb examination

Answer 11

patellar (L3/4), ankle (S1), babinski

Question 12

what is the nerve root for patellar reflex?

Answer 12

L3/4

Question 13

what is the nerve root for ankle reflex

Answer 13

S1

Question 14

what happens to reflexes with spinal cord lesions

Answer 14

brisk reflex below the level of the lesion

either reduced or normal reflexes at the level of the lesion

Question 15

how to test coordination in lower limb neuro

Answer 15

heel-shin test
if difficult, do foot tap on hand

Question 16

causes of an ataxic or broad based gait

Answer 16

cerebellar lesion or alcohol

Question 17

most sensitive test of ataxia

Answer 17

heel-to-toe walking

Question 18

causes of a shuffling gait

Answer 18

extra-pyramidal disease

Question 19

cause of a tilted gait

Answer 19

inner ear disorder

Question 20

what is Romberg’s test

Answer 20

ask patient to stand with feet close together and stretch out their arms. ask them to close their eyes (give reassurance that you will catch them)

if positive, patient will fall with eyes closed but not with their eyes open

Question 21

what is rombergs test positive in?

Answer 21

sensory ataxia (e.g. peripheral neuropathy)

or tabes dorsalis caused by syphilis

Question 22

three main principles in testing sensation

Answer 22

compare left to right
compare distal to proximal
test dermatomes

Question 23

lower limb dermatome key points (L2-S2)

Answer 23

L2: inner thigh
L3: medial knee
L4: medial malleolus
L5: big toe
S1: heel
S2: popliteal fossa