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T 3.1 > neuro exam motor > Flashcards

neuro exam motor Flashcards

1
Q

observing the pt

A

dementred or confussed
depressed or mood inappropriately elevated?

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2
Q

test higher function

A

Assess level of consciousness
Assess orientation
If abnormalities are suspected, test more fully – refer MSE (mental state examination)

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3
Q

Examine the head and neck

A

Check the head and neck
Test for meningism
Check carotid pulses

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3
Q

inspection

A

Gait
Musculature
Posture
Movement and the presence of abnormal movements

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4
Q

evaluations of motor system

A

INSPECTION
TONE
REFLEXES
POWER

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5
Q

gait inspection

A

Examine the gait in an ambulant patient
eg. hemiplegic circumductal (swinging single leg), ataxic, waddling - broad
Then position the patient comfortably supine on the couch

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6
Q

posture inspection

A

head trunk limbs
global

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7
Q

musaculature inspection

A

systemically examin bulk of muscle, fasciculations (twitching unpurposeful movement), compare sides, local or general atrophy

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8
Q

movement inspection

A

Look for abnormal movements, assess spontaneous movements eg. movements are slow or reduced in Parkinson’s

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9
Q

insprection swift

A

scar
wasting
invol mvnt
fasiculation
tremours

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10
Q

thenar

A

thumb side
look for signs of early wasting

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11
Q

abn posture of the head

A

tortus- twist
collis- column- neck
torticollis
latero- retro- antero- collis

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12
Q

chorea

A

non repetitive abrupt and jerky
eg huntingtons chorea

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13
Q

athetosis

A

sinous writhing distal, continuous
eg cp

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14
Q

dystonia

A

invol abn posture
eg spasmodic torticollis

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15
Q

tic

A

brief movement of untimed intervals
specific and predictable to the patient

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16
Q

tremours

A

resting in parkinsons
fine with thyrotoxicosis
intentional in cp

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17
Q

tone hyper vs hypo

A

hypertonia- upper motor neuron
hypotonia- lower motor neuron

18
Q

important principles for tone assessment

A

pt is relaxed
passive movement is necessary to assess the tone
the movement must be randomized in speed and direction
assess all joints
compare sides

19
Q

spacticity

A

lesion occurs in pyramidal tract
one muscle group invovled either ag or antag
hypertonia
streth senstive

20
Q

technique for reflex test

A

Fully expose the muscle
Limb must be fully relaxed
Joint must be in the mid range
Identify the tendon
Technique direct (as in knee jerk) or indirect (as in biceps jerk)
Strike the tendon firmly (technique must be practiced) and observe the response
Assess each reflex, compare with the opposite side and grade the reflex – see later slide
If the reflex is diminished, use reinforced techniques

20
Q

clonus

A

extreme hypertonicity
invol rythmic contr and rel

always assoc with upper motor neuron
always in extremity

21
Q

rigidity

A

occurs in basal gang lesions
both ag and antag
hypertonia
not stretch sensitive

21
Q

reflexes dfn

A

Involuntary stereotypical response involving a sensory (afferent) and motor (efferent) fibre.

22
Q

reflex grading

A

O ABSENT
+ PRESENT - NORMAL
++ PRESENT - NORMAL (brisk)
+++ BRISK - ABNORMAL (exaggerated)
++++ CLONIC OR HYPER-REFLEXIC - ABNORMAL

22
Q

deep tendon level of innervation

A

Biceps C5/6
Triceps C7/8
Supinator C5/6 (= Brachioradialis)
Knee L3/4
Ankle S1/S2

23
Q
A
23
Q

ABDOMINAL REFLEX

A

(upper approx T8 -10, lower T10 -12):
Test by lightly stroking the abdominal wall in all 4 quadrants towards the umbilicus.
Reflex contractions are absent in UMN lesions above the segmental level.

24
Q

CREMASTERIC REFLEX

A

(L1-2) Stroke the inner thigh in a downward direction.
Normal response is contraction of the cremaster muscle which pulls up the scrotum and testis on the side tested.
May be absent in old men, in patients with orchitis, hydrocoele or varicocoele.

24
Q

PLANTAR REFLEX

A

PLANTAR REFLEX
(L5/ S1/ S2)
inwards towards the middle MTP Joint

24
Q

Normal vs Babinski Response

A

Normal is down-going or flexor response
Babinski response is up-going or extensor (abnormal) response
Occurs with UMN lesion or after a seizure (bilateral)

25
Q

muscle power

A

Take into account age / gender / build
Compare sides
Evaluate muscle groups systematically:
Shoulder - abduction & adduction
Elbow, wrist - extension & flexion
Fingers - grip strength, finger strength
Hip - flexion/ extension/ abduction & adduction
Knee - extension & flexion
Ankle - dorsi- and plantar flexion

26
Q

upper limb myotomes

A

Shoulder abduction C5/6
Shoulder adduction C6/7/8
Elbow flexion C5/6
Elbow extension C7/8
Wrist flexion C6/7
Wrist extension C7/8

27
Q

test for shoulder power

A

abd c5/6
add c5/6/7

27
Q

test for power at elbow

A

Flexion (C5/6)
Extension (C7/8)

28
Q

power test at wrist

A

Flexion (C6/7)
Extension (C7/8)

28
Q

interossei (fingies) power test

A

C8/T1

29
Q

testy power at knee

A

Flexion (L5/S1)
Extension (L3/4)

29
Q

test power at hip

A

Flexion L2/3 Extension L5/S1/2
ADduction L2/3/4
ABduction L4/5/S1

29
Q

test power at ankle

A

Planter Flexion
Dorsiflexion/toe extension

30
Q

Asymmetrical muscle weakness

A

is most often the result of a peripheral nerve, brachial plexus or root lesion, or an upper motor neurone lesion.

30
Q

power grading

A

5/5 NORMAL (No weakness against resistance)
4/5 Weakness against resistance
3/5 Overcomes gravity, not resistance
2/5 Muscle contracts, cannot overcome gravity
1/5 Flicker of movement
0/5 No movement

31
Q

clinical features of lmn lesions

A

Interrupts spinal reflex arc
Muscle wasting marked
Flaccidity/hypotonicity
Reflexes diminished or absent
Plantar flexor or absent
Power diminished

31
Q

clinical features of umn lesion

A

Above anterior horn cell
Muscle wasting absent or slight
Spasticity/hypertonicity
Reflexes increased
Plantar extensor
Power diminished

T 3.1 (11 decks)

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