Lower limb neuro exam

Question 1

What’s the 1st step of the LL motor exam?

Answer 1

Prepare the patient

Question 2

What does “preparing the patient” involve? (3)

Answer 2

Explaining the exam
Asking if they have pain (and telling them to inform you if they do have pain)
Ensuring the legs are exposed

Question 3

What will your phrase for explaining the exam be?

Answer 3

“I’ve been asked to take a look at your legs - your muscle control and reflexes, as well as sensation. You’ll need to remove your pants so I can see everything properly, is this okay?”

Question 4

What step comes after preparing the patient?

Answer 4

HAND HYGIENE

Question 5

What step comes after hand hygiene?

Answer 5

Gait inspection

Question 6

What step comes after gait?

Answer 6

Inspect the lower limbs

Question 7

What are the 3 components of inspecting the lower limbs?

Answer 7

Look at them while standing
Look at the lower back
Look at them while lying

Question 8

What step comes after inspection?

Answer 8

Checking tone

Question 9

What are the components of checking tone?

Answer 9

Tone at the knee

Tone at the ankle

Question 10

What instruction will you give for testing tone?

Answer 10

“I’m going to lift up your leg now, please let them just hang loosely - I’ll take their weight

Question 11

What step comes after tone?

Answer 11

Power

Question 12

What actions will you test the power of?

Answer 12

Hip F & E
Hip ab' and ad'
Knee F & E
Ankle dossi & plantar flexion
Foot inversion & eversion
Great toe extension

Question 13

What phrase will you use for hip flexion?

Answer 13

“Lift your leg up… now try to keep it in that position”

Question 14

What phrase will you use for hip extension?

Answer 14

“I’m going to grab under your heel…. don’t let me lift it up”

Question 15

What phrase will you use for hip adduction?

Answer 15

“Now try to pull your knees together”

Question 16

What phrase will you use for hip abduction?

Answer 16

“And try to push them apart”

Question 17

What phrase will you use for knee flexion?

Answer 17

“Bend your knee, and try to pull your heel closer in to your bottom”

Question 18

What phrase will you use for knee extension?

Answer 18

“Now try to straighten your leg out”

Question 19

What phrase will you use for ankle dorsiflexion?

Answer 19

“Try to point your toes up to your face”

Question 20

What phrase will you use for ankle plantar flexion?

Answer 20

“Now try to point your toes down to the floor”

Question 21

What phrase will you use for inversion of the foot?

Answer 21

“I’m going to turn your foot in - can you keep it there?”

Question 22

What phrase will you use for eversion of the foot?

Answer 22

“Now I’m turning your foot outwards … try to keep it there”

Question 23

What phrase will you use for great toe extension?

Answer 23

“Now try to bring just your big toe up towards your face”

Question 24

What step comes after power?

Answer 24

Reflexes

Question 25

Which 3 reflexes do we test?

Answer 25

Knee Ankle Plantar (babinski)

Question 26

What step comes after reflexes?

Answer 26

Coordination

Question 27

What phrase will you say for coordination?

Answer 27

"Can you bring your foot up into the air and hold it there? Great, now bring your heel down to the knee of the other foot, and run your heel along your shin"

Question 28

Which what phrase will you introduce power?

Answer 28

I'm just going to take a look at your muscle strength, so I'm going to ask you to do a few different movements.

Question 29

The sensory exam phase comes after which step?

Answer 29

Coordination

Question 30

What's the 1st step of the sensory exam?

Answer 30

Pain

Question 31

What will you do & say to introduce the pain part of the sensory exam?

Answer 31

Prick their chest, and say "this is sharp", can you let me know if you can feel it again?

Question 32

Where are the 1st 3 places you prick? How do you find them?

Answer 32

Make a line from the mid-clavicular level of the inguinal canal, to the medial femoral condyle. 1/4 of the way is L1 1/2 of the way is L2

Question 33

Where do you prick L4?

Answer 33

Medial malleolus

Question 34

Where do you prick L3?

Answer 34

Medial femoral condyle above the knee

Question 35

Where do you prick L5?

Answer 35

Dorsum of the foot, at the 3rd metatarsal-phalangeal joint

Question 36

Where do you prick S1?

Answer 36

On the lateral aspect of the calcaneus

Question 37

Where do you prick S2?

Answer 37

At the middle of the popliteal fossa

Question 38

What step comes after pain sensation?

Answer 38

Light touch sensation

Question 39

What step comes after light touch (for us)?

Answer 39

Vibration sensation

Question 40

What does the vibration step involve?

Answer 40

Putting a tuning fork on the inter-phalangeal joint of the big toe

Question 41

What will your instructions be for the vibration step?

Answer 41

1st toe: Can you tell me what you feel? | 2nd toe: Tell me when it stops

Question 42

What step comes after vibration?

Answer 42

Proprioception testing