Lower Limb Neuro OSCE

Question 1

how to start the exam?

Answer 1

introduce self, identify, explain and consent.
wash hands!
inspect patient from the foot of the bed

Question 2

what is the second step in LLNE?

Answer 2

gait assessment and romberg test

Question 3

what does gait assessment include?

Answer 3

normal walk, tip toe, heel and tight rope.

Question 4

how to assess tone?

Answer 4

leg roll, leg lift and ankle clonus testing

Question 5

assessing power involves which joints?

Answer 5

hip, knee, ankle, big toe

Question 6

how is power in the hip assessed?

Answer 6

flexion- have the pt push thigh up to hand.
tests iliopsoas and l1/2
extension- have pt push thigh down on hand pushing up
tests gluteus maximus and L5/S1/S2

Question 7

how is power in the knee assessed?

Answer 7

flexion- bending leg onto bed and pt has to resist leg kicking out
tests hamstrings and S1
extension- try to kick leg out against the hand
tests quads and L3/4

Question 8

How is power in the ankle assessed?

Answer 8

dorsiflexion- pt resists downward force on foot
tests tibialis anterior and L4/5
plantarflexion- pt resists force pushing foot towards them
tests gastrocnemius, soleus and S1/2

Question 9

How is power in the big toe assessed?

Answer 9

extension- pt moves toe towards self
tests extensor hallucis longus and L5

Question 10

what weakness pattern does UMN lesions present with?

Answer 10

pyramidal- disproportionately affects lower limb flexors and upper limb extensors
eg. lower limb flexors are weaker than extensors in LLNE

Question 11

which reflexes are tested?

Answer 11

knee jerk, ankle jerk, plantar

Question 12

knee jerk reflex

Answer 12

L3/L4

Question 13

ankle jerk reflex

Answer 13

S1

Question 14

plantar reflex

Answer 14

L5, S1

Question 15

which dermatome is the inguinal region and the very top of the medial thigh innervated by

Answer 15

L1

Question 16

which dermatome is the middle and lateral aspect of the anterior thigh innervated by

Answer 16

L2

Question 17

which dermatome is the medial aspect of the knee innervated by

Answer 17

L3

Question 18

which dermatome is teh medial aspect of the lower leg and ankle innervated by

Answer 18

L4

Question 19

which dermatome is the dorsum adn medial aspect of the big toe innervated by

Answer 19

L5

Question 20

how do you test proprioception

Answer 20

bend big toe up and down and test pt on which one you used

Question 21

Which dermatome is the dorsum and lateral aspect of the little toe innervated by?

Answer 21

S1

Question 22

how to test coordination

Answer 22

heel to shin test

Question 23

what does dysmetria (incoordination) show?

Answer 23

ipsilateral cerebellar pathology

Question 24

how to finish the exam

Answer 24

explain to pt that you are finished
thank patient
dispose of PPE and wash hands
Summarise

Question 25

example of summary

Answer 25

I examined Mr X, (insert age). on General inspection the patient seemed X with normal/abnormal sign/stigmata. there was/wasnt any objects or medical equipment of relevence assessment of LL revealed gait, tone, power, reflexes, sensation and coordination. in summary these findings are consistent with Y.

Question 26

further assessment and investigation

Answer 26

full neuro exam including cranial nerves, upper limbs, cerebellar assessment. MRI spine and head.