Lower Limb Neurological Exam

Question 1

What do you look for on general inspection

Answer 1

SWIfT

Scars
Wasting of muscles
Involuntary movements
fasciculations
Tremor

Look for items around the bed: walking stick/wheelchair

Question 2

What does standing with arms crossed test for

Answer 2

Any proximal muscle weakness

Question 3

What do you assess during gait

Answer 3

Speed
Symmetry
Balance
Arm swing

Question 4

What does walking on tip-toes test

Answer 4

Power of plantar flexion

Question 5

What does walking on heels test

Answer 5

Power of dorsiflexion

Question 6

What is Romberg’s test and what is a positive result

Answer 6

Assessment of proprioception by standing with feet together and eyes closed

A positive test is a loss of balance and suggests the ataxia is sensory in nature

Question 7

What do you assess in tone

Answer 7

During leg roll:
Spasticity of the ankle= UMN lesion
Completely floppy ankle = LMN lesion

During leg drop:
Kicking out of the ankle = UMN lesion

Question 8

What is Ankle clonus and what does it indicate

Answer 8

It is repetitive muscle contractions and it signifies UMN lesion

Question 9

What are the spinal roots of hip flexion

Answer 9

L1/2

Question 10

What are the spinal roots of hip extension

Answer 10

L5/S1

Question 11

What are the spinal roots of leg adduction

Answer 11

L2/3

Question 12

What are the spinal roots of leg abduction

Answer 12

L4/5

Question 13

What are the spinal roots of knee flexion

Answer 13

L5/S1

Question 14

What are the spinal roots of knee extension

Answer 14

L3/4

Question 15

What are the spinal roots of dorsiflexion

Answer 15

L4

Question 16

What are the spinal roots of plantarflexion

Answer 16

S1/2

Question 17

What are the spinal roots of big toe extension (1st metatarsal extension)

Answer 17

L5

Question 18

What muscle is responsible for 1st metatarsal extension

Answer 18

Extensor hallucis longus

Question 19

What are the spinal roots of the knee reflex

Answer 19

L3/4

Question 20

What are the spinal roots of the ankle reflex

Answer 20

S1/2

Question 21

What are the spinal roots of the babinski reflex and what is a positive result

Answer 21

S1

A positive result is when the patients big toe dorsiflexes in response, indicating UMN lesion

Question 22

Describe all the dermatomes in the leg

Answer 22

Question 23

What can you do if there is peripheral sensory loss during sensation testing

Answer 23

Start from a distal point and repeatedly poke as you come more proximal to identify ‘stocking’ sensory loss

Question 24

What tuning fork is used during vibration testing

Answer 24

128Hz tuning fork

Question 25

Where do you place the tuning fork and what can you do if the patient doesn’t sense any vibration

Answer 25

Place the tuning fork at the distal interphalangeal joint of the big toe and if the patient doesn’t sense vibration then assess vibration at a more proximal bony point

Question 26

What can an abnormal knee to shin test or foot flapping indicate

Answer 26

Lower limb weakness

Impaired joint proprioception (knee-to-shin)

Cerebellar disorder

Question 27

What examinations would you do to complete findings

Answer 27

Cranial nerve exam

Upper limb exam