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Examination findings > Neuro exam - upper and lower limb > Flashcards

Neuro exam - upper and lower limb Flashcards

1
Q

When inspecting for upper and lower limb exam, what would you consider looking for?

A
  • Skeletal deformity
  • Wasting
  • Irregular movements
  • Fasiculations
  • Tremors
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2
Q

What are the core components to upper/ lower limb examination?

A
  • Inspection
  • Tone
  • Power
  • Coordination
  • Reflexes
  • Sensation
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3
Q

How would you assess tone in the lower limb?

A
  • Tone - roll leg from side to side
  • Spasticity - Brisk knee raise
  • Clonus
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4
Q

How many beats of clonus would indicate an UMN lesion?

A

> 5 beats

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5
Q

What are the 5 grades of the MRC power scale?

A
  • 5 - full power
  • 4 - some resistance
  • 3 - gravity
  • 2 - gravity eliminated
  • 1 - flicker of movement
  • 0 - nothing
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6
Q

How would you assess power in upper/lower limbs?

A

One joint at a time and compare sides

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7
Q

What spinal level is hip flexion?

A

L2/3

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8
Q

What spinal level is hip extension?

A

L4/5

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9
Q

What spinal level is knee extension?

A

L3/4

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10
Q

What spinal level is ankle dorsiflexion?

A

L4/5

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11
Q

What spinal level is knee flexion?

A

L5/S1

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12
Q

What spinal level is plantar flexion?

A

S1/2

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13
Q

What spinal level is big toe extension?

A

Purely L5

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14
Q

What reflexes would you assess in the lower limb, and what spinal levels are they associated with?

A
  • Patellar - L3/4 kick in the door
  • Ankle jerk - S1/2 buckle my shoe
  • Babinskis
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15
Q

How would you assess lower limb coordination?

A

Heel-to-shin test

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16
Q

What would inability to perform heel to shin test due to ataxia indicate?

A

Cerebellar pathology

17
Q

What would you assess in when assessing sensation in upper/lower neurological examination?

A
  • Dorsal columns - light touch, vibration, proprioception
  • Spinothalamic tracts - pain, temperature
18
Q

How would you assess pain and light touch?

A

Pin (spinothalamic) and cotton wool (dorsal column) respectively

19
Q

How would you assess sensation in somoene who you suspect has distal sensory loss, or glove and stocking distribution, or a sensory level?

A

In a straight line from distal to proximal

20
Q

How would you assess sensory distribution if you suspected nerve/nerve root pathology?

A

Test dermatomes +/- peripheral nerves

21
Q

How would you assess tone in the upper limbs?

A
  • Pronator drift
  • Isolate each joint
    • Shoulder
    • Elbow
    • Forearm
    • Wrist
22
Q

What would pronator drift with distal flexion indicate?

A

Pyramidal weakness on contraleteral side

23
Q

What would an upward drift on pronator drift testing indicate?

A

Cerebellar pathology

24
Q

WHat spinal level is shoulder abduction?

A

C5

25
Q

What spinal level is elbow flexion?

A

C6

26
Q

What spinal level is elbow extension?

A

C7

27
Q

What spinal level is wrist extension?

A

C7

28
Q

What spinal level is finger extension?

A

C7

29
Q

What spinal level is finger flexion?

A

C8

30
Q

What spinal level is finger abduction?

A

T1

31
Q

What spinal level is thumb abduction?

A

T1

32
Q

What spinal level is the biceps reflex?

A

C5/6 - pick up sticks

33
Q

What spinal level is the triceps tendon reflex?

A

C7/8 - push in the gate

34
Q

What spinal level is the supinator reflex?

A

C5/6

35
Q

What coordination tests would you do as part of your upper limb neuro exam?

A
  • Finger to nose
  • Dysdiadochokinesia
36
Q

What additional tests would you perform in a lower limb exam that you wouldn’t in an upper limb exam?

A
  • Clonus
  • Babinski’s
  • Gait analysis
37
Q

What muscles does the median nerve supply?

A
  • Lateral two lumbricals
  • Opponens pollicis
  • Abductor pollicis brevis
  • Flexor pollicis brevis
38
Q

What muscles does the ulnar nerve supply?

A
  • Adductor pollicis
  • Lumbricals medial two
  • Palmar and dorsal interossei

Examination findings (23 decks)

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