Lower Neurological Exam

Question 1

how would you begin a lower neuro exam?

Answer 1

inspect for: posture, wasting, tremor, fasciculations, involuntary movements
assess gait (walking normally + heel-toe
Romberg’s test (feet together, arms outstretched supinated eyes closed)

Question 2

how would you test for tone in a lower neuro exam?

Answer 2

relax legs
leg roll (while holding knee)
leg lift (lift leg while holding knee)
ankle clonus ( support knee then with other hand rapidly move ankle in circle then hold in dorsiflex)

Question 3

how would you test for power in a lower neuro exam?

Answer 3

hip: flexion (raise leg stop me pushing it down), extension (stop me lifting your leg up) adduction (push your legs together), abduction (push your legs apart)
knee: flexion (bend knee and stop me from straightening it) extension (kick your leg out against me)
ankle: dorsiflexion ( don’t let me push your foot down) plantar flexion (don’t let me push your foot up)
big toe : plantar flexion(don’t let me push your your big toe up) dorsiflexion ( don’t let me push your big toe down)

Question 4

how would you test for reflexes in a lower neuro exam

Answer 4

knee: hold under knee + hit patella tendon
ankle: bend leg + let it flop to side w ankle dorsiflexed and hit achilles tendon
plantar (babinski): run a blunt object along the lateral edge of sole of foot towards little toe then medially under toes ( shoudl see flexion of big toe + spread of other toes)

Question 5

how do you test for coordination in a lower neuro exam

Answer 5

heel to shin test (run heel down shin as fast as they can)

Question 6

how do you test for sensation in a lower neuro exam

Answer 6

soft touch with cotton wool
describe pinprick and temperature
vibration sensation on distal phalanx joint of big toe
proprioception big toe up and down