Neuro Exam Flashcards
What is the main question asked when doing a neurological exam?
Where is the lesion? (CNS, PNS)
What is the first sign of cauda equina?
Bladder retention
When should you consider a neurologic exam prior to performing OMM? (2)
- Pain in the axial skeleton
- Evaluating a joint problem that has neurologic symptoms associated with it
Is smooth or jagged (“give way”) weakness more concerning?
Smooth
If a pt comes in with bilateral LE weakness, what should you ask?
Numbness/weakness in other parts of the body
LMN lesions have what type of paralysis?
Flaccid
UMN lesions have what type of paralysis?
Spastic
True or false: it is okay to skip sections of the neuro exam if there are no symptoms in that area
False
Fasciculations are indicative of UMN or LMN lesions? What are these?
UMN
Stimulation of motor units (LMN units)
What are parkinsonian symptoms?
Resting tremors
What are the characteristics of cerebellar walking?
Wide based gait
Heel walking is checking for what spinal level?
L5
Toe walking is checking which spinal level?
S1
Romberg test is checking for what function?
Proprioception
Sway and falling with closing eyes in Romberg is positive for what type problem?
Proprioception
Sway and falling withOUT closing eyes in Romberg is positive for what type problem?
Cerebellar
How do you test for Hoffman’s reflex?
Flipping the dorsal surface of the middle finger, and observing for contraction of the thumb and second digit
What does Hoffman’s reflex check for?
UMN lesions
What is clonus?
To and fro rhythmic oscillation of a body part. Hyperreflexia
True or false: any clonus in mature individuals is abnormal
False- only sustained clonus
What is abortive clonus?
Few oscillations when eliciting clonus
What is the grade for hyperactive or hyperreflexia?
3/4
What is the grade for hyperreflexia with sustained clonus?
4/4
What is the root level for the biceps reflex? What is the peripheral nerve?
C5
Musculocutaneous n
What is the root level for the brachioradialis reflex?
C6
Radial n
What is the root level for the triceps?
C7
Radial n
What is the root level for the quadriceps?
L4
Femoral n
What is the root level for the achilles tendon reflex?
S1
Tibial n
True or false: to test reflexes, you should flex or extend the joint to alter the tension
true
What is a Jendrassik maneuver?
Distracting the individual while assessing reflexes
What is a positive Babinski sign?
Extension of the great toe, and flaring of the remaining digits (“up going”)
What is the appropriate way to document a babinski sign?
Flexor or extensor response
Which side of the foot should the babinski sign be started from? Why?
Lateral side of the plantar foot, otherwise may elicit the plantar grasp reflex, which may show as a down going Babinski
Grade this muscle strength: FROM against gravity only
3
Grade this muscle strength: FROM with gravity eliminated
2
Grade this muscle strength: no joint motion, but a slight muscle contraction can be palpated or observed
1
What causes the “give-way” weakness? (2)
- pain
- Not understanding physician
What are the four muscles that you should not be able to overcome?
- Trapezius
- Triceps
- Quad extension
- Gastrocnemius
What are the ASIA sensory points?
A series of points to test, to check for spinal cord injury
What are the common pitfalls of the neuro exam?
- Relying too much on the history
- Not having a reproducible way to elicit reflexes
What does Tandem walking test for?
Cerebellum
How do you ensure reproducibility with strength testing?
Overcome them for a few degrees
If a patient has full strength, but only to a certain degree of flexion/extension, how should this be documented?
5/5 strength at (__) degrees of whatever
Where is C3 sensation tested?
Supraclavicular fossa
Where is C4 sensation tested?
Top of AC joint
Where is C5 sensation tested?
Lateral antecubital fossa
Where is C6 sensation tested?
Dorsal, proximal thumb
Where is C7 sensation tested?
Dorsal, proximal middle finger
Where is C8 sensation tested?
Dorsal, proximal 5th finger
Where is T1 sensation tested?
Medial antecubital fossa
Where is L2 sensation tested?
Medial anterior thigh
Where is L3 sensation tested?
Medial, anterior knee
Where is L4 sensation tested?
Medial malleolus
Where is L5 sensation tested?
Medial dorsal foot
Where is S1 sensation tested?
Inferior lateral malleolus
Where is S3 sensation tested?
ITs
What spinal level: shoulder abduction/elbow flexion
C5
What spinal level: wrist extension
C6
What spinal level: elbow extension
C7
What spinal level: Long (3rd) finger flexion at the DIP
C8
What spinal level: Finger abduction
T1
What spinal level: hip flexion
L2
What spinal level: Knee extension
L3
What spinal level: ankle dorsiflexion
L4
What spinal level: big toe extension
L5
What spinal level: Ankle plantarflexion
S1
Which has more prominent atrophy: UMN lesion, or a LMN lesion?
LMN
Which has fasciculations: UMN or LMN lesions?
LMNs
