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Z Year3 Clinical Examinations > Lower Limb Neuro Exam 2 > Flashcards

Lower Limb Neuro Exam 2 Flashcards

1
Q

What myotome is assessed in hip flexion?

A

L1/2 iliofemoral nerve

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2
Q

What muscle is assessed in hip flexion?

A

iliopsoas

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3
Q

What myotome is assessed in hip extension?

A

L5/S1/S2 (inferior gluteal nerve)

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4
Q

What muscle is assessed in hip extension?

A

gluteus maximus

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5
Q

What myotome is assessed for knee flexion?

A

S1 (sciatic nerve)

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6
Q

What muscle is assessed in knee flexion?

A

hamstrings

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7
Q

What myotome is assessed in knee extension?

A

L3/4 (femoral nerve)

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8
Q

What muscles are assessed in knee extension?

A

quadriceps

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9
Q

What myotome is assessed in ankle dorsiflexion?

A

L4/5 (deep peroneal nerve)

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10
Q

What muscle is assessed in ankle dorsiflexion?

A

tibialis anterior

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11
Q

What myotome is assessed in ankle plantarflexion?

A

S1/2 (tibial nerve)

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12
Q

What muscle is assessed in ankle plantarflexion?

A

gastrocnemius, soleus

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13
Q

What myotome is assessed in big toe extension?

A

L5 (deep peroneal nerve)

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14
Q

What muscle is assessed in big toe extension?

A

extensor hallucis longus

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15
Q

What is the pattern of muscle weakness in upper motor neurone lesions?

A
  1. cause a ‘pyramidal’ pattern of weakness that disproportionately affects lower limb flexors and upper limb extensors
  2. lower limb flexors are weaker than extensors in a lower limb neurological assessment
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16
Q

What is the pattern of muscle weakness in lower motor neuron lesions?

A

focal pattern of weakness, with only the muscles directly innervated by the damaged neurones affected

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17
Q

What does MRC 0 mean?

A

no contraction

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18
Q

What is MRC 1?

A

flicker or trace of contraction

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19
Q

What is MRC 2?

A

active movement with gravity eliminated

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20
Q

What is MRC 3?

A

active movement against gravity

21
Q

What is MRC 4?

A

active movement against gravity and resistance

22
Q

What is MRC 5?

A

normal power

23
Q

What does the knee-jerk reflex test?

A

L3, L4

24
Q

What does the ankle-jerk reflex test?

A

S1

25
Q

What does the plantar reflex test?

A

L5, S1

26
Q

What is hyperreflexia associated with?

A

upper motor neuron lesions due to the loss of inhibition from higher brain centres which normally exert a degree of suppression over the lower motor neuron reflex arc.

27
Q

What are examples of upper motor lesions?

A

stroke, spinal cord injury

28
Q

What is hyporeflexia assoicted with?

A

lower motor neuron lesions due to loss of the efferent and afferent branches of normal reflex arc

29
Q

What are examples of LMN lesions?

A

e.g. brachial plexus pathology or other peripheral nerve injuries

30
Q

What are reflexes like in cerebellar disease?

A
  1. pendular
  2. means less brisk and slower in their rise and fall
  3. sign is subjective and often reflexes appear to be ‘normal’ in cerebellar disease
31
Q

What does light tough sensation involve?

A

dorsal column and spinothalamic tracts

32
Q

What does pin prick sensation involve?

A

spinothalamic tract

33
Q

What does vibration sensation involve?

A

dorsal columns

34
Q

What tuning fork is used?

A

128hz

35
Q

What joint is vibration placed?

A

place onto the interphalangeal joint of the patient’s big toe

36
Q

If they can’t identify when vibration starts and stops which joints do you check?

A

metatarsophalangeal joint of the big toe → ankle joint → knee joint until the patient is able to accurately identify vibration

37
Q

What does proprioception involve?

A

dorsal columns

38
Q

What can dysmetria (incoordination) suggest?

A

ipsilateral cerebellar pathology

39
Q

What are UMN signs in inspection?

A

no fasciculation or significant wasting (there may however be some disuse atrophy or contractures)

40
Q

What are the LMN signs for inspection?

A

wasting and fasciculation of muscles

41
Q

What are the UMN signs for tone?

A

increased (spasticity or rigidity) +/- ankle clonus

42
Q

What are the LMN signs for tone?

A

decreased (hypotonia) or normal

43
Q

What are the UMN signs on power?

A

classically a “pyramidal” pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs)

44
Q

What are the LMN signs on power?

A

different patterns of weakness, depending on the cause (e.g. classically a proximal weakness in muscle disease, a distal weakness in peripheral neuropathy)

45
Q

What are UMN signs for reflexes?

A

exaggerated or brisk (hyperreflexia)

46
Q

What are LMN signs for reflexes?

A

reduced or absent (hyporeflexia or areflexia)

47
Q

What are UMN signs on plantar reflexes?

A

Upgoing/extensor (Babinski positive)

48
Q

What are LMN signs for plantar reflexes?

A

normal (downgoing/flexor) or mute (i.e. no movement)

Z Year3 Clinical Examinations (33 decks)

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